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Alroomi M, Rajan R, Omar AA, Alsaber A, Pan J, Fatemi M, Zhanna KD, Aboelhassan W, Almutairi F, Alotaibi N, Saleh MA, AlNasrallah N, Al‐Bader B, Malhas H, Ramadhan M, Abdullah M, Abdelnaby H. Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients. Immun Inflamm Dis 2021; 9:1648-1655. [PMID: 34438471 PMCID: PMC8589386 DOI: 10.1002/iid3.517] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION This study aims to investigate in-hоsрitаl mоrtаlity in severe асute resрirаtоry syndrоme соrоnаvirus 2 раtients strаtified by serum ferritin levels. METHODS Patients were stratified based on ferritin levels (ferritin levels ≤ 1000 or >1000). RESULTS Approximately 89% (118) of the patients with ferritin levels > 1000 had pneumonia, and 51% (67) had hypertension. Fever (97, 73.5%) and shortness of breath (80, 61%) were two major symptoms among the patients in this group. Logistic regression analysis indicated that ferritin level (odds ratio [OR] = 0.36, 95% confidence interval [CI] = 0.21-0.62; p < .001), male sex (OR = 2.63, 95% CI = 1.43-5.06; p = .003), hypertension (OR = 4.16, 95% CI = 2.42-7.36; p < .001) and pneumonia (OR = 8.48, 95% CI = 3.02-35.45; p < .001) had significance in predicting in-hospital mortality. Additionally, the Cox proportional hazards analysis and Kaplan-Meier survival probability plot showed a higher mortality rate among patients with ferritin levels > 1000. CONCLUSION In this study, higher levels of serum ferritin were found to be an independent predictor of in-hоsрitаl mоrtаlity.
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Affiliation(s)
- Moudhi Alroomi
- Department of Infectious DiseasesInfectious Diseases Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Rajesh Rajan
- Department of CardiologySabah Al Ahmad Cardiac Centre, Al Amiri HospitalKuwait CitySharqKuwait
| | | | - Ahmad Alsaber
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUnited Kingdom
| | - Jiazhu Pan
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUnited Kingdom
| | - Mina Fatemi
- Public Health and Commissioning ManagerNottinghamshire County CouncilNottinghamUnited Kingdom
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. MoiseevPeoples' Friendship University of Russia (RUDN University)MoscowRussian Federation
| | - Wael Aboelhassan
- Division of Gastroenterology, Department of MedicineJaber Al Ahmed HospitalSouth SurraKuwait
| | | | | | | | | | | | - Haya Malhas
- Department of Emergency MedicineMubarak Al‐Kabeer HospitalJabriyaKuwait
| | - Maryam Ramadhan
- Department of Obstetrics and GynaecologyMaternity Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Mohammed Abdullah
- Department of Infectious DiseasesInfectious Diseases Hospital, Shuwaikh Medical AreaKuwait CityKuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
- Division of Gastroenterology, Department of MedicineAl Sabah Hospital, Shuwaikh Medical AreaKuwait CityKuwait
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Elhendawy M, El-Kalla F, Abd-Elsalam S, ElSharawy D, Soliman SS, Abdelhai D, Hagras MM, Khalaf M, Esmail ES, Kobtan A. A Simple Scoring Model Predicting the Outcome of COVID-19 Patients: Tanta COVID score. Endocr Metab Immune Disord Drug Targets 2021; 22:620-630. [PMID: 34825879 DOI: 10.2174/1871530321666211126104952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIM COVID-19 is a worldwide pandemic with high rates of morbidity and mortality, and an uncertain prognosis leading to an increased risk of infection in health providers and limited hospital care capacities. In this study, we have proposed a predictive, interpretable prognosis scoring system with the use of readily obtained clinical, radiological and laboratory characteristics to accurately predict worsening of the condition and overall survival of patients with COVID -19. METHODS This is a single-center, observational, prospective, cohort study. A total of 347 patients infected with COVID-19 presenting to the Tanta university hospital, Egypt, were enrolled in the study, and clinical, radiological and laboratory data were analyzed. Top-ranked variables were identified and selected to be integrated into a Cox regression model, building the scoring system for accurate prediction of the prognosis of patients with COVID-19. RESULTS The six variables that were finally selected in the scoring system were lymphopenia, serum CRP, ferritin, D-Dimer, radiological CT lung findings and associated chronic debilitating disease. The scoring system discriminated risk groups with either mild disease or severe illness characterized by respiratory distress (and also those with hypoxia and in need for oxygen therapy or mechanical ventilation) or death. The area under the curve to estimate the discrimination performance of the scoring system was more than 90%. CONCLUSION We proposed a simple and clinically useful predictive scoring model for COVID-19 patients. However, additional independent validation will be required before the scoring model can be used commonly.
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Affiliation(s)
- Mohammed Elhendawy
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ferial El-Kalla
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dalia ElSharawy
- Chest Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Shaimaa S Soliman
- Public health & Community Medicine department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Dina Abdelhai
- Clinical pathology department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Maha M Hagras
- Clinical pathology department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mai Khalaf
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Eslam Saber Esmail
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abdelrahman Kobtan
- Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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53
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Varikasuvu SR, Varshney S, Dutt N, Munikumar M, Asfahan S, Kulkarni PP, Gupta P. D-dimer, disease severity, and deaths (3D-study) in patients with COVID-19: a systematic review and meta-analysis of 100 studies. Sci Rep 2021; 11:21888. [PMID: 34750495 PMCID: PMC8576016 DOI: 10.1038/s41598-021-01462-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022] Open
Abstract
Hypercoagulability and the need for prioritizing coagulation markers for prognostic abilities have been highlighted in COVID-19. We aimed to quantify the associations of D-dimer with disease progression in patients with COVID-19. This systematic review and meta-analysis was registered with PROSPERO, CRD42020186661.We included 113 studies in our systematic review, of which 100 records (n = 38,310) with D-dimer data) were considered for meta-analysis. Across 68 unadjusted (n = 26,960) and 39 adjusted studies (n = 15,653) reporting initial D-dimer, a significant association was found in patients with higher D-dimer for the risk of overall disease progression (unadjusted odds ratio (uOR) 3.15; adjusted odds ratio (aOR) 1.64). The time-to-event outcomes were pooled across 19 unadjusted (n = 9743) and 21 adjusted studies (n = 13,287); a strong association was found in patients with higher D-dimers for the risk of overall disease progression (unadjusted hazard ratio (uHR) 1.41; adjusted hazard ratio (aHR) 1.10). The prognostic use of higher D-dimer was found to be promising for predicting overall disease progression (studies 68, area under curve 0.75) in COVID-19. Our study showed that higher D-dimer levels provide prognostic information useful for clinicians to early assess COVID-19 patients at risk for disease progression and mortality outcomes. This study, recommends rapid assessment of D-dimer for predicting adverse outcomes in COVID-19.
