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Johannsen B, Baumgartner D, Karkossa L, Paust N, Karpíšek M, Bostanci N, Zengerle R, Mitsakakis K. ImmunoDisk—A Fully Automated Bead-Based Immunoassay Cartridge with All Reagents Pre-Stored. BIOSENSORS 2022; 12:bios12060413. [PMID: 35735560 PMCID: PMC9221266 DOI: 10.3390/bios12060413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/31/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
In this paper, we present the ImmunoDisk, a fully automated sample-to-answer centrifugal microfluidic cartridge, integrating a heterogeneous, wash-free, magnetic- and fluorescent bead-based immunoassay (bound-free phase detection immunoassay/BFPD-IA). The BFPD-IA allows the implementation of a simple fluidic structure, where the assay incubation, bead separation and detection are performed in the same chamber. The system was characterized using a C-reactive protein (CRP) competitive immunoassay. A parametric investigation on air drying of protein-coupled beads for pre-storage at room temperature is presented. The key parameters were buffer composition, drying temperature and duration. A protocol for drying two different types of protein-coupled beads with the same temperature and duration using different drying buffers is presented. The sample-to-answer workflow was demonstrated measuring CRP in 5 µL of human serum, without prior dilution, utilizing only one incubation step, in 20 min turnaround time, in the clinically relevant concentration range of 15–115 mg/L. A reproducibility assessment over three disk batches revealed an average signal coefficient of variation (CV) of 5.8 ± 1.3%. A CRP certified reference material was used for method verification with a concentration CV of 8.6%. Our results encourage future testing of the CRP-ImmunoDisk in clinical studies and its point-of-care implementation in many diagnostic applications.
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Affiliation(s)
- Benita Johannsen
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (L.K.); (N.P.); (R.Z.)
- Correspondence: (B.J.); (K.M.); Tel.: +49-761-203-7252 (B.J.); +49-761-203-73252 (K.M.)
| | - Desirée Baumgartner
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
| | - Lena Karkossa
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (L.K.); (N.P.); (R.Z.)
| | - Nils Paust
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (L.K.); (N.P.); (R.Z.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
| | - Michal Karpíšek
- BioVendor-Laboratorní Medicína a.s., Research & Diagnostic Products Division, Karasek 1767/1, Reckovice, 62100 Brno, Czech Republic;
- Faculty of Pharmacy, Masaryk University, Palackeho trida 1946/1, 61242 Brno, Czech Republic
| | - Nagihan Bostanci
- Section of Oral Health and Periodontology, Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, 14104 Huddinge, Sweden;
| | - Roland Zengerle
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (L.K.); (N.P.); (R.Z.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
| | - Konstantinos Mitsakakis
- Hahn-Schickard, Georges-Koehler-Allee 103, 79110 Freiburg, Germany; (L.K.); (N.P.); (R.Z.)
- Laboratory for MEMS Applications, IMTEK—Department of Microsystems Engineering, University of Freiburg, Georges-Koehler-Allee 103, 79110 Freiburg, Germany;
- Correspondence: (B.J.); (K.M.); Tel.: +49-761-203-7252 (B.J.); +49-761-203-73252 (K.M.)
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The ratio of serum LL-37 levels to blood leucocyte count correlates with COVID-19 severity. Sci Rep 2022; 12:9447. [PMID: 35676519 PMCID: PMC9175165 DOI: 10.1038/s41598-022-13260-8] [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: 03/23/2022] [Accepted: 05/23/2022] [Indexed: 01/08/2023] Open
Abstract
AbstractBeneficial effects of vitamin D on COVID-19 progression have been discussed in several studies. Vitamin D stimulates the expression of the antimicrobial peptide LL-37, and evidence shows that LL-37 can antagonize SARS-CoV-2. Therefore, we investigated the association between LL-37 and vitamin D serum levels and the severity of COVID-19. To this end, 78 COVID-19 patients were divided into 5 groups according to disease severity. We determined serum levels of LL-37, vitamin D, and routine laboratory parameters. We demonstrated a correlation of CRP, IL-6, PCT, leukocyte count, and LDH with the severity of COVID-19. Our study did not demonstrate a direct relationship between serum levels of LL-37 and vitamin D and the severity of COVID-19. LL-37 is produced by granulocytes and released at the site of inflammation. Therefore, the analysis of LL-37 in broncho-alvelolar lavage rather than in patient serum seems critical. However, since LL-37 is produced by granulocytes, we determined serum LL-37 levels as a function of leukocyte count. The LL-37/leukocyte count ratio correlates highly significantly inversely proportional with COVID-19 severity. Our results indicate that the LL-37/leukocyte count ratio could be used to assess the risk of COVID-19 progression as early as hospital admission.
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Numaguchi R, Kurajoh M, Hiura Y, Imai T, Morioka T, Saito M, Shiraishi S, Emoto M, Nishiguchi Y. Glycated hemoglobin level on admission associated with progression to severe disease in hospitalized patients with non-severe coronavirus disease 2019. J Diabetes Investig 2022; 13:1779-1787. [PMID: 35616179 PMCID: PMC9348501 DOI: 10.1111/jdi.13845] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
Aims/Introduction Poor glycemic control is known to be associated with severe infection development. This retrospective observational study examined whether glycemic control before coronavirus disease 2019 (COVID‐19) onset contributes to progression from non‐severe to severe COVID‐19. Materials and Methods Glycated hemoglobin (HbA1c) was measured on hospital admission in 415 patients with non‐severe COVID‐19. The outcome was determined from time of hospital admission to severe progression, based on clinical practice guidelines for COVID‐19 in Japan. Results The median value for HbA1c on admission was 6.1%, with diabetes present in 138 patients (33.3%). Among the total cohort, 93 (22.4%) progressed to severe COVID‐19 with a median (interquartile range) time of 4 days (3–7 days), whereas 322 (77.6%) were discharged after 13 days (10–17 days). A multivariable Cox proportional hazards regression model showed that HbA1c level on admission was independently associated with progression to severe COVID‐19 (hazard ratio for 1% increase 1.237, 95% confidence interval 1.037–1.475; P = 0.018), with findings consistent among several sensitivity analyses. In subgroup analyses, such an association was significant in patients with diabetes, as well as older age, current smoking habit, lower estimated glomerular filtration rate, higher C‐reactive protein level, moderate II COVID‐19, dyslipidemia and chronic respiratory disease, with no remarkable inconsistency among the subgroups. Finally, higher HbA1c level (≥7%) was more strongly associated with severe COVID‐19 progression than diabetes. Conclusions The results suggest that poor glycemic control before COVID‐19 onset contributes to progression from non‐severe to severe COVID‐19, even in patients with severe COVID‐19 risk factors regardless of the presence of diabetes.
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Affiliation(s)
- Ryutaro Numaguchi
- Department of Diabetes and Endocrinology, Osaka City Juso Hospital, Osaka, Japan
| | - Masafumi Kurajoh
- Department of Metabolism, Endocrinology, and Molecular Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoshikazu Hiura
- Department of Diabetes and Endocrinology, Osaka City Juso Hospital, Osaka, Japan
| | - Takumi Imai
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mika Saito
- Department of Pediatrics, Osaka City Juso Hospital, Osaka, Japan
| | - Satoshi Shiraishi
- Department of Respiratory Medicine, Osaka City Juso Hospital, Osaka, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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A Novel Predictive Model in Recognizing Severe COVID-19 and Multiorgan Injuries: Platelet-to-CRP Ratio. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:6549399. [PMID: 35592303 PMCID: PMC9113906 DOI: 10.1155/2022/6549399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/03/2022] [Accepted: 04/23/2022] [Indexed: 01/08/2023]
Abstract
Aims In view of the emerging virus variations and pandemic worldwide, it is urgent to explore effective models predicting disease severity. Methods We aimed to investigate whether platelet-to-CRP ratio (PC ratio) could predict the severity of COVID-19 and multi-organ injuries. Patients who complained of pulmonary or gastrointestinal symptoms were enrolled after confirmation of SARS-CoV-2 infection via qRT-PCR. Those who complained of gastrointestinal symptoms were defined as having initial gastrointestinal involvement. Chest computed tomography (CT) was then performed to classify the patients into mild, moderate, and severe pneumonia groups according to the interim management guideline. qRT-PCR was also performed on stool to discern those discharging virus through the gastrointestinal tract. Logistic regression models were applied to analyze the association between PC ratio and severity of pneumonia, risk of initial gastrointestinal involvement, and multi-organ injuries. Results When compared to the bottom tertile of PC ratio, the adjusted odds ratio was −0.51, p < 0.001 and −0.53, p < 0.001 in moderate and severe pneumonia, respectively. Furthermore, the adjusted odds ratio for initial gastrointestinal involvement was 0.18 (82% lower) when compared to the bottom tertile of PC ratio, p=0.005. The area under ROC on moderate-to-severe pneumonia and initial gastrointestinal involvement was 0.836 (95% CI: 0.742, 0.930, p < 0.001) and 0.721 (95% CI: 0.604, 0.839, p=0.002), respectively. The upper tertiles of PC ratio showed lower levels of aspartate aminotransferase (p=0.016) and lactic dehydrogenase (p < 0.001). Conclusions Platelet-to-CRP ratio could act as an effective model in recognizing severe COVID-19 and multi-organ injuries.
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Thakar A, Goyal M, Bhinde S, Chhotala Y, Panara K, Chaudhari S. Impact of AYUSH 64 as an adjunctive to standard of care in mild COVID 19 - An open-label randomized controlled pilot study. J Ayurveda Integr Med 2022; 13:100587. [PMID: 35600633 PMCID: PMC9114151 DOI: 10.1016/j.jaim.2022.100587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/06/2022] [Accepted: 05/06/2022] [Indexed: 01/22/2023] Open
Abstract
Background Ayurveda herbal formulation AYUSH-64, proven to treat malaria and influenza-like illness in india was repurposed for COVID-19 patients considering preliminary evidances, however, scientific data was not available. Aim To evaluate the preliminary efficacy and safety of AYUSH 64 as an add-on to standard of care in mild COVID19 patients. Materials and methods A single centre, randomized, open-labeled, controlled, pilot study were conducted on mild COVID 19 confirmed patients. Patients allotted in interventional group (n = 41) recieved AYUSH 64, 3 gm per day in three divided dose for 14 days as an adjuvant to standard of care (SOC) whereas control group received SOC (n = 39) alone. Outcomes were reduction in WHO ordinal scale for clinical improvement, all-cause mortality, incidence of COVID19 symptoms among asymptomatic patients at baseline, use for oxygen therapy, use for a mechanical ventilator, the total duration of symptomatic phase and adverse events. Results Mean score of WHO ordinal scale was reduced as time lapse in both the groups (f (1) = 20.5, p < 0.001) indicating clinical improvement among groups. There was no statistically significant difference in mean WHO ordinal scale between groups (f (1) = 0.98, p = 0.32). The proportion of asymptomatic patients progressing to the symptomatic stage is lower in AYUSH 64 group [OR, 0.68 (CI, 0.17–2.66)]. Mean days for the total duration of the symptomatic phase was also short in AYUSH 64 group (4.68 ± 3.29 days) compared to SOC group (5.81 ± 3.5 days). No incidence of the requirement of a mechanical ventilator, adverse drug reaction and death were observed in either of the groups. Conclusion The findings of this pilot study show that an integrated approach of AYUSH 64 with SOC provide early trends of benefit by reduction in disease progression and in total symptom duration. However, its effects remains inconclusive on outcomes such as all cause mortality, use of oxygen therapy, invasive ventilator due to sparse outcomes.
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Domi E, Hoxha M, Kolovani E, Tricarico D, Zappacosta B. The Importance of Nutraceuticals in COVID-19: What's the Role of Resveratrol? MOLECULES (BASEL, SWITZERLAND) 2022; 27:molecules27082376. [PMID: 35458574 PMCID: PMC9030369 DOI: 10.3390/molecules27082376] [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] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
Since COVID-19 has affected global public health, there has been an urgency to find a solution to limit both the number of infections, and the aggressiveness of the disease once infected. The main characteristic of this infection is represented by a strong alteration of the immune system which, day by day, increases the risk of mortality, and can lead to a multiorgan dysfunction. Because nutritional profile can influence patient’s immunity, we focus our interest on resveratrol, a polyphenolic compound known for its immunomodulating and anti-inflammatory properties. We reviewed all the information concerning the different roles of resveratrol in COVID-19 pathophysiology using PubMed and Scopus as the main databases. Interestingly, we find out that resveratrol may exert its role through different mechanisms. In fact, it has antiviral activity inhibiting virus entrance in cells and viral replication. Resveratrol also improves autophagy and decreases pro-inflammatory agents expression acting as an anti-inflammatory agent. It regulates immune cell response and pro-inflammatory cytokines and prevents the onset of thrombotic events that usually occur in COVID-19 patients. Since resveratrol acts through different mechanisms, the effect could be enhanced, making a totally natural agent particularly effective as an adjuvant in anti COVID-19 therapy.