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Affiliation(s)
| | | | - Naveen Dutt
- Department of Respiratory Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Manne Munikumar
- Department of Bioinformatics, ICMR-National Institute of Nutrition, Hyderabad, 500007, India
| | - Shahir Asfahan
- Department of Respiratory Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Paresh P Kulkarni
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, 249203, India
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Adolf Helmy M, Magdy Milad L, Hasanin A, Mostafa M. The novel use of diaphragmatic excursion on hospital admission to predict the need for ventilatory support in patients with coronavirus disease 2019. Anaesth Crit Care Pain Med 2021; 40:100976. [PMID: 34748940 PMCID: PMC8570438 DOI: 10.1016/j.accpm.2021.100976] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 02/06/2023]
Abstract
Background We aimed to evaluate the ability of diaphragmatic excursion at hospital admission to predict outcomes in patients with coronavirus disease-2019 (COVID-19). Methods In this prospective observational study, we included adult patients with severe COVID-19 admitted to a tertiary hospital. Ultrasound examination of the diaphragm was performed within 12 h of admission. Other collected data included peripheral oxygen saturation (SpO2), respiratory rate, and computed tomography (CT) score. The outcomes included the ability of diaphragmatic excursion, respiratory rate, SpO2, and CT score at admission to predict the need for ventilatory support (need for non-invasive or invasive ventilation) and patient mortality using the area under the receiver operating characteristic curve (AUC) analysis. Univariate and multivariable analyses about the need for ventilatory support and mortality were performed. Results Diaphragmatic excursion showed an excellent ability to predict the need for ventilatory support, which was the highest among respiratory rate, SpO2, and CT score; the AUCs (95% confidence interval [CI]) was 0.96 (0.85–1.00) for the right diaphragmatic excursion and 0.94 (0.82–0.99) for the left diaphragmatic excursion. The right diaphragmatic excursion also had the highest AUC for predicting mortality in relation to respiratory rate, SpO2, and CT score. Multivariable analysis revealed that low diaphragmatic excursion was an independent predictor of mortality with an odds ratio (95% CI) of 0.55 (0.31–0.98). Conclusion Diaphragmatic excursion on hospital admission can accurately predict the need for ventilatory support and mortality in patients with severe COVID-19. Low diaphragmatic excursion was an independent risk factor for in-hospital mortality.
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Affiliation(s)
- Mina Adolf Helmy
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Lydia Magdy Milad
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
| | - Maha Mostafa
- Department of Anaesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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Voza A, Desai A, Luzzi S, Giotta Lucifero A, Azzolini E, Kogan M, Goretti G, Piovani D, Bonovas S, Angelotti G, Savevski V, Aghemo A, Greco M, Costantini E, Lleo A, Angelini C, Giordano M, Badalamenti S, Cecconi M. Clinical Outcomes in the Second versus First Pandemic Wave in Italy: Impact of Hospital Changes and Reorganization. APPLIED SCIENCES 2021; 11:9342. [DOI: 10.3390/app11199342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
The region of Lombardy was the epicenter of the COVID-19 outbreak in Italy. Emergency Hospital 19 (EH19) was built in the Milan metropolitan area during the pandemic’s second wave as a facility of Humanitas Clinical and Research Center (HCRC). The present study aimed to assess whether the implementation of EH19 was effective in improving the quality of care of COVID-19 patients during the second wave compared with the first one. The demographics, mortality rate, and in-hospital length of stay (LOS) of two groups of patients were compared: the study group involved patients admitted at HCRC and managed in EH19 during the second pandemic wave, while the control group included patients managed exclusively at HCRC throughout the first wave. The study and control group included 903 (56.7%) and 690 (43.3%) patients, respectively. The study group was six years older on average and had more pre-existing comorbidities. EH19 was associated with a decrease in the intensive care unit admission rate (16.9% vs. 8.75%, p < 0.001), and an equal decrease in invasive oxygen therapy (3.8% vs. 0.23%, p < 0.001). Crude mortality was similar but overlap propensity score weighting revealed a trend toward a potential small decrease. The adjusted difference in LOS was not significant. The implementation of an additional COVID-19 hospital facility was effective in improving the overall quality of care of COVID-19 patients during the first wave of the pandemic when compared with the second. Further studies are necessary to validate the suggested approach.
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56
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Naser MN, Al-Ghatam R, Darwish AH, Alqahtani MM, Alahmadi HA, Mohamed KA, Hasan NK, Perez NS. Risk factors, predictions, and progression of acute kidney injury in hospitalized COVID-19 patients: An observational retrospective cohort study. PLoS One 2021; 16:e0257253. [PMID: 34587189 PMCID: PMC8480894 DOI: 10.1371/journal.pone.0257253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/26/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI’s impact on prognosis while under different types of medications. Patients and methods This study is a retrospective observational cohort study conducted at Bahrain Defence Force (BDF) Royal Medical Services. Medical records of COVID-19 patients admitted to BDF hospital, treated, and followed up from April 2020 to October 2020 were retrieved. Data were analyzed using univariate and multivariate logistic regression with covariate adjustment, and the odds ratio (OR) and 95% confidence (95% CI) interval were reported. Results Among 353 patients admitted with COVID-19, 47.6% developed AKI. Overall, 51.8% of patients with AKI died compared to 2.2% of patients who did not develop AKI (p< 0.001 with OR 48.6 and 95% CI 17.2–136.9). Besides, deaths in patients classified with AKI staging were positively correlated and multivariate regression analysis revealed that moderate to severe hypoalbuminemia (<32 g/L) was independently correlated to death in AKI patients with an OR of 10.99 (CI 95% 4.1–29.3, p<0.001). In addition, 78.2% of the dead patients were on mechanical ventilation. Besides age as a predictor of AKI development, diabetes and hypertension were the major risk factors of AKI development (OR 2.04, p<0.01, and 0.05 for diabetes and hypertension, respectively). Also, two or more comorbidities substantially increased the risk of AKI development in COVID-19 patients. Furthermore, high levels upon hospital admission of D-Dimer, Troponin I, and ProBNP and low serum albumin were associated with AKI development. Lastly, patients taking ACEI/ARBs had less chance to develop AKI stage II/III with OR of 0.19–0.27 (p<0.05–0.01). Conclusions The incidence of AKI in hospitalized COVID-19 patients and the mortality rate among AKI patients were high and correlated with AKI staging. Furthermore, laboratory testing for serum albumin, hypercoagulability and cardiac injury markers maybe indicative for AKI development. Therefore, clinicians should be mandated to perform such tests on admission and follow-up in hospitalized patients.
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Affiliation(s)
- Maryam N. Naser
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
- * E-mail: ,
| | - Rana Al-Ghatam
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Abdulla H. Darwish
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Manaf M. Alqahtani
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Hajar A. Alahmadi
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Khalifa A. Mohamed
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Nahed K. Hasan
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
| | - Nuria S. Perez
- Bahrain Defence Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain
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Meng Z, Guo S, Zhou Y, Li M, Wang M, Ying B. Applications of laboratory findings in the prevention, diagnosis, treatment, and monitoring of COVID-19. Signal Transduct Target Ther 2021; 6:316. [PMID: 34433805 PMCID: PMC8386162 DOI: 10.1038/s41392-021-00731-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/21/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023] Open
Abstract
The worldwide pandemic of coronavirus disease 2019 (COVID-19) presents us with a serious public health crisis. To combat the virus and slow its spread, wider testing is essential. There is a need for more sensitive, specific, and convenient detection methods of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Advanced detection can greatly improve the ability and accuracy of the clinical diagnosis of COVID-19, which is conducive to the early suitable treatment and supports precise prophylaxis. In this article, we combine and present the latest laboratory diagnostic technologies and methods for SARS-CoV-2 to identify the technical characteristics, considerations, biosafety requirements, common problems with testing and interpretation of results, and coping strategies of commonly used testing methods. We highlight the gaps in current diagnostic capacity and propose potential solutions to provide cutting-edge technical support to achieve a more precise diagnosis, treatment, and prevention of COVID-19 and to overcome the difficulties with the normalization of epidemic prevention and control.
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Affiliation(s)
- Zirui Meng
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shuo Guo
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yanbing Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Mengjiao Li
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Binwu Ying
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Hakim A, Hasan MM, Hasan M, Lokman SM, Azim KF, Raihan T, Chowdhury PA, Azad AK. Major Insights in Dynamics of Host Response to SARS-CoV-2: Impacts and Challenges. Front Microbiol 2021; 12:637554. [PMID: 34512561 PMCID: PMC8424194 DOI: 10.3389/fmicb.2021.637554] [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: 12/03/2020] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19), a pandemic declared by the World Health Organization on March 11, 2020, is caused by the infection of highly transmissible species of a novel coronavirus called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of July 25, 2021, there are 194,372,584 cases and 4,167,937 deaths with high variability in clinical manifestations, disease burden, and post-disease complications among different people around the globe. Overall, COVID-19 is manifested as mild to moderate in almost 90% of the cases and only the rest 10% of the cases need hospitalization. However, patients with older age and those having different comorbidities have made worst the pandemic scenario. The variability of pathological consequences and clinical manifestations of COVID-19 is associated with differential host-SARS-CoV-2 interactions, which are influenced by the factors that originated from the SARS-CoV-2 and the host. These factors usually include the genomic attributes and virulent factors of the SARS-CoV-2, the burden of coinfection with other viruses and bacteria, age and gender of the individuals, different comorbidities, immune suppressions/deficiency, genotypes of major histocompatibility complex, and blood group antigens and antibodies. We herein retrieved and reviewed literatures from PubMed, Scopus, and Google relevant to clinical complications and pathogenesis of COVID-19 among people of different age, sex, and geographical locations; genomic characteristics of SARS-CoV-2 including its variants, host response under different variables, and comorbidities to summarize the dynamics of the host response to SARS-CoV-2 infection; and host response toward approved vaccines and treatment strategies against COVID-19. After reviewing a large number of published articles covering different aspects of host response to SARS-CoV-2, it is clear that one aspect from one region is not working with the scenario same to others, as studies have been done separately with a very small number of cases from a particular area/region of a country. Importantly, to combat such a pandemic as COVID-19, a conclusive understanding of the disease dynamics is required. This review emphasizes on the identification of the factors influencing the dynamics of host responses to SARS-CoV-2 and offers a future perspective to explore the molecular insights of COVID-19.
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Affiliation(s)
- Al Hakim
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Md. Mahbub Hasan
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
- Institute of Pharmaceutical Science, School of Cancer and Pharmaceutical Sciences, King’s College London, Franklin-Wilkins Building, London, United Kingdom
| | - Mahmudul Hasan
- Department of Pharmaceutical and Industrial Biotechnology, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Syed Mohammad Lokman
- Department of Genetic Engineering and Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Kazi Faizul Azim
- Department of Microbial Biotechnology, Faculty of Biotechnology and Genetic Engineering, Sylhet Agricultural University, Sylhet, Bangladesh
| | - Topu Raihan
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | | | - Abul Kalam Azad
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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Ciaglia E, Lopardo V, Montella F, Sellitto C, Manzo V, De Bellis E, Iannaccone T, Franci G, Zannella C, Pagliano P, Di Pietro P, Carrizzo A, Vecchione C, Conti V, Filippelli A, Puca AA. BPIFB4 Circulating Levels and Its Prognostic Relevance in COVID-19. J Gerontol A Biol Sci Med Sci 2021; 76:1775-1783. [PMID: 34396395 PMCID: PMC8436991 DOI: 10.1093/gerona/glab208] [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: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
Aging and comorbidities make individuals at greatest risk of COVID-19 serious illness and mortality due to senescence-related events and deleterious inflammation. Long-living individuals (LLIs) are less susceptible to inflammation and develop more resiliency to COVID-19. As demonstrated, LLIs are characterized by high circulating levels of BPIFB4, a protein involved in homeostatic response to inflammatory stimuli. Also, LLIs show enrichment of homozygous genotype for the minor alleles of a 4 missense single-nucleotide polymorphism haplotype (longevity-associated variant [LAV]) in BPIFB4, able to counteract progression of diseases in animal models. Thus, the present study was designed to assess the presence and significance of BPIFB4 level in COVID-19 patients and the potential therapeutic use of LAV-BPIFB4 in fighting COVID-19. BPIFB4 plasma concentration was found significantly higher in LLIs compared to old healthy controls while it significantly decreased in 64 COVID-19 patients. Further, the drop in BPIFB4 values correlated with disease severity. Accordingly to the LAV-BPIFB4 immunomodulatory role, while lysates of SARS-CoV-2-infected cells induced an inflammatory response in healthy peripheral blood mononuclear cells in vitro, the co-treatment with recombinant protein (rh) LAV-BPIFB4 resulted in a protective and self-limiting reaction, culminating in the downregulation of CD69 activating-marker for T cells (both TCD4+ and TCD8+) and in MCP-1 reduction. On the contrary, rhLAV-BPIFB4 induced a rapid increase in IL-18 and IL-1b levels, shown largely protective during the early stages of the virus infection. This evidence, along with the ability of rhLAV-BPIFB4 to counteract the cytotoxicity induced by SARS-CoV-2 lysate in selected target cell lines, corroborates BPIFB4 prognostic value and open new therapeutic possibilities in more vulnerable people.
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Affiliation(s)
- Elena Ciaglia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
| | - Valentina Lopardo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
| | - Francesco Montella
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
| | - Carmine Sellitto
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Valentina Manzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Emanuela De Bellis
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Teresa Iannaccone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Carla Zannella
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Pasquale Pagliano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Infectious Diseases Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Paola Di Pietro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy
| | - Albino Carrizzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Department of Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy
| | - Annibale Alessandro Puca
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Italy.,Cardiovascular Research Unit, IRCCS MultiMedica, Milan, Italy
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Lean-ing Method in an Emergency Department of the Italian Epicenter of the COVID-19 Outbreak: When the Algorithm Makes Difference. APPLIED SYSTEM INNOVATION 2021. [DOI: 10.3390/asi4030055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Lean method entails a set of standardized processes intending to optimize resources, reduce waste, and improve results. Lean has been proposed as an operative model for the COVID-19 outbreak. Herein, we summarized data resulted from the Lean model adoption in an Emergency Department of the Lombardy region, the Italian epicenter of the pandemic, to critically appraise its effectiveness and feasibility. The Lean algorithm was applied in the Humanitas Clinical and Research Hospital, Milan, north of Italy. At admission, patients underwent outdoor pre-triage for fever, respiratory, and gastrointestinal symptoms, with a focus on SpO2. Based on these data, they were directed to the most appropriate area for the COVID-19 first-level screening. High-risk patients were assisted by trained staff for second-level screening and planning of treatment. Out of 7.778 patients, 21.9% were suspected of SARS-CoV-2 infection. Mortality was 21.9% and the infection rate in health workers was 4.8%. The lean model has proved to be effective in optimizing the overall management of COVID-19 patients in an emergency setting. It allowed for screening of a large volume of patients, while also limiting the health workers’ infection rate. Further studies are necessary to validate the suggested approach.