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Affiliation(s)
- Elisa Domi
- Department for Chemical-Toxicological and Pharmacological Evaluation of Drugs, Faculty of Pharmacy, Catholic University Our Lady of Good Counsel, Rruga Dritan Hoxha, 1000 Tirana, Albania; (E.D.); (M.H.)
| | - Malvina Hoxha
- Department for Chemical-Toxicological and Pharmacological Evaluation of Drugs, Faculty of Pharmacy, Catholic University Our Lady of Good Counsel, Rruga Dritan Hoxha, 1000 Tirana, Albania; (E.D.); (M.H.)
| | - Entela Kolovani
- Infectious Diseases Department, Faculty of Medicine, University of Medicine, Tirana, Rruga e Dibrës, 1005 Tirana, Albania;
| | - Domenico Tricarico
- Section of Pharmacology, Department of Pharmacy-Pharmaceutical Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy;
| | - Bruno Zappacosta
- Department for Chemical-Toxicological and Pharmacological Evaluation of Drugs, Faculty of Pharmacy, Catholic University Our Lady of Good Counsel, Rruga Dritan Hoxha, 1000 Tirana, Albania; (E.D.); (M.H.)
- Correspondence: ; Tel.: +355-42-273-290
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Prognostic Markers in Hospitalized COVID-19 Patients: The Role of IP-10 and C-Reactive Protein. DISEASE MARKERS 2022; 2022:3528312. [PMID: 35242241 PMCID: PMC8886756 DOI: 10.1155/2022/3528312] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/14/2022] [Accepted: 02/12/2022] [Indexed: 01/09/2023]
Abstract
Background SARS-CoV-2 is responsible for COVID-19, a clinically heterogeneous disease, ranging from being completely asymptomatic to life-threating manifestations. An unmet clinical need is the identification at disease onset or during its course of reliable biomarkers allowing patients' stratification according to disease severity. In this observational prospective cohort study, patients' immunologic and laboratory signatures were analyzed to identify independent predictors of unfavorable (either death or intensive care unit admission need) or favorable (discharge and/or clinical resolution within the first 14 days of hospitalization) outcome. Methods Between January and May 2021 (third wave of the pandemic), we enrolled 139 consecutive SARS-CoV-2 positive patients hospitalized in Northern Italy to study their immunological and laboratory signatures. Multiplex cytokine, chemokine, and growth factor analysis, along with routine laboratory tests, were performed at baseline and after 7 days of hospital stay. Results According to their baseline characteristics, the majority of our patients experienced a moderate to severe illness. At multivariate analysis, the only independent predictors of disease evolution were the serum concentrations of IP-10 (at baseline) and of C-reactive protein (CRP) after 7 days of hospitalization. Receiver-operating characteristic (ROC) curve analysis confirmed that baseline IP − 10 > 4271 pg/mL and CRP > 2.3 mg/dL at 7 days predict a worsening in clinical conditions (87% sensitivity, 66% specificity, area under the curve (AUC) 0.772, p < 0.001 and 83% sensitivity, 73% specificity, AUC 0.826, p < 0.001, respectively). Conclusions According to our results, baseline IP-10 and CRP after 7 days of hospitalization could be useful in driving clinical decisions tailored to the expected disease trajectory in hospitalized COVID-19 patients.
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Shafiekhani M, Shekari Z, Boorboor A, Zare Z, Arabsheybani S, Azadeh N. Bacterial and fungal co-infections with SARS-CoV-2 in solid organ recipients: a retrospective study. Virol J 2022; 19:35. [PMID: 35246169 PMCID: PMC8894563 DOI: 10.1186/s12985-022-01763-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background SARS-CoV-2, a novel corona virus, has caused clusters of fatal pneumonia worldwide. Immune compromised patients are among the high risk groups with poor prognosis of the disease. The presence of bacterial or fungal co-infections with SARS-CoV-2 is associated with increased mortality. Methods The electronic data of the liver and kidney recipients, hospitalized in COVID-19 intensive care unit in an 8-month period in 2020 were retrospectively assessed. The documented bacterial or fungal infections alongside with outcome and risk factors were recorded and analyzed by binary logistic regression model and multivariate analyses. Results Sixty-Six liver and kidney recipients with positive RT-PCR for SARS-CoV-2 were included this study. Twenty one percent of the patients had at least one episode of co-infection during their COVID-19 course. Bacterial and fungal co-infections contributed to a significantly higher mortality. Urine and sputum were the most common sites of pathogen isolation (45.45% and 36.36%; respectively). The majority of infections were caused by vancomycin- resistant Enterococci (30%). Escherichia coli stood in the next position with 23.3%. Prior hospitalization and high doses of corticosteroids were associated with co-infections (p < 0.001 and p = 0.02; respectively.) Conclusions Bacterial and fungal co-infections with COVID-19 are more prevalent in solid organ recipients compared to the general population. Prior hospitalizations and use of broad-spectrum antimicrobial agents lead to emergence of multi-drug resistant pathogens in this susceptible patient population. Early detection and treatment of co-infections as well as antibiotic stewardship is recommended in solid organ recipients.
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Affiliation(s)
- Mojtaba Shafiekhani
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shekari
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Boorboor
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zare
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Arabsheybani
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Azadeh
- Shiraz Transplant Center, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs. Medicina (B Aires) 2022; 58:medicina58020216. [PMID: 35208539 PMCID: PMC8877355 DOI: 10.3390/medicina58020216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives: Scant data regarding early post-COVID-19 effects are available, especially in younger people. Therefore, the objective of this study was to explore the early clinical impacts of post-COVID-19 pneumonia, comparing severe and non-severe patients. Materials and Methods: A cross-sectional study was conducted in adult patients admitted with COVID-19 pneumonia from April to May 2021. Demographic data, symptoms and signs, quality of life, Hospital Anxiety and Depression Scale (HADS), chest radiograph (CXR), pulmonary function tests (spirometry, impulse oscillometry), fractional exhaled nitric oxide (FeNO), and exercise capacity were assessed one month after hospital discharge. Twenty-five healthy control subjects that were age- and gender-matched were recruited for comparisons. Results: One hundred and five patients, with a mean age of 35.6 ± 15.8 years and 54 (51.4%) males, participated and were categorized into the non-severe pneumonia (N = 68) and severe pneumonia groups (N = 37). At a one-month follow-up visit (the time from the onset of the disease symptoms = 45.4 ± 5.9 days), the severe group had more cough, fatigue, and skin rash with higher dyspnea scale, more residual CXR lesions, and lower quality of life scores. Forced vital capacity (FVC) was lower in the severe group (88.3% of predicted value) and non-severe group (94.6% of predicted value) than in the healthy controls (p = 0.001). The six-minute walk distance was significantly lower in the non-severe group, at 79.2 m, and in the severe group, at 103.8 m, than in the healthy control subjects (p < 0.001). Conclusions: Adult patients with COVID-19, especially those with clinically severe pneumonia, still had residual symptoms and chest radiographic abnormalities, together with poorer quality of life and lower exercise capacity, one month after hospital discharge.
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Zaidi AK, Dehgani-Mobaraki P. The mechanisms of action of ivermectin against SARS-CoV-2-an extensive review. J Antibiot (Tokyo) 2022; 75:60-71. [PMID: 34931048 PMCID: PMC8688140 DOI: 10.1038/s41429-021-00491-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
Considering the urgency of the ongoing COVID-19 pandemic, detection of new mutant strains and potential re-emergence of novel coronaviruses, repurposing of drugs such as ivermectin could be worthy of attention. This review article aims to discuss the probable mechanisms of action of ivermectin against SARS-CoV-2 by summarizing the available literature over the years. A schematic of the key cellular and biomolecular interactions between ivermectin, host cell, and SARS-CoV-2 in COVID-19 pathogenesis and prevention of complications has been proposed.
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Affiliation(s)
- Asiya Kamber Zaidi
- Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Corciano, Italy.
| | - Puya Dehgani-Mobaraki
- Association "Naso Sano" Onlus, Umbria Regional Registry of Volunteer Activities, Corciano, Italy
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Leoni MLG, Moschini E, Beretta M, Zanello M, Nolli M. The modified NUTRIC score (mNUTRIC) is associated with increased 28-day mortality in critically ill COVID-19 patients: internal validation of a prediction model. Clin Nutr ESPEN 2022; 48:202-209. [PMID: 35331492 PMCID: PMC8849901 DOI: 10.1016/j.clnesp.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Matteo Luigi Giuseppe Leoni
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy; Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Elisa Moschini
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Maurizio Beretta
- Department of Medicine and Surgery, University of Parma, School of Nursing, Piacenza, Italy
| | - Marco Zanello
- University Alma Mater Studiorum, Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
| | - Massimo Nolli
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Zaidi AK, Dehgani-Mobaraki P. RETRACTED ARTICLE: The mechanisms of action of Ivermectin against SARS-CoV-2: An evidence-based clinical review article. J Antibiot (Tokyo) 2022; 75:122. [PMID: 34127807 PMCID: PMC8203399 DOI: 10.1038/s41429-021-00430-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Asiya Kamber Zaidi
- Member, Association "Naso Sano" Onlus, Umbria Regional Registry of volunteer activities, Corciano, Italy.
- Mahatma Gandhi Memorial Medical College, Indore, India.
| | - Puya Dehgani-Mobaraki
- President, Association "Naso Sano" Onlus, Umbria Regional Registry of volunteer activities, Corciano, Italy
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Honarkar Shafie E, Taheri F, Alijani N, Okhovvat AR, Goudarzi R, Borumandnia N, Aghaghazvini L, Rezayat SM, Jamalimoghadamsiahkali S, Hosseinzadeh-Attar MJ. Effect of nanocurcumin supplementation on the severity of symptoms and length of hospital stay in patients with COVID-19: A randomized double-blind placebo-controlled trial. Phytother Res 2022; 36:1013-1022. [PMID: 35023260 DOI: 10.1002/ptr.7374] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/02/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022]
Abstract
It has been more than a year since the outbreak of COVID-19, and it is still the most critical issue of the healthcare system. Discovering effective strategies to treat infected patients is necessary to decrease the mortality rate. This study aimed to determine the effects of nanocurcumin on the severity of symptoms and length of hospital stay (LOS) in COVID-19 patients. Forty-eight COVID-19 patients were randomly assigned into nanocurcumin (n = 24) and placebo (n = 24) groups receiving 160 mg/day nanocurcumin or placebo capsules for 6 days. Mean differences of O2 saturation were significantly higher in patients who received nanocurcumin supplements (p = 0.02). Also, nanocurcumin treatment significantly reduced the scores of domains 3 and 4 and the total score of Wisconsin Upper Respiratory System Survey (WURSS-24), indicating milder symptoms in the treatment group (p = 0.01, 0.03, and 0.01 respectively). Besides, the LOS in curcumin groups was lower than in the placebo group, although the difference was not statistically significant (6.31 ± 5.26 vs. 8.87 ± 8.12 days; p = 0.416). CBC/differentiate, hs-CRP level and the pulmonary involvement in CT scan were not different between the two groups. As nanocurcumin can be effective in increasing O2 saturation and reducing the severity of symptoms in COVID-19 patients, it could probably be used as a complementary agent to accelerate the recovery of patients.
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Affiliation(s)
- Elaheh Honarkar Shafie
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Taheri
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Alijani
- Department of Infectious Disease, Shariati Hospital, Tehran university of medical sciences, Tehran, Iran
| | | | - Razieh Goudarzi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mahdi Rezayat
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Durnaoglu S, Lee SK, Ahnn J. Syncytin, envelope protein of human endogenous retrovirus (HERV): no longer 'fossil' in human genome. Anim Cells Syst (Seoul) 2022; 25:358-368. [PMID: 35059135 PMCID: PMC8765258 DOI: 10.1080/19768354.2021.2019109] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/17/2022] Open
Abstract
Human endogenous retroviruses (HERVs) are 'fossil viruses' that resulted from stable integrations of exogenous retroviruses throughout evolution. HERVs are defective and do not produce infectious viral particles. However, some HERVs retain a limited coding capacity and produce retroviral transcripts and proteins, which function in human developmental process and various pathologies, including many cancers and neurological diseases. Recently, it has been reported that HERVs are differently expressed in COVID-19 disease caused by infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this review, we discuss the molecular structure and function of HERV ENV proteins, particularly syncytins, and their conventional roles in human development and diseases, and potential involvement in COVID-19 regarding the newly reported mental symptoms. We also address COVID-19 vaccine-related infertility concerns arising from the similarity of syncytin with the spike protein of SARS-CoV-2, which have been proved invalid.
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Affiliation(s)
- Serpen Durnaoglu
- College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
- Research Institute for Natural Sciences, College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
| | - Sun-Kyung Lee
- College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
- Research Institute for Natural Sciences, College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
| | - Joohong Ahnn
- College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
- Research Institute for Natural Sciences, College of Natural Sciences, Hanyang University, Seoul, Republic of Korea
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65
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Alsuwaidi L, Al Heialy S, Shaikh N, Al Najjar F, Seliem R, Han A, Hachim M. Monocyte distribution width as a novel sepsis indicator in COVID-19 patients. BMC Infect Dis 2022; 22:27. [PMID: 34983404 PMCID: PMC8724663 DOI: 10.1186/s12879-021-07016-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus (SARS-CoV-2) is a highly transmittable virus which causes the novel coronavirus disease (COVID-19). Monocyte distribution width (MDW) is an in-vitro hematological parameter which describes the changes in monocyte size distribution and can indicate progression from localized infection to systemic infection. In this study we evaluated the correlation between the laboratory parameters and available clinical data in different quartiles of MDW to predict the progression and severity of COVID-19 infection. METHODS A retrospective analysis of clinical data collected in the Emergency Department of Rashid Hospital Trauma Center-DHA from adult individuals tested for SARS-CoV-2 between January and June 2020. The patients (n = 2454) were assigned into quartiles based on their MDW value on admission. The four groups were analyzed to determine if MDW was an indicator to identify patients who are at increased risk for progression to sepsis. RESULTS Our data showed a significant positive correlation between MDW and various laboratory parameters associated with SARS-CoV-2 infection. The study also revealed that MDW ≥ 24.685 has a strong correlation with poor prognosis of COVID-19. CONCLUSIONS Monitoring of monocytes provides a window into the systemic inflammation caused by infection and can aid in evaluating the progression and severity of COVID-19 infection.
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Affiliation(s)
- Laila Alsuwaidi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box: 505055, Dubai, UAE.
| | - Saba Al Heialy
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box: 505055, Dubai, UAE.,Meakins-Christie Laboratories, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Nahid Shaikh
- Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | | | - Rania Seliem
- Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - Aaron Han
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box: 505055, Dubai, UAE.,Kings College Hospital London Dubai, Dubai, UAE
| | - Mahmood Hachim
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, P.O. Box: 505055, Dubai, UAE
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Kandasamy S, Gopalakrishnan S, Krishnan B, Krishnan M, Sahul Hameed P, Karunakaran V. The prognostic role of inflammatory markers in COVID-19 patients: A retrospective analysis in a tertiary care hospital of southern India. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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67
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Diggikar P, Gopal P, Satya Saranya N. Study of clinical features, laboratory and radiological findings, morbidity, and mortality in COVID-19 patients with controlled and uncontrolled diabetes mellitus. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_753_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Beimdiek J, Janciauskiene S, Wrenger S, Volland S, Rozy A, Fuge J, Olejnicka B, Pink I, Illig T, Popov A, Chorostowska J, Buettner FFR, Welte T. Plasma markers of COVID-19 severity: a pilot study. Respir Res 2022; 23:343. [PMID: 36514048 PMCID: PMC9745704 DOI: 10.1186/s12931-022-02272-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND SARS-CoV-2 infected patients show heterogeneous clinical presentations ranging from mild symptoms to severe respiratory failure and death. Consequently, various markers reflect this wide spectrum of disease presentations. METHODS Our pilot cohort included moderate (n = 10) and severe (n = 10) COVID-19 patients, and 10 healthy controls. We determined plasma levels of nine acute phase proteins (APPs) by nephelometry, and full-length (M65), caspase-cleaved (M30) cytokeratin 18, and ADAMTS13 (a disintegrin-like and metalloprotease with thrombospondin type-1 motif 13) by ELISA. In addition, we examined whole plasma N-glycosylation by capillary gel electrophoresis coupled to laser-induced fluorescence detection (CGE-LIF). RESULTS When compared to controls, COVID-19 patients had significantly lower concentrations of ADAMTS13 and albumin (ALB) but higher M30, M65, α1-acid glycoprotein (AGP), α1-antitrypsin (AAT), ceruloplasmin (CP), haptoglobin (HP), and high-sensitivity C-reactive protein (hs-CRP). The concentrations of α1-antichymotrypsin (ACT), α2-macroglobulin (A2MG) and serum amyloid A (SAA) proteins did not differ. We found significantly higher levels of AAT and M65 but lower ALB in severe compared to moderate COVID-19 patients. N-glycan analysis of the serum proteome revealed increased levels of oligomannose- and sialylated di-antennary glycans and decreased non-sialylated di-antennary glycan A2G2 in COVID-19 patients compared to controls. CONCLUSIONS COVID-19-associated changes in levels and N-glycosylation of specific plasma proteins highlight complexity of inflammatory process and grant further investigations.
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Affiliation(s)
- Julia Beimdiek
- grid.10423.340000 0000 9529 9877Institute of Clinical Biochemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sabina Janciauskiene
- grid.10423.340000 0000 9529 9877Department of Pulmonary and Infectious Diseases, Hannover Medical School, BREATH German Center for Lung Research (DZL) Hannover University School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sabine Wrenger
- grid.10423.340000 0000 9529 9877Department of Pulmonary and Infectious Diseases, Hannover Medical School, BREATH German Center for Lung Research (DZL) Hannover University School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Sonja Volland
- grid.10423.340000 0000 9529 9877Hannover Unified Biobank, Hannover Medical School, Feodor-Lynen-Str. 15, 30625 Hannover, Germany
| | - Adriana Rozy
- grid.419019.40000 0001 0831 3165Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, 26 Plocka St., 01138 Warsaw, Poland
| | - Jan Fuge
- grid.10423.340000 0000 9529 9877Department of Pulmonary and Infectious Diseases, Hannover Medical School, BREATH German Center for Lung Research (DZL) Hannover University School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Beata Olejnicka
- grid.10423.340000 0000 9529 9877Department of Pulmonary and Infectious Diseases, Hannover Medical School, BREATH German Center for Lung Research (DZL) Hannover University School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Isabell Pink
- grid.10423.340000 0000 9529 9877Department of Pulmonary and Infectious Diseases, Hannover Medical School, BREATH German Center for Lung Research (DZL) Hannover University School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Thomas Illig
- grid.10423.340000 0000 9529 9877Hannover Unified Biobank, Hannover Medical School, Feodor-Lynen-Str. 15, 30625 Hannover, Germany
| | - Alexander Popov
- grid.10423.340000 0000 9529 9877Hannover Unified Biobank, Hannover Medical School, Feodor-Lynen-Str. 15, 30625 Hannover, Germany
| | - Joanna Chorostowska
- grid.419019.40000 0001 0831 3165Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, 26 Plocka St., 01138 Warsaw, Poland
| | - Falk F. R. Buettner
- grid.10423.340000 0000 9529 9877Institute of Clinical Biochemistry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Tobias Welte
- grid.10423.340000 0000 9529 9877Department of Pulmonary and Infectious Diseases, Hannover Medical School, BREATH German Center for Lung Research (DZL) Hannover University School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Pezoulas VC, Kourou KD, Papaloukas C, Triantafyllia V, Lampropoulou V, Siouti E, Papadaki M, Salagianni M, Koukaki E, Rovina N, Koutsoukou A, Andreakos E, Fotiadis DI. A Multimodal Approach for the Risk Prediction of Intensive Care and Mortality in Patients with COVID-19. Diagnostics (Basel) 2021; 12:56. [PMID: 35054223 PMCID: PMC8774804 DOI: 10.3390/diagnostics12010056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/22/2021] [Accepted: 12/26/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although several studies have been launched towards the prediction of risk factors for mortality and admission in the intensive care unit (ICU) in COVID-19, none of them focuses on the development of explainable AI models to define an ICU scoring index using dynamically associated biological markers. METHODS We propose a multimodal approach which combines explainable AI models with dynamic modeling methods to shed light into the clinical features of COVID-19. Dynamic Bayesian networks were used to seek associations among cytokines across four time intervals after hospitalization. Explainable gradient boosting trees were trained to predict the risk for ICU admission and mortality towards the development of an ICU scoring index. RESULTS Our results highlight LDH, IL-6, IL-8, Cr, number of monocytes, lymphocyte count, TNF as risk predictors for ICU admission and survival along with LDH, age, CRP, Cr, WBC, lymphocyte count for mortality in the ICU, with prediction accuracy 0.79 and 0.81, respectively. These risk factors were combined with dynamically associated biological markers to develop an ICU scoring index with accuracy 0.9. CONCLUSIONS to our knowledge, this is the first multimodal and explainable AI model which quantifies the risk of intensive care with accuracy up to 0.9 across multiple timepoints.
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Affiliation(s)
- Vasileios C. Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR45110 Ioannina, Greece; (V.C.P.); (K.D.K.); (C.P.)
| | - Konstantina D. Kourou
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR45110 Ioannina, Greece; (V.C.P.); (K.D.K.); (C.P.)
| | - Costas Papaloukas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR45110 Ioannina, Greece; (V.C.P.); (K.D.K.); (C.P.)
- Department of Biological Applications and Technology, University of Ioannina, GR45100 Ioannina, Greece
| | - Vassiliki Triantafyllia
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, GR11527 Athens, Greece; (V.T.); (V.L.); (E.S.); (M.P.); (M.S.); (E.A.)
| | - Vicky Lampropoulou
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, GR11527 Athens, Greece; (V.T.); (V.L.); (E.S.); (M.P.); (M.S.); (E.A.)
| | - Eleni Siouti
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, GR11527 Athens, Greece; (V.T.); (V.L.); (E.S.); (M.P.); (M.S.); (E.A.)
| | - Maria Papadaki
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, GR11527 Athens, Greece; (V.T.); (V.L.); (E.S.); (M.P.); (M.S.); (E.A.)
| | - Maria Salagianni
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, GR11527 Athens, Greece; (V.T.); (V.L.); (E.S.); (M.P.); (M.S.); (E.A.)
| | - Evangelia Koukaki
- Intensive Care Unit (ICU), 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, ‘Sotiria’ General Hospital of Chest Diseases, GR11527 Athens, Greece; (E.K.); (N.R.); (A.K.)
| | - Nikoletta Rovina
- Intensive Care Unit (ICU), 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, ‘Sotiria’ General Hospital of Chest Diseases, GR11527 Athens, Greece; (E.K.); (N.R.); (A.K.)
| | - Antonia Koutsoukou
- Intensive Care Unit (ICU), 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens, ‘Sotiria’ General Hospital of Chest Diseases, GR11527 Athens, Greece; (E.K.); (N.R.); (A.K.)
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, GR11527 Athens, Greece; (V.T.); (V.L.); (E.S.); (M.P.); (M.S.); (E.A.)
| | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, GR45110 Ioannina, Greece; (V.C.P.); (K.D.K.); (C.P.)
- Department of Biomedical Research, Foundation for Research and Technology-Hellas, Institute of Molecular Biology and Biotechnology (FORTH-IMBB), GR45110 Ioannina, Greece
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Kłosiewicz T, Szkudlarek W, Węglewska M, Konieczka P, Zalewski R, Podlewski R, Sowińska A, Puślecki M. Dynamics of the Third Wave of COVID-19 from the Perspective of the Emergency Department in a Large Regional Hospital—Single Center Observational Study. Healthcare (Basel) 2021; 10:healthcare10010018. [PMID: 35052182 PMCID: PMC8775057 DOI: 10.3390/healthcare10010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic has caused many significant social and economic changes. The consecutive waves of the epidemic in various countries have had dissimilar courses depending on the methods used to combat it. The aim of this study was to determine the dynamics of the third wave of COVID-19 from the perspective of emergency departments (ED). Methods: This was a retrospective review of medical records from ED. The authors have identified the most frequent symptoms. Prognostic factors have been chosen—prognostic scales, length of stay (LOS)—and a number of resources required have been calculated. Results: As the time passed, there were fewer patients and they presented mild symptoms. A statistically significant difference was observed in the median of blood oxygenation measurement (p = 0.00009), CRP level (p = 0.0016), and admission rate. Patients admitted to the hospital required more resources at ED. LOS was shorter in patients discharged home (p < 0.0001). Conclusions: The blood oxygen saturation (SPO2) and CPR levels can be helpful in decision-making regarding medical treatment. The fast-track for patients in good clinical condition may shorten the duration of stay in ED, and reduce the number of required resources.
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Affiliation(s)
- Tomasz Kłosiewicz
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
- Correspondence: ; Tel.: +48-668956969
| | - Weronika Szkudlarek
- Students’ Scientific Circle of Emergency Medicine, Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (W.S.); (M.W.)
| | - Magdalena Węglewska
- Students’ Scientific Circle of Emergency Medicine, Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (W.S.); (M.W.)
| | - Patryk Konieczka
- Department of Emergency Medicine, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland;
| | - Radosław Zalewski
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
| | - Roland Podlewski
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
| | - Anna Sowińska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-608 Poznan, Poland;
| | - Mateusz Puślecki
- Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, 60-608 Poznan, Poland; (R.Z.); (R.P.); (M.P.)
- Department of Cardiac Surgery and Transplantology, Medical Faculty, Poznan University of Medical Sciences, 61-848 Poznan, Poland
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Ahmed MH, Ahmed HAAM, Nosair NAEA, Hassan AM, Sherief DE, Mahros AM. Fecal Calprotectin as a Predictor of COVID-19 Severity. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1055/s-0041-1736646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AbstractCoronavirus disease 2019 (COVID-19) is highly transmittable through contact with respiratory droplets. The virus is also shed in fecal matter. Some patients may present with effects in more than one system; however, there are no defined biomarkers that can accurately predict the course or progression of the disease. The present study aimed to estimate the severity of the disease, to correlate the severity of the disease with biochemical predictors, to identify valuable biomarkers indicative of gastrointestinal disease, and to determine the cutoff values. A cross-sectional study was conducted on COVID-19 patients admitted to the Kafrelsheikh University Hospital (isolation unit) between July 10, 2020, and October 30, 2020. The diagnosis of COVID-19 was confirmed via reverse transcription-polymerase chain reaction (RT-PCR), which was employed for the detection of the viral RNA. We conclude that lymphopenia, elevated C-reactive protein (CRP) level, and liver enzymes were among the most important laboratory findings in COVID-19 patients. Statistically significant differences in platelet count, neutrophil count, D-dimer level, and fecal calprotectin levels were observed among patients presenting with chest symptoms only and patients with both chest and gastrointestinal symptoms (p = 0.004; < 0.001; 0.010; 0.003; and < 0.001, respectively). C-reactive protein, D-dimer, and fecal calprotectin levels positively correlated with disease severity. The cutoff value for fecal calprotectin that can predict gastrointestinal involvement in COVID-19 was 165.0, with a sensitivity of 88.1% and a specificity of 76.5%.