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Zucker J, Gomez-Simmonds A, Purpura LJ, Shoucri S, LaSota E, Morley NE, Sovic BW, Castellon MA, Theodore DA, Bartram LL, Miko BA, Scherer ML, Meyers KA, Turner WC, Kelly M, Pavlicova M, Basaraba CN, Baldwin MR, Brodie D, Burkart KM, Bathon J, Uhlemann AC, Yin MT, Castor D, Sobieszczyk ME. Supervised Machine Learning Approach to Identify Early Predictors of Poor Outcome in Patients with COVID-19 Presenting to a Large Quaternary Care Hospital in New York City. J Clin Med 2021; 10:jcm10163523. [PMID: 34441819 PMCID: PMC8397083 DOI: 10.3390/jcm10163523] [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: 06/20/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The progression of clinical manifestations in patients with coronavirus disease 2019 (COVID-19) highlights the need to account for symptom duration at the time of hospital presentation in decision-making algorithms. Methods: We performed a nested case–control analysis of 4103 adult patients with COVID-19 and at least 28 days of follow-up who presented to a New York City medical center. Multivariable logistic regression and classification and regression tree (CART) analysis were used to identify predictors of poor outcome. Results: Patients presenting to the hospital earlier in their disease course were older, had more comorbidities, and a greater proportion decompensated (<4 days, 41%; 4–8 days, 31%; >8 days, 26%). The first recorded oxygen delivery method was the most important predictor of decompensation overall in CART analysis. In patients with symptoms for <4, 4–8, and >8 days, requiring at least non-rebreather, age ≥ 63 years, and neutrophil/lymphocyte ratio ≥ 5.1; requiring at least non-rebreather, IL-6 ≥ 24.7 pg/mL, and D-dimer ≥ 2.4 µg/mL; and IL-6 ≥ 64.3 pg/mL, requiring non-rebreather, and CRP ≥ 152.5 mg/mL in predictive models were independently associated with poor outcome, respectively. Conclusion: Symptom duration in tandem with initial clinical and laboratory markers can be used to identify patients with COVID-19 at increased risk for poor outcomes.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
- Correspondence: ; Tel.: +1-201-723-6637
| | - Angela Gomez-Simmonds
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Sherif Shoucri
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Elijah LaSota
- Tulane University School of Medicine, Tulane Medical Center, New Orleans, LA 70112, USA;
| | - Nicholas E. Morley
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Brit W. Sovic
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Marvin A. Castellon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Deborah A. Theodore
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Logan L. Bartram
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Benjamin A. Miko
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Matthew L. Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Kathrine A. Meyers
- Aaron Diamond AIDS Research Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA;
| | - William C. Turner
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Maureen Kelly
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Martina Pavlicova
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Cale N. Basaraba
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Matthew R. Baldwin
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Daniel Brodie
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Kristin M. Burkart
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Joan Bathon
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Michael T. Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
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Mukhtar A, Rady A, Hasanin A, Lotfy A, El Adawy A, Hussein A, El-Hefnawy I, Hassan M, Mostafa H. Admission SpO 2 and ROX index predict outcome in patients with COVID-19. Am J Emerg Med 2021; 50:106-110. [PMID: 34332217 PMCID: PMC8313790 DOI: 10.1016/j.ajem.2021.07.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background This study aimed to evaluate the accuracy of pulse oximetry-derived oxygen saturation (SpO2) on room air, determined at hospital admission, as a predictor for the need for mechanical ventilatory support in patients with Coronavirus Disease-2019 (COVID-19). Methods In this retrospective observational study, demographic and clinical details of the patients were obtained during ICU admission. SpO2 and respiratory rate (RR) on room air were determined within the first 6 h of hospital admission. As all measurements were obtained on room air, we calculated the simplified respiratory rate‑oxygenation (ROX) index by dividing the SpO2 by the RR. Based on the use of any assistance of mechanical ventilator (invasive or noninvasive), patients were divided into mechanical ventilation (MV) group and oxygen therapy group. The accuracy of the SpO2, CT score, and ROX index to predict the need to MV were determined using the Area under receiver operating curve (AUC). Results We included 72 critically ill patients who tested COVID-19-positive. SpO2 on the room air could predict any MV requirement (AUC [95% confidence interval]: 0.9 [0.8–0.96], sensitivity: 70%, specificity 100%, cut-off value ≤78%, P < 0.001). Within the MV group, the use of noninvasive ventilation (NIV) was successful in 37 (74%) patients, whereas 13 patients (26%) required endotracheal intubation. The cut-off ROX value for predicting early NIV failure was ≤1.4, with a sensitivity of 85%, a specificity of 86%, and an AUC of 0.86 (95% confidence interval of 0.73–0.94, P < 0.0001). Conclusions A baseline SpO2 ≤78% is an excellent predictor of MV requirement with a positive predictive value of 100%. Moreover, the ROX index measured within the first 6 h of hospital admission is a good indicator of early NIV failure.
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Affiliation(s)
- Ahmed Mukhtar
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Ashraf Rady
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt.
| | - Ahmed Lotfy
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Akram El Adawy
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | - Amr Hussein
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
| | | | | | - Hanan Mostafa
- Anesthesia and Surgical Intensive Care Department, Cairo University, Cairo, Egypt
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Tiotiu A, Chong Neto H, Bikov A, Kowal K, Steiropoulos P, Labor M, Cherrez-Ojeda I, Badellino H, Emelyanov A, Garcia R, Guidos G. Impact of the COVID-19 pandemic on the management of chronic noninfectious respiratory diseases. Expert Rev Respir Med 2021; 15:1035-1048. [PMID: 34253132 DOI: 10.1080/17476348.2021.1951707] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction: The COVID-19 pandemic has challenged health care across the world, not just by the severity of the disease and the high mortality rate but also by the consequences on the management of the patients with chronic diseases.Areas covered: This review summarizes the most up-to-date published data regarding the impact of COVID-19 on the management and outcomes of patients with chronic noninfectious respiratory illnesses including obstructive sleep apnea, asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial and pulmonary vascular diseases, and lung cancer.Expert opinion: Most of chronic respiratory diseases (except asthma and cystic fibrosis) are associated with more severe COVID-19 and poor outcomes but the mechanisms involved are not yet identified. The therapeutic management of the patients with chronic respiratory diseases and COVID-19 is similar to the other patients but the post-recovery course could be worse in this population and followed by the development of pulmonary fibrosis, bronchiectasis, and pulmonary hypertension. The pandemic highly impacted our usual medical activities by limiting the access to several diagnosis procedures, the necessity to develop new methods for the monitoring of the disease and adapt the therapeutic strategies. The long-term consequences of all these changes are still unknown.