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Affiliation(s)
- Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | | | - Nahla Abd el-Aziz Nosair
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Asmaa Mbarak Hassan
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Dalia ElSayed Sherief
- Department of Clinical Pathology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Aya Mohammed Mahros
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Chou YY, Hou CC, Wu CW, Huang DW, Tsai SL, Liu TH, Ding LM, Chang CK, Ou KL, Chiu YL, Tzeng YS. Risk factors that predict major amputations and amputation time intervals for hospitalised diabetic patients with foot complications. Int Wound J 2021; 19:1329-1338. [PMID: 34879446 PMCID: PMC9493235 DOI: 10.1111/iwj.13727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/20/2021] [Accepted: 12/01/2021] [Indexed: 12/05/2022] Open
Abstract
Diabetes‐related lower extremity amputations are an enormous burden on global health care and social resources because of the rapid worldwide growth of the diabetic population. This research aimed to determine risk factors that predict major amputation and analyse the time interval from first hospitalisation to amputation by using standard management protocols and Kaplan–Meier survival curves. Data from 246 patients with diabetes mellitus and diabetic foot ulcers from the Division of Plastic and Reconstructive Surgery of the Department of Surgery at XXX Hospital between January 2016 and May 2020 were analysed. Univariate and multivariate analyses of 44 potential risk factors, including invasive ulcer depth and C‐reactive protein levels, showed statistically significant differences for those at increased risk for major amputation. The median time from hospitalisation to lower extremity amputation was approximately 35 days. Most patients with abnormal C‐reactive protein levels and approximately 70% of patients with ulcers invading the bone were at risk for lower extremity amputations within 35 days. Therefore, invasive ulcer depth and C‐reactive protein levels are significant risk factors. Other potential risk factors for major amputation and the time intervals from first hospitalisation to amputation should be analysed to establish further prediction strategies.
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Affiliation(s)
- Yu-Yu Chou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Chun Hou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Wei Wu
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Dun-Wei Huang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Lin Tsai
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Hsuan Liu
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Lu-Ming Ding
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Kai Chang
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuang-Ling Ou
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Hejazi ME, Malek Mahdavi A, Navarbaf Z, Tarzamni MK, Moradi R, Sadeghi A, Valizadeh H, Namvar L. Relationship between chest CT scan findings with SOFA score, CRP, comorbidity, and mortality in ICU patients with COVID-19. Int J Clin Pract 2021; 75:e14869. [PMID: 34525236 PMCID: PMC8646744 DOI: 10.1111/ijcp.14869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the relationship between chest computed tomography (CT) scan findings with sequential organ failure assessment (SOFA) score, C-reactive protein (CRP), comorbidity, and mortality in intensive care unit (ICU) patients with coronavirus disease 19 (COVID-19). METHOD Adult patients (≥18 years old) with COVID-19 who were consecutively admitted to the Imam-Reza Hospital, Tabriz, East-Azerbaijan Province, North-West of Iran between March 2020 and August 2020 were screened and total of 168 patients were included. Demographic, clinical, and mortality data were gathered. Severity of disease was evaluated using the SOFA score system. CRP levels were measured and chest CT scans were performed. RESULTS Most of patients had multifocal and bilateral ground glass opacity (GGO) pattern in chest CT scan. There were significant correlations between SOFA score on admission with multifocal and bilateral GGO (P = .010 and P = .011, respectively). Significant relationships were observed between unilateral and bilateral GGO patterns with CRP (P = .049 and P = .046, respectively). There was significant relationship between GGO patterns with comorbidities including overweight/obesity, heart failure, cardiovascular diseases, and malignancy (P < .05). No significant relationships were observed between chest CT scan results with mortality (P > .05). CONCLUSION Multifocal bilateral GGO was the most common pattern. Although chest CT scan characteristics were significantly related with SOFA score, CRP, and comorbidity in ICU patients with COVID-19, a relationship with mortality was not significant.
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Affiliation(s)
- Mohammad Esmaeil Hejazi
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Aida Malek Mahdavi
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Zahra Navarbaf
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
- Clinical Research Development UnitImam Reza General HospitalTabriz University of Medical SciencesTabrizIran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research GroupTabriz University of Medical SciencesTabrizIran
- Department of RadiologyMedical SchoolTabriz University of Medical SciencesTabrizIran
| | - Rozhin Moradi
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
- Clinical Research Development UnitImam Reza General HospitalTabriz University of Medical SciencesTabrizIran
| | - Armin Sadeghi
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Hamed Valizadeh
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Leila Namvar
- Tuberculosis and Lung Diseases Research CenterTabriz University of Medical SciencesTabrizIran
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74
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Keshavarz F, Ghalamfarsa F, Javdansirat S, Hasanzadeh S, Azizi A, Sabz G, Salehi M, Ghalamfarsa G. Patients with Covid 19 have significantly reduced CH50 activity. Virusdisease 2021; 32:681-689. [PMID: 34631971 PMCID: PMC8486960 DOI: 10.1007/s13337-021-00710-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/08/2021] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is a new virus that emerged in China and immediately spread around the world. Evidence has been documented that the immune system is impressively involved in the pathogenesis of this disease, especially in causing inflammation. One of the important components of the immune system is the complement system whose increased activity has been shown in inflammatory diseases and consequently damage caused by the activity of its components. In the present study, serum levels of C3 and C4 factors as well as the activity level of complement system in the classical pathway were measured by CH50 test in patients with SARS-CoV-2. Participants in the study consisted of 53 hospitalized patients whose real-time PCR test was positive for SARS-CoV-2. The mean age of these patients was 42.06 ± 18.7 years, including 40% women and 60% men. The most common symptoms in these patients were cough (70%), fever (59%), dyspnea (53%) and chills (53%), respectively. Analysis of biochemical and hematological test results revealed that 26 (49%) patients had lymphopenia, 34 (64%) patients were positive for C-reactive protein (CRP) and 26 (49%) patients had ESR and LDH levels significantly higher than normal. In addition, 27 patients (51%) had vitamin D deficiency. The mean CH50 activity level in COVID-19 patients was significantly reduced compared to healthy individuals (84.9 versus 169.9 U/ml, p = < 0.0001). Comparison of the mean CH50 activity levels between different subgroups of patients indicated that COVID-19 patients with decreased peripheral blood lymphocyte count and positive CRP had a significant increase in activity compared to the other groups (p = 0.0002). The serum levels of C3 and C4 factors had no significant change between patients and healthy individuals. Conclusion: The activity level of complement system in the classical pathway decreases in COVID-19 patients compared to healthy individuals, due to increased activity of complement system factors in these patients.
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Affiliation(s)
- Fatemeh Keshavarz
- Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Farideh Ghalamfarsa
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Javdansirat
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sajad Hasanzadeh
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Arsalan Azizi
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gholamabbas Sabz
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Marziyeh Salehi
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Ghasem Ghalamfarsa
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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75
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Berksoy E, Kanik A, Çiçek A, Bardak Ş, Elibol P, Demir G, Yilmaz N, Nalbant T, Gökalp G, Yilmaz Çiftdoğan D. Clinical and laboratory characteristics of children with SARS-CoV-2 infection. Pediatr Pulmonol 2021; 56:3674-3681. [PMID: 34516721 PMCID: PMC8661911 DOI: 10.1002/ppul.25654] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/08/2023]
Abstract
We describe the demographic, clinical, radiological, and laboratory findings of 422 children (0-18 year-of-age) suspected of having severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection admitted to a pediatric emergency department between March 23, and July 23, 2020. We compared the characteristics of SARS-CoV-2-positive patients to SARS-CoV-2-negative patients. SARS-CoV-2 infection was confirmed in 78 (18.4%). Fever (51.2%) and cough (43.5%) were the most commonly reported signs in the SARS-CoV-2-positive patients. Isolated rhinorrhea (7.2%) was reported only in the SARS-CoV-2-negative group (p = .0014). Patients with SARS-CoV-2 infection were classified according to severity, with the percentages of asymptomatic, mild, moderate, severe, and critical cases determined to be 29.5%, 56.4%, 12.9%, 1.2%, and 0%, respectively. Of the 422 children, 128 (30.3%) underwent nasopharyngeal polymerase chain reaction testing for other respiratory viral pathogens; 21 (16.4%) were infected with viral pathogens other than SARS-CoV-2. Only one patient (4.7%) with confirmed coronavirus disease 2019 (COVID-19) disease was coinfected with respiratory syncytial virus and rhinovirus. The results indicate lower median white blood cell, neutrophil, and lymphocyte counts, lower lactate dehydrogenase, d-dimer, and procalcitonin levels in the SARS-CoV-2-positive group (p ≤ .001). Our findings confirm that COVID-19 in children has a mild presentation. In our cohort, no patient with SARS-CoV-2 infection had isolated rhinorrhea.
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Affiliation(s)
- Emel Berksoy
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Ali Kanik
- Department of Pediatrics, Faculty of Medicineİzmir Katip Çelebi ÜniversityİzmirTurkey
| | - Alper Çiçek
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Şefika Bardak
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Pelin Elibol
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Gülşah Demir
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Nisel Yilmaz
- Department of Microbiologyİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Tuğçe Nalbant
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Gamze Gökalp
- Pediatric Emergency Departmentİzmir Tepecik Education and Research HospitalİzmirTurkey
| | - Dilek Yilmaz Çiftdoğan
- Pediatric Infection Department, Faculty of Medicineİzmir Katip Çelebi ÜniversityİzmirTurkey
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76
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Bohra GK, Purohit A, Kumar D, Garg MK, Midha NK, Manglia R, Jain K, Didel S, Nag V, Sharma P, Sharma A, Bhatia P, Misra S. A Composite study of Coagulation Milieu in Covid-19: Experience from a Tertiary Care Centre from India. Cardiovasc Hematol Disord Drug Targets 2021; 21:185-195. [PMID: 34852756 DOI: 10.2174/1871529x21666211201110007] [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: 06/19/2021] [Revised: 09/14/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The understanding of pathogenesis is necessary for the development of effective treatment for COVID-19. Various studies have postulated that there is a complex interplay of mediators of coagulation and inflammation responsible for the pathogenesis of COVID-19. We did this study on coagulation parameters and inflammatory markers and their effect on outcome in patients with COVID-19. METHODS This was a single centre observational cross-sectional study. Procoagulants [Prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, lupus anticoagulant (LA), fibrinogen, factor-VIII (F-VIII)]; anticoagulants [protein-C (PC), protein-S (PS), antithrombin] and inflammatory markers [interleukin-6 (IL-6) and highly sensitive - C-reactive protein (hs-CRP)] were measured at the time of hospitalization and correlated with the severity of the disease. RESULTS A total of 230 patients were enrolled, of which 61.3%, 20.0%, and 18.7% had asymptomatic/ mild, moderate, or severe disease, respectively. COVID-19 disease severity was associated with rising trends with coagulation parameters (PT, APTT, D-Dimer; p value 0.01, <0.0001, <0.0001, respectively). Falling trends of anticoagulant (PC, Antithrombin; p value <0.0001, 0.003 respectively) and rising trends of procoagulant (fibrinogen, F-VIII; p value 0.004, <0.0001 respectively) were observed with increasing COVID-19 disease severity. Multivariate logistic regression analysis found that advanced age, D-Dimer, and hs-CRP (p value 0.035, 0.018, <0.0001 respectively) were independent predictors of mortality in COVID-19. Procoagulant parameters (D-dimer, APTT, Factor VIII) were positively correlated with anticoagulant parameters (PC and PS) and inflammatory parameters (hs-CRP). CONCLUSIONS This study revealed increased levels of coagulation and inflammatory parameters, which correlated with the severity of COVID-19. Age, D-dimer, IL-6, hs-CRP, APTT, fibrinogen, and Factor VIII were significantly higher in patients with moderate and severe disease as compared to asymptomatic/mild disease. Advanced age, D dimer, and hs-CRP were significantly associated with poor outcomes.
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Affiliation(s)
- Gopal Krishana Bohra
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Abhishek Purohit
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Deepak Kumar
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Mahendra Kumar Garg
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Naresh Kumar Midha
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Ravi Manglia
- Department of Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Kartik Jain
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Siyaram Didel
- Department of Paediatrics, All India Institute of Medical Sciences, Jodhpur. India
| | - Vijayalakshami Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Ankur Sharma
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Pradeep Bhatia
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
| | - Sanjeev Misra
- All India Institute of Medical Sciences, Jodhpur, Rajasthan. India
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77
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Pandilov S, Klenkoski S, Jovanovska Janeva E, Mehmeti G, Mijakoski D, Stoleski S, Duma H, Dokic D. C-reactive protein and Neutrophil-Lymphocyte Ratio as predictors of clinical severity of COVID-19. Arch Public Health 2021. [DOI: 10.3889/aph.2021.6006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
COVID-19 is an infectious disease that can manifest quite differently. In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients. Materials and methods: We followed 95 COVID-19 positive patients who were hospitalized at the University Clinic for Eye Diseases - COVID Center. We analyzed the initial laboratory parameters of white blood cells and CRP on admission of the patients and the results of laboratory analyses performed before they left the Clinic, or the last parameters before the lethal outcome in those patients who died. Several models of logistic regression were tested to analyze the predictive value of these markers of inflammation for lethal outcome in patients hospitalized for COVID-19. Results: Bivariate analysis demonstrated that the length of hospital stay was significantly shorter in patients with lethal outcome (p=0.001). The NLR was significantly higher in patients with lethal outcome at both times (p=0.005; and p=0.017). Leukocyte’s count (p=0.046, and p<0.001) and CRP (p=0.013,and p=0.005) were also significantly higher in patients with lethal outcome at both times. The increase on the NLR scale both at hospitalization and at discharge (or the last analysis before death) leads to increase in the odds of lethal outcome (T1:40.4% increased odds; T2:36% increased odds). Conclusion: CRP and NLR are laboratory parameters that can predict the severity of the clinical manifestation in patients with COVID-19.