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Affiliation(s)
- Angelica Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.,Development, Adaptation and Disadvantage. Cardiorespiratory Regulations and Motor Control (EA 3450 DevAH) Research Unit, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Herberto Chong Neto
- Division of Allergy, Immunology and Pulmonology, Department of Pediatrics, Federal University of Paraná, Curitiba, Brazil
| | - Andras Bikov
- Department of Respiratory Medicine, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, United Kingdom; Andras
| | - Krzysztof Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Sklodowskiej-Curie 24a, Bialystok, Poland.,Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland
| | - Paschalis Steiropoulos
- Department of Respiratory Medicine, Medical School, Democritus University of Thrace, University General Hospital Dragana, Alexandroupolis, Greece
| | - Marina Labor
- Department of Pulmonology, Värnamo Hospital, Värnamo, Sweden
| | - Ivan Cherrez-Ojeda
- Department of Allergy, Immunology & Pulmonary Medicine, Universidad Espíritu Santo, Samborondón, Ecuador
| | | | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University Named after I.I.Mechnikov, Saint-Petesrburg, Russian Federation
| | - Rocio Garcia
- Department of Pneumology. Universitary Hospital « 12 De Octubre », Madrid, Spain
| | - Guillermo Guidos
- Department of Inmmunology, SEPI-ENMH, Instituto Politecnico Nacional, Mexico City
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Oliveira J, Gameiro J, Bernardo J, Marques F, Costa C, Branco C, Duarte I, Fonseca J, Carreiro C, Braz S, Lopes JA. Impact of Chronic RAAS Use in Elderly COVID-19 Patients: A Retrospective Analysis. J Clin Med 2021; 10:jcm10143147. [PMID: 34300311 PMCID: PMC8307646 DOI: 10.3390/jcm10143147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 12/29/2022] Open
Abstract
Corona Virus Disease-19 (COVID-19) recently emerged as a global pandemic. Advanced age is the most important risk factor for increased virus susceptibility and worse outcomes. Many older adults are currently treated with renin–angiotensin–aldosterone system (RAAS) inhibitors and there is concern that these medications might increase the risk of mortality by COVID-19. This is a retrospective cohort of 346 patients older than 65 years with COVID-19, at the Department of Medicine of the Centro Hospitalar Universitário Lisboa Norte, in Portugal, hospitalized between March 2020 and August 2020. Mean age was 80.9 ± 8.7 years old. Most patients had arterial hypertension (n = 279, 80.6%), almost half (n = 161, 46.5%) had cardiovascular disease and approximately one-third of patients had heart failure (n = 127, 36.7%) or diabetes Mellitus (n = 113, 32.7%). Ninety-eight patients (28.3%) had chronic kidney disease and almost half of the patients (49.4%) were chronically under renin–angiotensin–aldosterone system (RAAS) inhibitors. Twenty percent of patients died during hospitalization. In a multivariate analysis, older age (OR 1.11, 95% CI 1.04, 1.18, p = 0.002), absence of baseline medication with RAAS inhibitors (OR 0.27, 95% CI 0.10, 0.75, p = 0.011), higher serum ferritin (OR 1.00, 95% CI 1.00, 1.00, p = 0.003) and higher lactate levels (OR 1.08, 95% CI 1.02, 1.14, p = 0.006) were independent predictors of mortality. Older age, higher serum ferritin and lactate levels at admission were found to be independent predictors of mortality and might act as early predictors of worsening disease in clinical practice. Chronic treatment with RAAS inhibitors appeared to be protective, supporting guidelines in not discontinuing such drugs.
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Affiliation(s)
- João Oliveira
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
- Correspondence: ; Tel.: +351-192-440-3217
| | - Joana Gameiro
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - João Bernardo
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - Filipe Marques
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - Cláudia Costa
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - Carolina Branco
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - Inês Duarte
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - José Fonseca
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
| | - Carolina Carreiro
- Department of Internal Medicine, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.C.); (S.B.)
| | - Sandra Braz
- Department of Internal Medicine, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (C.C.); (S.B.)
| | - José António Lopes
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; (J.G.); (J.B.); (F.M.); (C.C.); (C.B.); (I.D.); (J.F.); (J.A.L.)
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Martinot M, Eyriey M, Gravier S, Bonijoly T, Kayser D, Ion C, Mohseni-Zadeh M, Camara S, Dubois J, Haerrel E, Drouaine J, Kaiser J, Ongagna JC, Schieber-Pachart A, Kempf C. Predictors of mortality, ICU hospitalization, and extrapulmonary complications in COVID-19 patients. Infect Dis Now 2021; 51:518-525. [PMID: 34242842 PMCID: PMC8260549 DOI: 10.1016/j.idnow.2021.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/08/2021] [Accepted: 07/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE A major coronavirus disease 2019 (COVID-19) outbreak occurred in Northeastern France in spring 2020. This single-center retrospective observational cohort study aimed to compare patients with severe COVID-19 and those with non-severe COVID-19 (survivors vs. non-survivors, ICU patients vs. non-ICU patients) and to describe extrapulmonary complications. PATIENTS AND METHODS We included all patients with a confirmed diagnosis of COVID-19 admitted to Colmar Hospital in March 2020. RESULTS We examined 600 patients (median age 71.09 years; median body mass index: 26.9 kg/m2); 57.7% were males, 86.3% had at least one comorbidity, 153 (25.5%) required ICU hospitalization, and 115 (19.1%) died. Baseline independent factors associated with death were older age (>75 vs. ≤75 years), male sex, oxygen supply, chronic neurological, renal, and pulmonary diseases, diabetes, cancer, low platelet and hemoglobin counts, and high levels of C-reactive protein (CRP) and serum creatinine. Factors associated with ICU hospitalization were age <75 years, oxygen supply, chronic pulmonary disease, absence of dementia, and high levels of CRP, hemoglobin, and serum creatinine. Among the 600 patients, 80 (13.3%) had an acute renal injury, 33 (5.5%) had a cardiovascular event, 27 (4.5%) had an acute liver injury, 24 (4%) had venous thromboembolism, eight (1.3%) had a neurological event, five (0.8%) had rhabdomyolysis, and one had acute pancreatitis. Most extrapulmonary complications occurred in ICU patients. CONCLUSION This study highlighted the main risk factors for ICU hospitalization and death caused by severe COVID-19 and the frequency of numerous extrapulmonary complications in France.
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Affiliation(s)
- M Martinot
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France.
| | - M Eyriey
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - S Gravier
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - T Bonijoly
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - D Kayser
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - C Ion
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - M Mohseni-Zadeh
- Infectious Diseases Department, Hôpitaux Civils, 39, avenue de la liberté, 68024 Colmar, France
| | - S Camara
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Dubois
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - E Haerrel
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Drouaine
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J Kaiser
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France; Pharmacy Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J C Ongagna
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | | | - C Kempf
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
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Lanza E, Mancuso ME, Messana G, Ferrazzi P, Lisi C, Di Micco P, Barco S, Balzarini L, Lodigiani C. Compromised Lung Volume and Hemostatic Abnormalities in COVID-19 Pneumonia: Results from an Observational Study on 510 Consecutive Patients. J Clin Med 2021; 10:jcm10132894. [PMID: 34209720 PMCID: PMC8268714 DOI: 10.3390/jcm10132894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hemostatic abnormalities have been described in COVID-19, and pulmonary microthrombosis was consistently found at autopsy with concomitant severe lung damage. METHODS This is a retrospective observational cross-sectional study including consecutive patients with COVID-19 pneumonia who underwent unenhanced chest CT upon admittance at the emergency room (ER) in one large academic hospital. QCT was used for the calculation of compromised lung volume (%CL). Clinical data were retrieved from patients' files. Laboratory data were obtained upon presentation at the ER. AIM The aim of this study was to evaluate the correlation between hemostatic abnormalities and lung involvement in patients affected by COVID-19 pneumonia as described using computer-aided quantitative evaluation of chest CT (quantitative CT (QCT)). RESULTS A total of 510 consecutive patients (68% males), aged 67 years in median, diagnosed with COVID-19 pneumonia, who underwent unenhanced CT scan upon admission to the ER, were included. In all, 115 patients had %CL > 23%; compared to those with %CL < 23%, they showed higher levels of D-dimer, fibrinogen, and CRP, greater platelet count, and longer PT ratio. Via multivariate regression analysis, BMI ≥ 30 kg/m2, D-dimer levels > 500 ng/mL, CRP > 5.0 ng/mL and PT ratio > 1.2 were found to be independent predictors of a %CL > 23% (adjusted odds ratios (95% confidence intervals): 2.1 (1.1-4.0), 3.1 (1.6-5.8), 2.4 (1.3-4.5), and 3.4 (1.4-8.5), respectively). CONCLUSIONS Hemostatic abnormalities in patients affected by COVID-19 correlate with the severity of lung injury as measured by %CL. Our results underline the pathogenetic role of hemostasis in COVID-19 pneumonia beyond the presence of clinically evident thromboembolic complications.