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78
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Liu Y, Hong F, Lebaka VR, Mohammed A, Ji L, Zhang Y, Korivi M. Calorie Restriction With Exercise Intervention Improves Inflammatory Response in Overweight and Obese Adults: A Systematic Review and Meta-Analysis. Front Physiol 2021; 12:754731. [PMID: 34867458 PMCID: PMC8634604 DOI: 10.3389/fphys.2021.754731] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background/Purpose: In this systematic review and meta-analysis, we assessed the effects of exercise (EX) combined with calorie restriction (CR) intervention on inflammatory biomarkers, and correlations between biomarkers and participants' characteristics were calculated in overweight and obese adults. Methods: An article search was conducted through PubMed, Web of Science, EMBASE, the Cochrane database, Scopus, and Google Scholar to identify articles published up to April 2021. Studies that examined the effect of EX + CR intervention on inflammatory biomarkers, including C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), and compared them with a CR trial in overweight and obese adults were included. We calculated the pooled effect by meta-analysis, identified the correlations (between inflammatory biomarkers and participants' characteristics) through meta-regression, and explored the beneficial variable through subgroup analysis. The Cochrane risk of bias tool and Methodological Index for Non-randomized Studies were used to assess the risk of bias for the included trials. Results: A total of 23 trials, including 1196 overweight and obese adults, were included in the meta-analysis. The pooled effect showed that EX + CR intervention significantly decreased CRP levels (P = 0.02), but had no effect on IL-6 (P = 0.62) and TNF-α (P = 0.11). Meta-regression analysis showed that the effect of EX + CR on CRP, IL-6, and TNF-α changes was correlated with lifestyle behavior of adults (Coef. = -0.380, P = 0.018; Coef. = -0.359, P = 0.031; Coef. = -0.424, P = 0.041, respectively), but not with age and BMI. The subgroup analysis results revealed that participants with sedentary lifestyle behavior did not respond to EX + CR intervention, as we found no changes in CRP, IL-6, and TNF-α concentrations (P = 0.84, P = 0.16, P = 0.92, respectively). However, EX + CR intervention significantly decreased CRP (P = 0.0003; SMD = -0.39; 95%CI: -0.60 to -0.18), IL-6 (P = 0.04; SMD = -0.21; 95%CI: -0.40 to -0.01) and TNF-α (P = 0.006; SMD = -0.40, 95%CI: -0.68 to -0.12) in adults without a sedentary lifestyle or with a normal lifestyle. Furthermore, the values between sedentary and normal lifestyle subgroups were statistically significant for CRP, IL-6, and TNF-α. Conclusion: Our findings showed that combination EX + CR intervention effectively decreased CRP, IL-6, and TNF-α in overweight and obese adults with active lifestyles, but not with sedentary lifestyle behavior. We suggest that 'lifestyle behavior' is a considerable factor when designing new intervention programs for overweight or obese adults to improve their inflammatory response.
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Affiliation(s)
- Yubo Liu
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- Key Laboratory of Intelligent Education Technology and Application of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Feng Hong
- Department of Sports Operation and Management, Jinhua Polytechnic, Jinhua, China
| | | | - Arifullah Mohammed
- Faculty of Agro Based Industry, Universiti Malaysia Kelantan, Kota Bharu, Malaysia
| | - Lei Ji
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Yean Zhang
- School of Communication and Arts, Shanghai University of Sport, Shanghai, China
| | - Mallikarjuna Korivi
- Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
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79
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Mosquera‐Sulbaran JA, Pedreañez A, Carrero Y, Callejas D. C-reactive protein as an effector molecule in Covid-19 pathogenesis. Rev Med Virol 2021; 31:e2221. [PMID: 34773448 PMCID: PMC7995022 DOI: 10.1002/rmv.2221] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
The current pandemic caused by SARS‐CoV‐2 virus infection is known as Covid‐19 (coronavirus disease 2019). This disease can be asymptomatic or can affect multiple organ systems. Damage induced by the virus is related to dysfunctional activity of the immune system, but the activity of molecules such as C‐reactive protein (CRP) as a factor capable of inducing an inflammatory status that may be involved in the severe evolution of the disease, has not been extensively evaluated. A systematic review was performed using the NCBI‐PubMed database to find articles related to Covid‐19 immunity, inflammatory response, and CRP published from December 2019 to December 2020. High levels of CRP were found in patients with severe evolution of Covid‐19 in which several organ systems were affected and in patients who died. CRP activates complement, induces the production of pro‐inflammatory cytokines and induces apoptosis which, together with the inflammatory status during the disease, can lead to a severe outcome. Several drugs can decrease the level or block the effect of CRP and might be useful in the treatment of Covid‐19. From this review it is reasonable to conclude that CRP is a factor that can contribute to severe evolution of Covid‐19 and that the use of drugs able to lower CRP levels or block its activity should be evaluated in randomized controlled clinical trials.
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Affiliation(s)
- Jesús A. Mosquera‐Sulbaran
- Instituto de Investigaciones Clinicas “Dr. Americo Negrette”Facultad de MedicinaUniversidad del ZuliaMaracaiboVenezuela
| | - Adriana Pedreañez
- Catedra de InmunologiaEscuela de BioanalisisFacultad de MedicinaUniversidad del ZuliaMaracaiboVenezuela
| | - Yenddy Carrero
- Facultad de Ciencias de la SaludCarrera de MedicinaUniversidad Tecnica de AmbatoAmbatoEcuador
| | - Diana Callejas
- Facultad de Ciencias de la SaludDepartamento de Ciencias BiologicasUniversidad Tecnica de ManabiPortoviejoEcuador
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80
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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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81
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Gu X, Sha L, Zhang S, Shen D, Zhao W, Yi Y. Neutrophils and Lymphocytes Can Help Distinguish Asymptomatic COVID-19 From Moderate COVID-19. Front Cell Infect Microbiol 2021; 11:654272. [PMID: 34722325 PMCID: PMC8554189 DOI: 10.3389/fcimb.2021.654272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction Asymptomatic coronavirus disease 2019 (COVID-19) and moderate COVID-19 may be the most common COVID-19 cases. This study was designed to develop a diagnostic model for patients with asymptomatic and moderate COVID-19 based on demographic, clinical, and laboratory variables. Methods This retrospective study divided the subjects into 2 groups: asymptomatic COVID-19 (without symptoms, n = 15) and moderate COVID-19 (with symptoms, n = 57). Demographic characteristics, clinical data, routine blood tests, other laboratory tests, and inpatient data were collected and analyzed to compare patients with asymptomatic COVID-19 and moderate COVID-19. Results Comparison of the asymptomatic COVID-19 group with the moderate COVID-19 group yielded the following results: the patients were younger (P = 0.045); the cluster of differentiation (CD)8+ (cytotoxic) T cell level was higher (P = 0.017); the C-reactive protein (CRP) level was lower (P = 0.001); the white blood cell (WBC, P < 0.001), neutrophil (NEU, P = 0.036), lymphocyte (LYM, P = 0.009), and eosinophil (EOS, P = 0.036) counts were higher; and the serum iron level (P = 0.049) was higher in the asymptomatic COVID-19 group. The multivariate analysis showed that the NEU count (odds ratio [OR] = 2.007, 95% confidence interval (CI): 1.162 - 3.715, P = 0.014) and LYM count (OR = 9.380, 95% CI: 2.382 - 36.934, P = 0.001) were independent factors for the presence of clinical symptoms after COVID-19 infection. The NEU count and LYM count were diagnostic predictors of asymptomatic COVID-19. This diagnostic prediction model showed high discriminatory power, consistency, and net clinical benefits. Conclusions The proposed model can distinguish asymptomatic COVID-19 from moderate COVID-19, thereby helping clinicians identify and distinguish patients with potential asymptomatic COVID-19 from those with moderate COVID-19.
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Affiliation(s)
- Xuefeng Gu
- Medical School, Southeast University, Nanjing, China.,Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ling Sha
- Department of Neurology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Shaofeng Zhang
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Duo Shen
- Medical School, Southeast University, Nanjing, China.,Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Wei Zhao
- Medical School, Southeast University, Nanjing, China.,Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yongxiang Yi
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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82
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Abstract
The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), results in life-threatening disease in a minority of patients, especially elderly people and those with co-morbidities such as obesity and diabetes. Severe disease is characterized by dysregulated cytokine release, pneumonia and acute lung injury, which can rapidly progress to acute respiratory distress syndrome, disseminated intravascular coagulation, multisystem failure and death. However, a mechanistic understanding of COVID-19 progression remains unclear. Here we review evidence that SARS-CoV-2 directly or indirectly activates inflammasomes, which are large multiprotein assemblies that are broadly responsive to pathogen-associated and stress-associated cellular insults, leading to secretion of the pleiotropic IL-1 family cytokines (IL-1β and IL-18), and pyroptosis, an inflammatory form of cell death. We further discuss potential mechanisms of inflammasome activation and clinical efforts currently under way to suppress inflammation to prevent or ameliorate severe COVID-19.
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Affiliation(s)
- Setu M Vora
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Judy Lieberman
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Hao Wu
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA.
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA.
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83
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Turan O, Mirici A, Duru Akçalı S, Turan PA, Batum Ö, Şengül A, Ekici Ünsal Z, Işık Kabakoğlu N, Ogan N, Torun Ş, Ak G, Akçay Ş, Kömürcüoğlu B, Şen N, Mutlu P, Yilmaz Ü. Characteristics of hospitalised COVID-19 patients and parameters associated with severe pneumonia. Int J Clin Pract 2021; 75:e14786. [PMID: 34480831 PMCID: PMC8646398 DOI: 10.1111/ijcp.14786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND After the first case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019, it caused a global pandemic, including Turkey. OBJECTIVES The aim of this study was to analyse the characteristics of hospitalised COVID-19 patients and assess the parameters related to severe pneumonia. METHODS Included in the study were hospitalised COVID-19 patients with positive naso-oropharyngeal swabs. Patients' demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively. RESULTS Of 1013 patients, 583 were males (57.6%) and 430 were females (42.4%), with a mean age of 53.7 ± 17.9. More than half of the patients had at least one comorbidities, the most common of which were hypertension and diabetes mellitus. Cough (59.8%), fatigue (49.5%) and fever (41.2%) were the most common presenting symptoms. Of the hospitalised COVID-19 patients, 84.9% had pneumonia and 83.5% had typical radiological COVID-19 appearances (94.5%: ground-glass areas). The most common laboratory findings were high C-reactive protein (CRP) (73.6%) and lactate dehydrogenase (LDH) (46.2%) levels, as well as lymphopenia (30.1%). Severe pneumonia was present in 28.1% of COVID-19 patients. Multivariate logistic regression analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID-19 pneumonia (P = .011, .006, .017, .003 and .001, respectively). CONCLUSION This study, as one of the first multicentre studies about characteristics of COVID-19 in Turkey, may guide about disease-related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia.
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Affiliation(s)
- Onur Turan
- Chest Diseases DepartmentIzmir Katip Celebi University Atatürk Research and Training HospitalİzmirTurkey
| | - Arzu Mirici
- Chest Diseases DepartmentCanakkale 18 Mart UniversityCanakkaleTurkey
| | - Serap Duru Akçalı
- Chest Diseases DepartmentAnkara Dışkapı Yıldırım Beyazıt Research and Training HospitalAnkaraTurkey
| | | | - Özgür Batum
- Chest Diseases DepartmentIzmir Dr. Suat Seren Chest Diseases and Surgery Research and Training HospitalİzmirTurkey
| | - Aysun Şengül
- Chest Diseases DepartmentSakarya Üniversitesi UniversitySakaryaTurkey
| | - Zühal Ekici Ünsal
- Chest Diseases DepartmentBaşkent University Adana Dr. Turgut Noyan Application and Research CenterAdanaTurkey
| | - Nalan Işık Kabakoğlu
- Chest Diseases Departmentİzmir Bornova Dr. Türkan Özilhan State HospitalİzmirTurkey
| | - Nalan Ogan
- Chest Diseases DepartmentUfuk UniversityAnkaraTurkey
| | - Şerife Torun
- Chest Diseases DepartmentKonya Başkent University Application and Research CenterKonyaTurkey
| | - Güntülü Ak
- Chest Diseases DepartmentEskişehir Osmangazi UniversityEskişehirTurkey
| | - Şule Akçay
- Chest Diseases DepartmentBaşkent UniversityAnkaraTurkey
| | - Berna Kömürcüoğlu
- Chest Diseases DepartmentIzmir Dr. Suat Seren Chest Diseases and Surgery Research and Training HospitalİzmirTurkey
| | - Nazan Şen
- Chest Diseases DepartmentBaşkent University Adana Dr. Turgut Noyan Application and Research CenterAdanaTurkey
| | - Pınar Mutlu
- Chest Diseases DepartmentCanakkale 18 Mart UniversityCanakkaleTurkey
| | - Ülkü Yilmaz
- Chest Diseases DepartmentAnkara Atatürk Chest Diseases and Chest Surgery Research and Training HospitalAnkaraTurkey
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84
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Bhatt A, Deshwal H, Luoma K, Fenianos M, Hena K, Chitkara N, Zhong H, Mukherjee V. Respiratory Mechanics and Association With Inflammation in COVID-19-Related ARDS. Respir Care 2021; 66:1673-1683. [PMID: 34521759 PMCID: PMC9993540 DOI: 10.4187/respcare.09156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The novel coronavirus-associated ARDS (COVID-19 ARDS) often requires invasive mechanical ventilation. A spectrum of atypical ARDS with different phenotypes (high vs low static compliance) has been hypothesized in COVID-19. METHODS We conducted a retrospective analysis to identify respiratory mechanics in COVID-19 ARDS. Berlin definition was used to categorize severity of ARDS. Correlational analysis using t test, chi-square test, ANOVA test, and Pearson correlation was used to identify relationship between subject variables and respiratory mechanics. The primary outcome was duration of mechanical ventilation. Secondary outcomes were correlation between fluid status, C- reactive protein, PEEP, and D-dimer with respiratory and ventilatory parameters. RESULTS Median age in our cohort was 60.5 y with predominantly male subjects. Up to 53% subjects were classified as severe ARDS (median [Formula: see text] = 86) with predominantly low static compliance (median Cst- 25.5 mL/cm H2O). The overall mortality in our cohort was 61%. The total duration of mechanical ventilation was 35 d in survivors and 14 d in nonsurvivors. High PEEP (r = 0.45, P < .001) and D-dimer > 2,000 ng/dL (P = .009) correlated with significant increase in physiologic dead space without significant correlation with [Formula: see text]. Higher net fluid balance was inversely related to static compliance (r = -0.24, P = .045), and elevation in C- reactive protein was inversely related to [Formula: see text] (r = -0.32, P = .02). CONCLUSIONS In our cohort of mechanically ventilated COVID-19 ARDS subjects, high PEEP and D-dimer were associated with increase in physiologic dead space without significant effect on oxygenation, raising the question of potential microvascular dysfunction.
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Affiliation(s)
- Alok Bhatt
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, New York
| | - Himanshu Deshwal
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, New York.
| | - Kelsey Luoma
- Division of Pulmonary, Critical Care, and Sleep, University of California, San Diego, San Diego, California
| | - Madelin Fenianos
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside and Mount Sinai West, New York, New York
| | - Kerry Hena
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, New York
| | - Nishay Chitkara
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, New York
| | - Hua Zhong
- Department of Biostatistics, Epidemiology, and Research Design, New York University Grossman School of Medicine, New York, New York
| | - Vikramjit Mukherjee
- Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, New York
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85
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Shrivastava S, Chelluboina S, Jedge P, Doke P, Palkar S, Mishra AC, Arankalle VA. Elevated Levels of Neutrophil Activated Proteins, Alpha-Defensins (DEFA1), Calprotectin (S100A8/A9) and Myeloperoxidase (MPO) Are Associated With Disease Severity in COVID-19 Patients. Front Cell Infect Microbiol 2021; 11:751232. [PMID: 34746027 PMCID: PMC8566808 DOI: 10.3389/fcimb.2021.751232] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Understanding of the basis for severity and fatal outcome of SARS-CoV-2 infection is of paramount importance for developing therapeutic options and identification of prognostic markers. So far, accumulation of neutrophils and increased levels of pro-inflammatory cytokines are associated with disease severity in COVID-19 patients. In this study, we aimed to compare circulatory levels of neutrophil secretory proteins, alpha-defensins (DEFA1), calprotectin (S100A8/A9), and myeloperoxidase (MPO) in COVID-19 patients with different clinical presentations. We studied 19 healthy subjects, 63 COVID-19 patients with mild (n=32) and severe (n=31) disease, 23 asymptomatic individuals identified through contact tracing programme and 23 recovering patients (1-4 months post-disease). At the time of disease presentation, serum levels of DEFA1 were significantly higher in patients with mild (mean230 ± 17, p<0.0001) and severe (mean452 ± 46, p<0.0001) disease respectively in comparison to healthy subjects (mean113 ± 11). S100A8/A9 proteins were significantly higher in COVID-19 patients (p<0.0001) irrespective of disease severity. The levels of DEFA1, S100A8/A9 and MPO reduced to normal in recovering patients and comparable to healthy subjects. Surprisingly, DEFA1 levels were higher in severe than mild patients in first week of onset of disease (p=0.004). Odds-ratio analysis showed that DEFA1 could act as potential biomarker in predicting disease severity (OR=11.34). In addition, levels of DEFA1 and S100A8/A9 were significantly higher in patients with fatal outcome (p=0.004 and p=0.03) respectively. The rise in DEFA1 levels was independent of secondary infections. In conclusion, our data suggest that induction of elevated levels of alpha-defensins and S100A8/A9 is associated with poor disease outcome in COVID-19 patients.
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Affiliation(s)
- Shubham Shrivastava
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shweta Chelluboina
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Prashant Jedge
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Purwa Doke
- Department of Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Sonali Palkar
- Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Akhilesh Chandra Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Vidya A. Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs (IRSHA), Bharati Vidyapeeth (Deemed to be University), Pune, India
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86
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Yitbarek GY, Walle Ayehu G, Asnakew S, Ayele FY, Bariso Gare M, Mulu AT, Dagnaw FT, Melesie BD. The role of C-reactive protein in predicting the severity of COVID-19 disease: A systematic review. SAGE Open Med 2021; 9:20503121211050755. [PMID: 34659766 PMCID: PMC8516378 DOI: 10.1177/20503121211050755] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/16/2021] [Indexed: 01/08/2023] Open
Abstract
Since December 2019, coronavirus diseases-2019 (COVID-19) dispersed into 200 countries and affected more than 70 million people. The clear picture of the SARS-CoV-2 infection is still under investigation. In this review, we evaluated whether C-reactive protein biomarker is able to predict the clinical outcomes or correlated with the severity of COVID-19 disease. The databases MEDLINE, Hinari, Google Scholar, and Google search were used to find potential studies published from COVID-19 epidemic until May 2021. A format prepared in Microsoft Excel spreadsheet was used to extract the appropriate details from each original report. For further review, the extracted data were exported to STATA/MP version 16.0 software. Keywords including "COVID-19," "SARS-CoV-2," and "C-reactive protein," among others were used to search relevant articles. Only studies which reported the average C-reactive protein value and COVID-19 disease stage outcomes were included. Twenty articles were included in the review. All studies found considerably higher level of C-reactive protein in patients with severe COVID-19 as compared to mildly infected patients. This review evidenced that it is still there for a given biomarker to early identify the state of progression in asymptomatic and/or mildly infected individuals into severe disease; the level of C-reactive protein may be used in predicting the likelihood of disease progression. Findings from this review showed level of C-reactive protein is a good biomarker to predict the severity of COVID-19 disease. Although COVID-19 researches are at the early stages, investigation of C-reactive protein levels throughout the disease course may have paramount importance for clinicians in early detection of severe manifestations and subsequently improve the prognosis. However, further large-scale studies are required to confirm these findings.
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Affiliation(s)
- Getachew Yideg Yitbarek
- Department of Biomedical Sciences, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gashaw Walle Ayehu
- Department of Biomedical Sciences, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Public Health, College of Health Science, Wollo University, Dessie, Ethiopia
| | - Moyeta Bariso Gare
- Department of Biomedical Science, College of Public Health and Medical Science, Jimma University, Jimma, Ethiopia
| | - Anemut Tilahun Mulu
- Department of Biomedical Sciences, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome Dagnaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie Melesie
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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87
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Rajamanickam A, Kumar NP, Pandiarajan AN, Selvaraj N, Munisankar S, Renji RM, Venkatramani V, Murhekar M, Thangaraj JWV, Kumar MS, Kumar CPG, Bhatnagar T, Ponnaiah M, Sabarinathan R, Saravanakumar V, Babu S. Dynamic alterations in monocyte numbers, subset frequencies and activation markers in acute and convalescent COVID-19 individuals. Sci Rep 2021; 11:20254. [PMID: 34642411 PMCID: PMC8511073 DOI: 10.1038/s41598-021-99705-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/13/2021] [Indexed: 02/06/2023] Open
Abstract
Monocytes are thought to play an important role in host defence and pathogenesis of COVID-19. However, a comprehensive examination of monocyte numbers and function has not been performed longitudinally in acute and convalescent COVID-19. We examined the absolute counts of monocytes, the frequency of monocyte subsets, the plasma levels of monocyte activation markers using flowcytometry and ELISA in seven groups of COVID-19 individuals, classified based on days since RT-PCR confirmation of SARS-CoV2 infection. Our data shows that the absolute counts of total monocytes and the frequencies of intermediate and non-classical monocytes increases from Days 15-30 to Days 61-90 and plateau thereafter. In contrast, the frequency of classical monocytes decreases from Days 15-30 till Days 121-150. The plasma levels of sCD14, CRP, sCD163 and sTissue Factor (sTF)-all decrease from Days 15-30 till Days 151-180. COVID-19 patients with severe disease exhibit higher levels of monocyte counts and higher frequencies of classical monocytes and lower frequencies of intermediate and non-classical monocytes and elevated plasma levels of sCD14, CRP, sCD163 and sTF in comparison with mild disease. Thus, our study provides evidence of dynamic alterations in monocyte counts, subset frequencies and activation status in acute and convalescent COVID-19 individuals.
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Affiliation(s)
- Anuradha Rajamanickam
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India.
| | - Nathella Pavan Kumar
- Immunology-ICMR-National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Arul Nancy Pandiarajan
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Nandhini Selvaraj
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Saravanan Munisankar
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Rachel Mariam Renji
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Vijayalakshmi Venkatramani
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
| | - Manoj Murhekar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | | | | | - C P Girish Kumar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | - Tarun Bhatnagar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | | | - R Sabarinathan
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | - V Saravanakumar
- ICMR-National Institute of Epidemiology, Chennai, TamilNadu, India
| | - Subash Babu
- International Center for Excellence in Research - ICMR- National Institute for Research in Tuberculosis, Chennai, TamilNadu, India
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88
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Lentner J, Adams T, Knutson V, Zeien S, Abbas H, Moosavi R, Manuel C, Wallace T, Harmon A, Waters R, Ledford S, Vijayakrishnan R, Jagan N, Falluji N, DelCore M, Bay C, Jhamnani S. C-reactive protein levels associated with COVID-19 outcomes in the United States. J Osteopath Med 2021; 121:869-873. [PMID: 34592071 DOI: 10.1515/jom-2021-0103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023]
Abstract
CONTEXT COVID-19 caused a worldwide pandemic, and there are still many uncertainties about the disease. C-reactive protein (CRP) levels could be utilized as a prognosticator for disease severity in COVID-19 patients. OBJECTIVES This study aims to determine whether CRP levels are correlated with COVID-19 patient outcomes and length of stay (LoS). METHODS A retrospective cohort study was conducted utilizing data obtained between March and May 2020. Data were collected by abstracting past medical records through electronic medical records at 10 hospitals within CommonSpirit Health. Patients were included if they had a positive COVID-19 test from a nasopharyngeal swab sample, and if they were admitted and then discharged alive or had in-hospital mortality and were ≥18 years. A total of 541 patients had CRP levels measured and were included in this report. Patient outcome and LoS were the endpoints measured. RESULTS The 541 patients had their CRP levels measured, as well as the demographic and clinical data required for analysis. While controlling for body mass index (BMI), number of comorbidities, and age, the first CRP was significantly predictive of mortality (p<0.001). The odds ratio for first CRP indicates that for each one-unit increase in CRP, the odds of death increased by 0.007. For LoS, the first CRP was a significant predictor (p<0.001), along with age (p=0.002). The number of comorbidities also predicted LoS (p=0.007), but BMI did not. The coefficient for the first CRP indicates that, for each one-unit increase in CRP, LoS increased 0.003 days. CONCLUSIONS The results indicate that there is a positive correlation between the CRP levels of COVID-19 patients and their respective outcomes with regard to death and LoS.
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Affiliation(s)
- Jacob Lentner
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | - Taylor Adams
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | - Valene Knutson
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | - Sarah Zeien
- A.T. Still University - Kirksville College of Medicine, Kirksville, MO, USA
| | | | | | | | - Thomas Wallace
- Department of Cardiovascular Medicine, CHI St. Vincent Infirmary, Chicago, IL, USA
| | - Adam Harmon
- Department of Cardiovascular Medicine, Sequoia Hospital, Redwood City, CA, USA
| | - Richard Waters
- Department of Cardiovascular Medicine, St. Joseph Medical Center, Stockton, CA, USA
| | - Samuel Ledford
- Department of Cardiovascular Medicine, CHI Memorial Hospital, Chattanooga, TN, USA
| | | | - Nikhil Jagan
- Department of Pulmonary and Critical Care Medicine, CHI Health St. Francis, Grand Island, NE, USA
| | - Nezar Falluji
- Department of Cardiovascular Medicine, CHI St. Joseph Hospital, Lexington, KY, USA
| | - Michael DelCore
- Department of Cardiovascular Medicine, CHI Health Creighton University Medical Center - Bergan Mercy, Omaha, NE, USA
| | - Curt Bay
- A.T. Still University, Mesa, AZ, USA
| | - Sunny Jhamnani
- Department of Cardiology, Chandler Regional Medical Center, Chandler, AZ, USA
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89
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Fazal M. C-Reactive Protein a Promising Biomarker of COVID-19 Severity. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2021. [DOI: 10.15324/kjcls.2021.53.3.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Muntaha Fazal
- Department of Biomedical Laboratory Sciences, School of Health Sciences, University of Management and Technology, Lahore, Pakistan
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90
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Kalyon S, Gültop F, Şimşek F, Adaş M. Relationships of the neutrophil-lymphocyte and CRP-albumin ratios with the duration of hospitalization and fatality in geriatric patients with COVID-19. J Int Med Res 2021; 49:3000605211046112. [PMID: 34581218 PMCID: PMC8485297 DOI: 10.1177/03000605211046112] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to determine the associations of the neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP)–albumin ratio (CAR) with the duration of hospital stay and fatality rate in geriatric patients with coronavirus disease 2019 (COVID-19). Methods Patients older than 65 years with polymerase chain reaction-positive COVID-19 were included. Neutrophil, lymphocyte, CRP, albumin, and demographic data and the duration of hospitalization were recorded. Results The mean length of stay was 15 days. NLR and CAR were significantly higher in patients who died than in those who survived. The cutoffs predictive of mortality were 4.02 (area under the curve [AUC] = 0.717) for NLR and 23 for CAR (AUC = 0.781). The fatality rate among patients who required inpatient treatment was 33%. Conclusion NLR and CAR, which can be calculated inexpensively and quickly at the first admission to the hospital, are extremely useful for estimating the duration of hospitalization and risk of mortality in geriatric patients with COVID-19. Using these data, treatment can quickly be intensified when needed.