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Affiliation(s)
- Ezio Lanza
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.L.); (L.B.)
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.F.); (C.L.)
- Correspondence: or ; Tel.: +39-02-8224-5981; Fax: +39-02-8224-4682
| | - Gaia Messana
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (G.M.); (C.L.)
| | - Paola Ferrazzi
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.F.); (C.L.)
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (G.M.); (C.L.)
| | - Pierpaolo Di Micco
- Department of Internal Medicine, Ospedale Fatebenefratelli, 80123 Naples, Italy;
| | - Stefano Barco
- Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg University Mainz, 55122 Mainz, Germany;
- Clinic for Angiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Luca Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.L.); (L.B.)
| | - Corrado Lodigiani
- Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (P.F.); (C.L.)
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Zhou K, Sun Y, Li L, Zang Z, Wang J, Li J, Liang J, Zhang F, Zhang Q, Ge W, Chen H, Sun X, Yue L, Wu X, Shen B, Xu J, Zhu H, Chen S, Yang H, Huang S, Peng M, Lv D, Zhang C, Zhao H, Hong L, Zhou Z, Chen H, Dong X, Tu C, Li M, Zhu Y, Chen B, Li SZ, Guo T. Eleven routine clinical features predict COVID-19 severity uncovered by machine learning of longitudinal measurements. Comput Struct Biotechnol J 2021; 19:3640-3649. [PMID: 34188785 PMCID: PMC8225590 DOI: 10.1016/j.csbj.2021.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 01/08/2023] Open
Abstract
Severity prediction of COVID-19 remains one of the major clinical challenges for the ongoing pandemic. Here, we have recruited a 144 COVID-19 patient cohort, resulting in a data matrix containing 3,065 readings for 124 types of measurements over 52 days. A machine learning model was established to predict the disease progression based on the cohort consisting of training, validation, and internal test sets. A panel of eleven routine clinical factors constructed a classifier for COVID-19 severity prediction, achieving accuracy of over 98% in the discovery set. Validation of the model in an independent cohort containing 25 patients achieved accuracy of 80%. The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.70, 0.99, 0.93, and 0.93, respectively. Our model captured predictive dynamics of lactate dehydrogenase (LDH) and creatine kinase (CK) while their levels were in the normal range. This model is accessible at https://www.guomics.com/covidAI/ for research purpose.
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Key Words
- ABG, arterial blood gas
- APTT, activated partial thromboplastin time
- AST, aspartate aminotransferase
- AUC, area under the curve
- BASO#, basophil counts
- CFDA, China Food and Drug Administration
- CK, creatine kinase
- COVID-19
- CRP, C-reactive protein
- CT, computed tomography
- ESR, erythrocyte sedimentation rate
- GA, genetic algorithm
- GGT, gamma glutamyl transpeptidase
- HIS, hospital information system
- LAC, lactate
- LDH, lactate dehydrogenase
- LOESS, locally estimated scatterplot smoothing
- LOS, length of stay
- Longitudinal dynamics
- Machine learning
- Mg, magnesium
- NETs, neutrophil extracellular traps
- NPV, negative predictive value
- PCT, procalcitonin
- PPV, positive predictive value
- ROC, receiver operating characteristics
- RT-PCR, reverse transcriptase -polymerase chain reaction
- Routine clinical test
- SARS-CoV-2
- SHAP, SHapley Additive exPlanations
- SVM, support vector machine
- SaO2, oxygen saturation
- Severity prediction
- TT, thrombin time
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Kai Zhou
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Yaoting Sun
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
| | - Lu Li
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
| | - Zelin Zang
- School of Engineering, Westlake University, Hangzhou 310024, Zhejiang Province, China
| | - Jing Wang
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Jun Li
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Junbo Liang
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Fangfei Zhang
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
| | - Qiushi Zhang
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou 310024, Zhejiang Province, China
| | - Weigang Ge
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou 310024, Zhejiang Province, China
| | - Hao Chen
- Westlake Omics (Hangzhou) Biotechnology Co., Ltd., Hangzhou 310024, Zhejiang Province, China
| | - Xindong Sun
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
| | - Liang Yue
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
| | - Xiaomai Wu
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Bo Shen
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Jiaqin Xu
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Hongguo Zhu
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Shiyong Chen
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Hai Yang
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Shigao Huang
- Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, 999078 Macau SAR, China
| | - Minfei Peng
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Dongqing Lv
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Chao Zhang
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Haihong Zhao
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Luxiao Hong
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Zhehan Zhou
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Haixiao Chen
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xuejun Dong
- Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing 312000, Zhejiang Province, China
| | - Chunyu Tu
- Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing 312000, Zhejiang Province, China
| | - Minghui Li
- Shaoxing People's Hospital, Shaoxing Hospital, Zhejiang University School of Medicine, Shaoxing 312000, Zhejiang Province, China
| | - Yi Zhu
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
| | - Baofu Chen
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Stan Z. Li
- School of Engineering, Westlake University, Hangzhou 310024, Zhejiang Province, China
| | - Tiannan Guo
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou 310024, Zhejiang Province, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou 310024, Zhejiang Province, China
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Kalkanis A, Wauters E, Testelmans D, Yserbyt J, Lorent N, Louvaris Z, Godinas L, Van Mol P, Wauters J, Eleftheriou M, Dooms C. Early lung ultrasound assessment for the prognosis of patients hospitalized for COVID-19 pneumonia. A pilot study. Respir Med Res 2021; 80:100832. [PMID: 34130209 PMCID: PMC8177497 DOI: 10.1016/j.resmer.2021.100832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/14/2021] [Accepted: 05/26/2021] [Indexed: 01/19/2023]
Abstract
Objective SARS CoV-2 is an epidemic viral infection that can cause mild to severe lung involvement. Newly apprehended knowledge on thoracic imaging abnormalities and the growing clinical experience on the evolution of this disease make the radiographic follow-up of hospitalized patients relevant. The value of consecutive bedside lung ultrasonography in the follow-up of hospitalized patients with SARS CoV-2 pneumonia and its correlation with other clinical and laboratory markers needs to be evaluated. Methods We assessed 39 patients [age: 64 y(60.1–68.7)] with confirmed SARS CoV-2 pneumonia. A total of 24 patients were hospitalized until the follow-up test, 9 were discharged early and 6 required a transfer to critical care unit. Two ultrasound scans of the lung were performed on day 1 and 4 of patients’ hospitalization. Primary endpoint was the magnitude of association between a global lung ultrasound score (LUS) and clinical and laboratory markers. Secondary endpoint was the association between the evolution of LUS with the corresponded changes in clinical and laboratory outcomes during hospitalization period. Results LUS score on admission was higher among the deteriorating patients and significantly (P = 0.038–0.0001) correlated (Spearman's rho) with the levels of C-reactive protein (0.58), lymphocytes (−0.33), SpO2 (−0.48) and oxygen supplementation (0.48) upon admission. The increase in LUS score between the two scans was significantly correlated (0.544, P = 0.006) with longer hospital stay. Conclusion Lung ultrasound assessment can be a useful as an imaging modality for SARS CoV-2 patients. Larger studies are needed to further investigate the predictive role of LUS in the duration and the outcome of the hospitalization of these patients.