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Affiliation(s)
- Semih Kalyon
- Asst Prof. MD. Prof. Dr. Cemil Taşcıoğlu City Hospital, Internal Medicine Department, Istanbul, Turkey
| | - Fethi Gültop
- Asst Prof. MD. Prof. Dr. Cemil Taşcıoğlu City Hospital, Anesthesia and Reanimation Department, Istanbul, Turkey
| | - Funda Şimşek
- Assoc Prof. MD. Prof. Dr. Cemil Taşcıoğlu City Hospital, Infectious Diseases Department, Istanbul, Turkey
| | - Mine Adaş
- Asst Prof. MD. Prof. Dr. Cemil Taşcıoğlu City Hospital, Internal Medicine Department, Istanbul, Turkey
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91
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Labarrere CA, Kassab GS. Pattern Recognition Proteins: First Line of Defense Against Coronaviruses. Front Immunol 2021; 12:652252. [PMID: 34630377 PMCID: PMC8494786 DOI: 10.3389/fimmu.2021.652252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
The rapid outbreak of COVID-19 caused by the novel coronavirus SARS-CoV-2 in Wuhan, China, has become a worldwide pandemic affecting almost 204 million people and causing more than 4.3 million deaths as of August 11 2021. This pandemic has placed a substantial burden on the global healthcare system and the global economy. Availability of novel prophylactic and therapeutic approaches are crucially needed to prevent development of severe disease leading to major complications both acutely and chronically. The success in fighting this virus results from three main achievements: (a) Direct killing of the SARS-CoV-2 virus; (b) Development of a specific vaccine, and (c) Enhancement of the host's immune system. A fundamental necessity to win the battle against the virus involves a better understanding of the host's innate and adaptive immune response to the virus. Although the role of the adaptive immune response is directly involved in the generation of a vaccine, the role of innate immunity on RNA viruses in general, and coronaviruses in particular, is mostly unknown. In this review, we will consider the structure of RNA viruses, mainly coronaviruses, and their capacity to affect the lungs and the cardiovascular system. We will also consider the effects of the pattern recognition protein (PRP) trident composed by (a) Surfactant proteins A and D, mannose-binding lectin (MBL) and complement component 1q (C1q), (b) C-reactive protein, and (c) Innate and adaptive IgM antibodies, upon clearance of viral particles and apoptotic cells in lungs and atherosclerotic lesions. We emphasize on the role of pattern recognition protein immune therapies as a combination treatment to prevent development of severe respiratory syndrome and to reduce pulmonary and cardiovascular complications in patients with SARS-CoV-2 and summarize the need of a combined therapeutic approach that takes into account all aspects of immunity against SARS-CoV-2 virus and COVID-19 disease to allow mankind to beat this pandemic killer.
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Affiliation(s)
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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92
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Sargin Altunok E, Satici C, Dinc V, Kamat S, Alkan M, Demirkol MA, Toprak ID, Kostek ME, Yazla S, Esatoglu SN. Comparison of demographic and clinical characteristics of hospitalized COVID-19 patients with severe/critical illness in the first wave versus the second wave. J Med Virol 2021; 94:291-297. [PMID: 34491575 PMCID: PMC8661950 DOI: 10.1002/jmv.27319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/14/2021] [Accepted: 09/03/2021] [Indexed: 11/10/2022]
Abstract
Due to current advances and growing experience in the management of coronavirus Disease 2019 (COVID‐19), the outcome of COVID‐19 patients with severe/critical illness would be expected to be better in the second wave compared with the first wave. As our hospitalization criteria changed in the second wave, we aimed to investigate whether a favorable outcome occurred in hospitalized COVID‐19 patients with only severe/critical illness. Among 642 laboratory‐confirmed hospitalized COVID‐19 patients in the first wave and 1121 in the second wave, those who met World Health Organization (WHO) definitions for severe or critical illness on admission or during follow‐up were surveyed. Data on demographics, comorbidities, C‐reactive protein (CRP) levels on admission, and outcomes were obtained from an electronic hospital database. Univariate analysis was performed to compare the characteristics of patients in the first and second waves. There were 228 (35.5%) patients with severe/critical illness in the first wave and 681 (60.7%) in the second wave. Both groups were similar in terms of age, gender, and comorbidities, other than chronic kidney disease. Median serum CRP levels were significantly higher in patients in the second wave compared with those in the first wave [109 mg/L (interquartile range [IQR]: 65–157) vs. 87 mg/L (IQR: 39–140); p < 0.001]. However, intensive care unit admission and mortality rates were similar among the waves. Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID‐19 patients, we found similar demographics and outcomes among hospitalized COVID‐19 patients with severe/critical illness in the first and second wave. Even though a lower mortality rate in the second wave has been reported in previous studies, including all hospitalized COVID‐19 patients, we found similar AQ4demographics and outcomes among hospitalized COVID‐19 patients with severe/critical illness in the first and second wave.
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Affiliation(s)
- Elif Sargin Altunok
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Celal Satici
- Department of Chest Diseases, Istanbul Yedikule Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Veysel Dinc
- Department of Anesthesia and Reanimation, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sadettin Kamat
- Department of Chest Diseases, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Alkan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Asim Demirkol
- Department of Chest Diseases, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ilkim Deniz Toprak
- Department of Internal Medicine, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Muhammed Emin Kostek
- Department of Internal Medicine, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semih Yazla
- Department of Otolaryngology, Head and Neck Surgery, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Department of Rheumatology, Istanbul Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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93
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Bae S, Kim Y, Hwang S, Kwon KT, Chang HH, Kim SW. New Scoring System for Predicting Mortality in Patients with COVID-19. Yonsei Med J 2021; 62:806-813. [PMID: 34427066 PMCID: PMC8382723 DOI: 10.3349/ymj.2021.62.9.806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/24/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE We aimed to develop a novel mortality scoring system for inpatients with COVID-19 based on simple demographic factors and laboratory findings. MATERIALS AND METHODS We reviewed and analyzed data from patients who were admitted and diagnosed with COVID-19 at 10 hospitals in Daegu, South Korea, between January and July 2020. We randomized and assigned patients to the development and validation groups at a 70% to 30% ratio. Each point scored for selected risk factors helped build a new mortality scoring system using Cox regression analysis. We evaluated the accuracy of the new scoring system in the development and validation groups using the area under the curve. RESULTS The development group included 1232 patients, whereas the validation group included 528 patients. In the development group, predictors for the new scoring system as selected by Cox proportional hazards model were age ≥70 years, diabetes, chronic kidney disease, dementia, C-reactive protein levels >4 mg/dL, infiltration on chest X-rays at the initial diagnosis, and the need for oxygen support on admission. The areas under the curve for the development and validation groups were 0.914 [95% confidence interval (CI) 0.891-0.937] and 0.898 (95% CI 0.854-0.941), respectively. According to our scoring system, COVID-19 mortality was 0.4% for the low-risk group (score 0-3) and 53.7% for the very high-risk group (score ≥11). CONCLUSION We developed a new scoring system for quickly and easily predicting COVID-19 mortality using simple predictors. This scoring system can help physicians provide the proper therapy and strategy for each patient.
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Affiliation(s)
- Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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Predicting Intensive Care Unit Admissions for COVID-19 Patients in the Emergency Department. Disaster Med Public Health Prep 2021; 16:1594-1598. [PMID: 34462044 PMCID: PMC8460423 DOI: 10.1017/dmp.2021.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: Determining the parameters that can predict the requirement of intensive care unit (ICU) admissions among the coronavirus disease 2019 (COVID-19) patients presented to the emergency departments (EDs). Methods: In adult consecutive patients admitted (March 15 - April 15, 2020) to the ED of a state hospital for COVID-19, we retrospectively analyzed demographic data, symptoms, laboratory tests, and chest computed tomography (CT) on arrival. Results: We included 458 patients [213 (46.5%) females, median age 48 y]. Body temperature, respiration rate, C-reactive protein (CRP), D-dimer, ferritin values, and the number of comorbidities were significantly higher in patients admitted to the ICU than others. Also, diffuse infiltration in chest CT is more common in patients who need ICU follow-up. As a result of the binary regression analysis, a statistically significant correlation was found between the presence of dyspnea (odds ratio [OR]: 12.55), tachypnea (relative risk [RR] ≥ 18) (OR: 14.54), multiple comorbidities (≥2) (OR: 23.39), diffuse infiltration in CT (OR: 14.52), and CRP (≥45 mg/L) (OR: 4.71); and the need for ICU admission. Conclusion: It has been concluded that the presence of dyspnea and tachypnea, elevated CRP, presence of multiple comorbidities, and diffuse infiltration in CT may predict the need for ICU admissions of the patients, who presented to the EDs.
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95
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Gupta S, Mohindra R, Singla M, Khera S, Sahni V, Kanta P, Soni RK, Kumar A, Gauba K, Goyal K, Singh MP, Ghosh A, Kajal K, Mahajan V, Bhalla A, Sorsa T, Räisänen I. The clinical association between Periodontitis and COVID-19. Clin Oral Investig 2021; 26:1361-1374. [PMID: 34448073 PMCID: PMC8390180 DOI: 10.1007/s00784-021-04111-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The study aimed to clinically assess the association between periodontitis and COVID-19-related outcomes. MATERIAL AND METHODS Data pertaining to patient demographics, medical history, blood parameters, periodontal clinical examination and aMMP-8 point-of-care diagnostics (both site-level and patient-level) was recorded for eighty-two COVID-19-positive patients. COVID-19-related outcomes such as COVID-19 pneumonia, death/survival, types of hospital admission and need of assisted ventilation were also assessed. RESULTS Males were predominantly afflicted with COVID-19, with advanced age exhibiting a greater association with the presence of periodontitis. Higher severity of periodontitis led to 7.45 odds of requiring assisted ventilation, 36.52 odds of hospital admission, 14.58 odds of being deceased and 4.42 odds of COVID-19-related pneumonia. The aMMP-8 mouthrinse kit was slightly more sensitive but less specific than aMMP-8 site-specific tests. CONCLUSIONS Based on the findings of the present study, periodontitis seems to be related to poorer COVID-19-related outcomes. However, within the constraints of this work, a direct causality may not be established. Periodontitis, by means of skewing the systemic condition for a number of comorbidities, may eventually influence COVID-19 outcomes in an indirect manner. CLINICAL RELEVANCE The study is the first to clinically, and by means of a validated point-of-care diagnostic methodology, assess the association between periodontal health and COVID-19-related outcomes. Assessment of the periodontal status of individuals can aid in the identification of risk groups during the pandemic along with reinforcing the need to maintain oral hygiene and seeking periodontal care.
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Affiliation(s)
- Shipra Gupta
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
| | - Ritin Mohindra
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Mohita Singla
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sagar Khera
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Poonam Kanta
- Department of Virology, PGIMER, Chandigarh, India
| | | | - Amit Kumar
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Krishan Gauba
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kapil Goyal
- Department of Virology, PGIMER, Chandigarh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, PGIMER, Chandigarh, India
| | - Kamal Kajal
- Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India
| | - Varun Mahajan
- Department of Anaesthesia & Intensive Care, PGIMER, Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Oral Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Ismo Räisänen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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96
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Li HK, Kaforou M, Rodriguez-Manzano J, Channon-Wells S, Moniri A, Habgood-Coote D, Gupta RK, Mills EA, Arancon D, Lin J, Chiu YH, Pennisi I, Miglietta L, Mehta R, Obaray N, Herberg JA, Wright VJ, Georgiou P, Shallcross LJ, Mentzer AJ, Levin M, Cooke GS, Noursadeghi M, Sriskandan S. Discovery and validation of a three-gene signature to distinguish COVID-19 and other viral infections in emergency infectious disease presentations: a case-control and observational cohort study. LANCET MICROBE 2021; 2:e594-e603. [PMID: 34423323 PMCID: PMC8367196 DOI: 10.1016/s2666-5247(21)00145-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Emergency admissions for infection often lack initial diagnostic certainty. COVID-19 has highlighted a need for novel diagnostic approaches to indicate likelihood of viral infection in a pandemic setting. We aimed to derive and validate a blood transcriptional signature to detect viral infections, including COVID-19, among adults with suspected infection who presented to the emergency department. Methods Individuals (aged ≥18 years) presenting with suspected infection to an emergency department at a major teaching hospital in the UK were prospectively recruited as part of the Bioresource in Adult Infectious Diseases (BioAID) discovery cohort. Whole-blood RNA sequencing was done on samples from participants with subsequently confirmed viral, bacterial, or no infection diagnoses. Differentially expressed host genes that met additional filtering criteria were subjected to feature selection to derive the most parsimonious discriminating signature. We validated the signature via RT-qPCR in a prospective validation cohort of participants who presented to an emergency department with undifferentiated fever, and a second case-control validation cohort of emergency department participants with PCR-positive COVID-19 or bacterial infection. We assessed signature performance by calculating the area under receiver operating characteristic curves (AUROCs), sensitivities, and specificities. Findings A three-gene transcript signature, comprising HERC6, IGF1R, and NAGK, was derived from the discovery cohort of 56 participants with bacterial infections and 27 with viral infections. In the validation cohort of 200 participants, the signature differentiated bacterial from viral infections with an AUROC of 0·976 (95% CI 0·919−1·000), sensitivity of 97·3% (85·8−99·9), and specificity of 100% (63·1−100). The AUROC for C-reactive protein (CRP) was 0·833 (0·694−0·944) and for leukocyte count was 0·938 (0·840−0·986). The signature achieved higher net benefit in decision curve analysis than either CRP or leukocyte count for discriminating viral infections from all other infections. In the second validation analysis, which included SARS-CoV-2-positive participants, the signature discriminated 35 bacterial infections from 34 SARS-CoV-2-positive COVID-19 infections with AUROC of 0·953 (0·893−0·992), sensitivity 88·6%, and specificity of 94·1%. Interpretation This novel three-gene signature discriminates viral infections, including COVID-19, from other emergency infection presentations in adults, outperforming both leukocyte count and CRP, thus potentially providing substantial clinical utility in managing acute presentations with infection. Funding National Institute for Health Research, Medical Research Council, Wellcome Trust, and EU-FP7.
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Affiliation(s)
- Ho Kwong Li
- Department of Infectious Disease, Imperial College London, London, UK
- Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK
| | - Myrsini Kaforou
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jesus Rodriguez-Manzano
- Department of Infectious Disease, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
| | | | - Ahmad Moniri
- Department of Electrical & Electronic Engineering, Imperial College London, London, UK
| | | | - Rishi K Gupta
- Institute of Global Health, University College London, London, UK
| | - Ewurabena A Mills
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Jessica Lin
- Department of Infectious Disease, Imperial College London, London, UK
| | - Yueh-Ho Chiu
- Department of Infectious Disease, Imperial College London, London, UK
| | - Ivana Pennisi
- Department of Infectious Disease, Imperial College London, London, UK
| | - Luca Miglietta
- Department of Infectious Disease, Imperial College London, London, UK
- Department of Electrical & Electronic Engineering, Imperial College London, London, UK
| | - Ravi Mehta
- Department of Infectious Disease, Imperial College London, London, UK
| | - Nelofar Obaray
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jethro A Herberg
- Department of Infectious Disease, Imperial College London, London, UK
| | - Victoria J Wright
- Department of Infectious Disease, Imperial College London, London, UK
| | - Pantelis Georgiou
- Department of Electrical & Electronic Engineering, Imperial College London, London, UK
- Centre for Bio-Inspired Technology, Imperial College London, London, UK
| | | | | | - Michael Levin
- Department of Infectious Disease, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mahdad Noursadeghi
- Division of Infection and Immunity, University College London, London, UK
| | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, UK
- Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infection & Antimicrobial Resistance, Imperial College London, London, UK
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97
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Luo MH, Qian YQ, Huang DL, Luo JC, Su Y, Wang H, Yu SJ, Liu K, Tu GW, Luo Z. Tailoring glucocorticoids in patients with severe COVID-19: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1261. [PMID: 34532398 PMCID: PMC8421952 DOI: 10.21037/atm-21-1783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/10/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To discuss the pathogenesis of severe coronavirus disease 2019 (COVID-19) infection and the pharmacological effects of glucocorticoids (GCs) toward this infection. To review randomized controlled trials (RCTs) using GCs to treat patients with severe COVID-19, and investigate whether GC timing, dosage, or duration affect clinical outcomes. Finally. to discuss the use of biological markers, respiratory parameters, and radiological evidence to select patients for improved GC therapeutic precision. BACKGROUND COVID-19 has become an unprecedented global challenge. As GCs have been used as key immunomodulators to treat inflammation-related diseases, they may play key roles in limiting disease progression by modulating immune responses, cytokine production, and endothelial function in patients with severe COVID-19, who often experience excessive cytokine production and endothelial and renin-angiotensin system (RAS) dysfunction. Current clinical trials have partially proven this efficacy, but GC timing, dosage, and duration vary greatly, with no unifying consensus, thereby creating confusion. METHODS Publications through March 2021 were retrieved from the Web of Science and PubMed. Results from cited references in published articles were also included. CONCLUSIONS GCs play key roles in treating severe COVID-19 infections. Pharmacologically, GCs could modulate immune cells, reduce cytokine and chemokine, and improve endothelial functions in patients with severe COVID-19. Benefits of GCs have been observed in multiple clinical trials, but the timing, dosage and duration vary across studies. Tapering as an option is not widely accepted. However, early initiation of treatment, a tailored dosage with appropriate tapering may be of particular importance, but evidence is inconclusive and more investigations are needed. Biological markers, respiratory parameters, and radiological evidence could also help select patients for specific tailored treatments.
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Affiliation(s)
- Ming-Hao Luo
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Qi Qian
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dan-Lei Huang
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing-Chao Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huan Wang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shen-Ji Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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98
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BAHADIRLI S, KURT E. Predictive value of C-reactive protein/albumin ratio in predicting poor outcome of hospitalized patients with COVID-19. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.945522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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99
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Blum VF, Cimerman S, Hunter JR, Tierno P, Lacerda A, Soeiro A, Cardoso F, Bellei NC, Maricato J, Mantovani N, Vassao M, Dias D, Galinskas J, Janini LMR, Santos-Oliveira JR, Da-Cruz AM, Diaz RS. Nitazoxanide superiority to placebo to treat moderate COVID-19 - A Pilot prove of concept randomized double-blind clinical trial. EClinicalMedicine 2021; 37:100981. [PMID: 34222847 PMCID: PMC8235996 DOI: 10.1016/j.eclinm.2021.100981] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The absence of specific antivirals to treat COVID-19 leads to the repositioning of candidates' drugs. Nitazoxanide (NTZ) has a broad antiviral effect. METHODS This was a randomized, double-blind pilot clinical trial comparing NTZ 600 mg BID versus Placebo for seven days among 50 individuals (25 each arm) with SARS-COV-2 RT-PCR+ (PCR) that were hospitalized with mild respiratory insufficiency from May 20th, 2020, to September 21st, 2020 (ClinicalTrials.gov NCT04348409). Clinical and virologic endpoints and inflammatory biomarkers were evaluated. A five-point scale for disease severity (SSD) was used. FINDINGS Two patients died in the NTZ arm compared to 6 in the placebo arm (p = 0.564). NTZ was superior to placebo when considering SSD (p < 0001), the mean time for hospital discharge (6.6 vs. 14 days, p = 0.021), and negative PCR at day 21 (p = 0.035), whereas the placebo group presented more adverse events (p = 0.04). Among adverse events likely related to the study drug, 14 were detected in the NTZ group and 22 in placebo (p = 0.24). Among the 30 adverse events unlikely related, 21 occurred in the placebo group (p = 0.04). A decrease from baseline was higher in the NTZ group for d-Dimer (p = 0.001), US-RCP (p < 0.002), TNF (p < 0.038), IL-6 (p < 0.001), IL-8 (p = 0.014), HLA DR. on CD4+ T lymphocytes (p < 0.05), CD38 in CD4+ and CD8+ T (both p < 0.05), and CD38 and HLA-DR. on CD4+ (p < 0.01). INTERPRETATION Compared to placebo in clinical and virologic outcomes and improvement of inflammatory outcomes, the superiority of NTZ warrants further investigation of this drug for moderate COVID-19 in larger clinical trials. A higher incidence of adverse events in the placebo arm might be attributed to COVID-19 related symptoms.
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Affiliation(s)
| | | | | | - Paulo Tierno
- Hospital Municipal Dr. Francisco Moran (Barueri), Rua Ângela Mirella, Brazil
| | | | | | | | | | | | | | | | - Danilo Dias
- Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | - Alda Maria Da-Cruz
- Instituto Oswaldo Cruz/FIOCRUZ, Rio de Janeiro, Brazil (Laboratório Interdisciplinar de Pesquisa Médicas, Instituto Oswaldo Cruz (FIOCRUZ), Brazil
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100
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Duarte M, Pelorosso F, Nicolosi LN, Victoria Salgado M, Vetulli H, Aquieri A, Azzato F, Castro M, Coyle J, Davolos I, Criado IF, Gregori R, Mastrodonato P, Rubio MC, Sarquis S, Wahlmann F, Rothlin RP. Telmisartan for treatment of Covid-19 patients: An open multicenter randomized clinical trial. EClinicalMedicine 2021; 37:100962. [PMID: 34189447 PMCID: PMC8225700 DOI: 10.1016/j.eclinm.2021.100962] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/09/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Angiotensin receptor blockers (ARBs), such as telmisartan, have been postulated to treat Covid-19-induced lung inflammation. Methods This is a parallel-group, randomized, two-arm, open-label, adaptive, multicenter superiority trial with 1:1 allocation ratio. Participants included patients from 18 years of age hospitalized with Covid-19 with 4 or fewer days since symptom onset enrolled at a university and a community hospital in Buenos Aires, Argentina. Exclusion criteria included prior intensive care unit (ICU) admission and use of ARBs/angiotensin converting enzyme inhibitors at randomization. Control arm received standard care alone and treatment arm telmisartan 80 mg twice daily for 14 days. Primary outcomes were C-reactive protein (CRP) plasma levels at day 5 and 8 after randomization. Secondary outcomes included time to discharge within 15 days, admission to ICU and death at 15- and 30-days. NCT04355936 (Completed). Findings A pragmatic decision to end the study before the third interim analysis was made on Oct. 30th due to sharp reduction in recruitment. A total of 162 patients were randomized. 158 patients enrolled between May 14 and October 30 2020, were included in the analysis, 80 in the standard care and 78 in the telmisartan added to standard care group. Baseline absolute CRP serum levels were 5.53 ± 6.19 mg/dL (95% CI 6.91 to 4.15, n = 80) and 9.04 ± 7.69 (95% CI 9.04 to 10.82, n = 74) in the standard care and telmisartan added to standard care groups, respectively. Day 5 control-group CRP levels were 6.06 ± 6.95 mg/dL (95% CI 7.79-4.35, n = 66) while telmisartan group were 3.83 ± 5.08 mg/dL (95% CI 5.08-2.59, n = 66, p = 0.038). Day 8 CRP levels were 6.30 ± 8.19 mg/dL (95% CI 8.79-3.81, n = 44) and 2.37 ± 3.47 mg/dL (95% CI 3.44-1.30, n = 43, p = 0.0098) in the control and telmisartan groups, respectively (all values expressed as mean ± SD). Kaplan-Meier analysis showed that telmisartan-treated patients had a lower median time-to-discharge (control=15 days; telmisartan=9 days). Death by day 30 was reduced in the telmisartan-treated group (control 22.54%, 16/71; telmisartan 4.29%, 3/70 participants; p = 0.0023). Composite ICU, mechanical ventilation or death was reduced by telmisartan treatment at days 15 and 30. No adverse events were reported. Interpretation Our study suggests that the ARB telmisartan, a widely used antihypertensive drug, is safe and could reduce morbidity and mortality in hospitalized patients infected with SARS -CoV-2 by anti-inflammatory effects. Further studies employing telmisartan are needed for confirmation of our results and to define its true therapeutic value as a tool against Covid-19.
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Affiliation(s)
- Mariano Duarte
- Laboratorio de Hipertensión, División de Cardiología, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
- Segunda Cátedra de Fisiología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Facundo Pelorosso
- Asociación Argentina de Medicamentos, Ciudad Autónoma de Buenos Aires, Argentina
- Servicio de Anatomía Patológica, Hospital de Alta Complejidad El Calafate SAMIC, Argentina
| | | | - M. Victoria Salgado
- Centro de Estudios de Estado y Sociedad, Ciudad Autónoma de Buenos Aires, Argentina
- Servicio de Medicina Familiar, Hospital de Alta Complejidad El Calafate SAMIC, Argentina
| | - Héctor Vetulli
- Servicio de Electrofisiología Cardíaca, Arritmias y Marcapasos, Sanatorio Otamendi y Miroli, Ciudad Autónoma de Buenos Aires, Argentina
| | - Analía Aquieri
- Laboratorio de Hipertensión, División de Cardiología, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Francisco Azzato
- Departamento de Medicina, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Marcela Castro
- Laboratorio de Terapia Intensiva y Urgencias, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Javier Coyle
- División de Cardiología, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Ignacio Davolos
- División de Cardiología, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Ignacio Fernandez Criado
- Sección de Tecnología Educativa e Informática Médica, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Rosana Gregori
- Servicio de Guardia, Hospital Español de Buenos Aires, Argentina
| | | | - María C. Rubio
- División de Cardiología, Hospital Español de Buenos Aires, Argentina
| | - Sergio Sarquis
- Unidad de Cuidados Intensivos, Hospital de Clínicas “José de San Martín”, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Fernando Wahlmann
- Departamento de Medicina Interna, Hospital Español de Buenos Aires, Argentina
| | - Rodolfo P. Rothlin
- Asociación Argentina de Medicamentos, Ciudad Autónoma de Buenos Aires, Argentina
- Sociedad Argentina de Farmacología Clínica, Asociación Médica Argentina, Argentina
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