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Affiliation(s)
- A Kalkanis
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - E Wauters
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - D Testelmans
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - J Yserbyt
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - N Lorent
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Z Louvaris
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - L Godinas
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - P Van Mol
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Laboratory of Translational Genetics, VIB - KU Leuven Center for Cancer Biology, Herestraat 49 b912, 3000 Leuven, Belgium
| | - J Wauters
- Department of Internal Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - M Eleftheriou
- Aristotle University of Thessaloniki, Department of Mathematics, Thessaloniki, Greece
| | - C Dooms
- Department of Respiratory Diseases, University Hospitals KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Budu MO, Rugel EJ, Nocos R, Teo K, Rangarajan S, Lear SA. Psychological Impact of COVID-19 on People with Pre-Existing Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5972. [PMID: 34199516 PMCID: PMC8199726 DOI: 10.3390/ijerph18115972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic has caused an increase in anxiety and depression levels across broad populations. While anyone can be infected by the virus, the presence of certain chronic diseases has been shown to exacerbate the severity of the infection. There is a likelihood that knowledge of this information may lead to negative psychological impacts among people with chronic illness. We hypothesized that the pandemic has resulted in increased levels of anxiety and depression symptoms among people with chronic illness. We recruited 540 participants from the ongoing Prospective Urban and Rural Epidemiology (PURE) study in British Columbia, Canada. Participants were asked to fill out an online survey that included the Hospital Anxiety Depression Scale (HADS) to assess anxiety and depression symptoms. We tested our hypothesis using bivariate and multivariable linear regression models. Out of 540 participants, 15% showed symptoms of anxiety and 17% reported symptoms of depression. We found no significant associations between having a pre-existing chronic illness and reporting higher levels of anxiety or depression symptoms during COVID-19. Our results do not support the hypothesis that having a chronic illness is associated with greater anxiety or depression symptoms during the COVID-19 pandemic. Our results were similar to one study but in contrast with other studies that found a positive association between the presence of chronic illness and developing anxiety or depression during this pandemic.
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Affiliation(s)
- Michael Owusu Budu
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (E.J.R.); (R.N.); (S.A.L.)
- Community Health Research Team, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Emily J. Rugel
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (E.J.R.); (R.N.); (S.A.L.)
- Westmead Applied Research Centre (WARC), The University of Sydney, 2145 Sydney, Australia
| | - Rochelle Nocos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (E.J.R.); (R.N.); (S.A.L.)
- Community Health Research Team, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada; (K.T.); (S.R.)
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada; (K.T.); (S.R.)
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (E.J.R.); (R.N.); (S.A.L.)
- Community Health Research Team, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
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Rezoagli E, Magliocca A, Bellani G, Pesenti A, Grasselli G. Development of a Critical Care Response - Experiences from Italy During the Coronavirus Disease 2019 Pandemic. Anesthesiol Clin 2021; 39:265-284. [PMID: 34024430 PMCID: PMC7879060 DOI: 10.1016/j.anclin.2021.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Italy was the first western country facing an outbreak of coronavirus disease 2019 (COVID-19). The first Italian patient diagnosed with COVID-19 was admitted, on Feb. 20, 2020, to the intensive care unit (ICU) in Codogno (Lodi, Lombardy, Italy), and the number of reported positive cases increased to 36 in the next 24 hours, and then exponentially for 18 days. This triggered a response that resulted in a massive surge in ICU bed capacity. The COVID19 Lombardy Network organized a structured logistic response and provided scientific evidence to highlight information on COVID-19 associated respiratory failure.
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Affiliation(s)
- Emanuele Rezoagli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, Monza 20900, Italy,Department of Emergency and Intensive Care, San Gerardo Hospital, Via G. B. Pergolesi, 33, Monza 20900, Italy,Corresponding author. Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza (MB) 20900, Italy
| | - Aurora Magliocca
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, Monza 20900, Italy
| | - Giacomo Bellani
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, Monza 20900, Italy,Department of Emergency and Intensive Care, San Gerardo Hospital, Via G. B. Pergolesi, 33, Monza 20900, Italy
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, Milano 20122, Italy,Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 10, Milano 20122, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, Milano 20122, Italy,Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 10, Milano 20122, Italy
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Qiu J, Yang X, Liu L, Wu T, Cui L, Mou Y, Sun Y. Prevalence and prognosis of otorhinolaryngological symptoms in patients with COVID-19: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2021; 279:49-60. [PMID: 34032909 PMCID: PMC8147593 DOI: 10.1007/s00405-021-06900-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/20/2021] [Indexed: 01/08/2023]
Abstract
Objective A systematic review and meta-analysis were performed to evaluate the prevalence and prognosis of otorhinolaryngological symptoms in patients with the diagnosed coronavirus disease 2019 (COVID-19). Methods A systematic search of PubMed, Embase, Web of Science, and Google Scholar databases was performed up to August 19, 2020.We included studies that reported infections with COVID-19 and symptoms of otolaryngology. The retrieved data from the respective studies were evaluated and summarized. The study's immediate result was to assess the combined prevalence of otorhinolaryngological symptoms in patients with COVID-19. However, the secondary result was to determine the exacerbation of COVID-19 infection in patients with otorhinolaryngological symptoms. Results Fifty-four studies with 16,478 patients were included. Olfactory dysfunction, sneezing and sputum production were the 3 most prevalent otorhinolaryngological symptoms in patients with COVID-19. The pooled prevalence amongst the prevalent symptoms was 47% (95% CI 29–65; range 0–98; I2 = 99.58%), 27% (95% CI 11–48; range 12–40; I2 = 93.34%), and 22% (95% CI 16–30; range 2–56; I2 = 97.60%), respectively. The proportion of severely ill patients with sputum production and shortness of breath was significantly higher among patients with COVID-19 infections (OR 1.66 [95% CI 1.08–2.54]; P = 0.02, I2 = 51% and 3.29 [95% CI 1.57–6.90]; P = 0.002, I2 = 49%, respectively). Subgroup analysis showed no statistically significant differences between the incidence of otolaryngology symptoms in severely ill patients and non-severely ill patients (OR 1.43 [95% CI 1.12–1.82]; P = 0.07 I2 = 53.1%). In contrast, the incidence of shortness of breath in severely ill patients was significantly increased (3.29 [1.57–6.90]; P = 0.002, I2 = 49%). Conclusion Our research shows that otorhinolaryngology symptoms in patients with COVID-19 are not uncommon, which should attract otorhinolaryngologists' attention.
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Affiliation(s)
- Jingjing Qiu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Xin Yang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Limei Liu
- Department of Ophthalmology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Ting Wu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Limei Cui
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
| | - Yakui Mou
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
| | - Yan Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
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DOĞAN NÖ, DOĞAN S, PEKDEMİR M, YILMAZ S, FEREK EMİR D, TEKE KB. Prediction of Mortality, Hospitalization and Mechanical Ventilation Need of Patients with Pneumonia in COVID-19 Outbreak. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.824886] [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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Wingert A, Pillay J, Gates M, Guitard S, Rahman S, Beck A, Vandermeer B, Hartling L. Risk factors for severity of COVID-19: a rapid review to inform vaccine prioritisation in Canada. BMJ Open 2021; 11:e044684. [PMID: 33986052 PMCID: PMC8126435 DOI: 10.1136/bmjopen-2020-044684] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Rapid review to determine the magnitude of association between potential risk factors and severity of COVID-19, to inform vaccine prioritisation in Canada. SETTING Ovid MEDLINE(R) ALL, Epistemonikos COVID-19 in L·OVE Platform, McMaster COVID-19 Evidence Alerts and websites were searched to 15 June 2020. Eligible studies were conducted in high-income countries and used multivariate analyses. PARTICIPANTS After piloting, screening, data extraction and quality appraisal were performed by a single experienced reviewer. Of 3740 unique records identified, 34 were included that reported on median 596 (range 44-418 794) participants, aged 42-84 years. 19/34 (56%) were good quality. OUTCOMES Hospitalisation, intensive care unit admission, length of stay in hospital or intensive care unit, mechanical ventilation, severe disease, mortality. RESULTS Authors synthesised findings narratively and appraised the certainty of the evidence for each risk factor-outcome association. There was low or moderate certainty evidence for a large (≥2-fold) magnitude of association between hospitalisation in people with COVID-19, and: obesity class III, heart failure, diabetes, chronic kidney disease, dementia, age >45 years, male gender, black race/ethnicity (vs non-Hispanic white), homelessness and low income. Age >60 and >70 years may be associated with large increases in mechanical ventilation and severe disease, respectively. For mortality, a large magnitude of association may exist with liver disease, Bangladeshi ethnicity (vs British white), age >45 years, age >80 years (vs 65-69 years) and male gender among 20-64 years (but not older). Associations with hospitalisation and mortality may be very large (≥5-fold) for those aged ≥60 years. CONCLUSIONS Increasing age (especially >60 years) may be the most important risk factor for severe outcomes. High-quality primary research accounting for multiple confounders is needed to better understand the magnitude of associations for severity of COVID-19 with several other factors. PROSPERO REGISTRATION NUMBER CRD42020198001.
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Affiliation(s)
- Aireen Wingert
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Jennifer Pillay
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Samantha Guitard
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Sholeh Rahman
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Andrew Beck
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Venturini S, Orso D, Cugini F, Crapis M, Fossati S, Callegari A, Pellis T, Tomasello DC, Tonizzo M, Grembiale A, D'Andrea N, Vetrugno L, Bove T. Artificial neural network model from a case series of COVID-19 patients: a prognostic analysis. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021202. [PMID: 33988146 PMCID: PMC8182608 DOI: 10.23750/abm.v92i2.11086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM There is a need to determine which clinical variables predict the severity of COVID-19. We analyzed a series of critically ill COVID-19 patients to see if any of our dataset's clinical variables were associated with patient outcomes. METHODS We retrospectively analyzed the data of COVID-19 patients admitted to the ICU of the Hospital in Pordenone from March 11, 2020, to April 17, 2020. Patients' characteristics of survivors and deceased groups were compared. The variables with a different distribution between the two groups were implemented in a generalized linear regression model (LM) and in an Artificial Neural Network (NN) model to verify the "robustness" of the association with mortality. RESULTS In the considered period, we reviewed the data of 22 consecutive patients: 8 died. The causes of death were a severe respiratory failure (3), multi-organ failure (1), septic shock (1), pulmonary thromboembolism (2), severe hemorrhage (1). Lymphocyte and the platelet count were significantly lower in the group of deceased patients (p-value 0.043 and 0.020, respectively; cut-off values: 660/mm3; 280,000/mm3, respectively). Prothrombin time showed a statistically significant trend (p-value= 0.065; cut-off point: 16.8/sec). The LM model (AIC= 19.032), compared to the NN model (Mean Absolute Error, MAE = 0.02), was substantially alike (MSE 0.159 vs. 0.136). CONCLUSIONS In the context of critically ill COVID-19 patients admitted to ICU, lymphocytopenia, thrombocytopenia, and lengthening of prothrombin time were strictly correlated with higher mortality. Additional clinical data are needed to be able to validate this prognostic score.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Daniele Orso
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Francesco Cugini
- Department of Emergency Medicine, ASUFC Hospital of San Daniele, Udine, Italy.
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Sara Fossati
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Tommaso Pellis
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Dario Carmelo Tomasello
- Department of Anesthesia and Intensive Care, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Alessandro Grembiale
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Natascia D'Andrea
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy; Department of Anesthesia and Intensive Care, ASUFC Santa Maria della Misericordia University Hospital of Udine, Udine, Italy.
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Mardian Y, Kosasih H, Karyana M, Neal A, Lau CY. Review of Current COVID-19 Diagnostics and Opportunities for Further Development. Front Med (Lausanne) 2021; 8:615099. [PMID: 34026773 PMCID: PMC8138031 DOI: 10.3389/fmed.2021.615099] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnostic testing plays a critical role in addressing the coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Rapid and accurate diagnostic tests are imperative for identifying and managing infected individuals, contact tracing, epidemiologic characterization, and public health decision making. Laboratory testing may be performed based on symptomatic presentation or for screening of asymptomatic people. Confirmation of SARS-CoV-2 infection is typically by nucleic acid amplification tests (NAAT), which requires specialized equipment and training and may be particularly challenging in resource-limited settings. NAAT may give false-negative results due to timing of sample collection relative to infection, improper sampling of respiratory specimens, inadequate preservation of samples, and technical limitations; false-positives may occur due to technical errors, particularly contamination during the manual real-time polymerase chain reaction (RT-PCR) process. Thus, clinical presentation, contact history and contemporary phyloepidemiology must be considered when interpreting results. Several sample-to-answer platforms, including high-throughput systems and Point of Care (PoC) assays, have been developed to increase testing capacity and decrease technical errors. Alternatives to RT-PCR assay, such as other RNA detection methods and antigen tests may be appropriate for certain situations, such as resource-limited settings. While sequencing is important to monitor on-going evolution of the SARS-CoV-2 genome, antibody assays are useful for epidemiologic purposes. The ever-expanding assortment of tests, with varying clinical utility, performance requirements, and limitations, merits comparative evaluation. We herein provide a comprehensive review of currently available COVID-19 diagnostics, exploring their pros and cons as well as appropriate indications. Strategies to further optimize safety, speed, and ease of SARS-CoV-2 testing without compromising accuracy are suggested. Access to scalable diagnostic tools and continued technologic advances, including machine learning and smartphone integration, will facilitate control of the current pandemic as well as preparedness for the next one.
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Affiliation(s)
- Yan Mardian
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Herman Kosasih
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
| | - Muhammad Karyana
- Indonesia Research Partnership on Infectious Disease (INA-RESPOND), Jakarta, Indonesia
- National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia, Jakarta, Indonesia
| | - Aaron Neal
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Chuen-Yen Lau
- National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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76
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Cavalcante Pinto Júnior V, Moura LFWG, Cavalcante RC, Lima JRC, Bezerra AS, de Sousa Dantas DR, Amaral CML, Lima DF, Júnior ABV, Florindo Guedes MI. Prevalence of COVID-19 in children, adolescents and adults in remote education situations in the city of Fortaleza, Brazil. Int J Infect Dis 2021; 108:20-26. [PMID: 33945867 PMCID: PMC8088039 DOI: 10.1016/j.ijid.2021.04.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES A retrospective study was conducted to identify the prevalence of COVID-19 through serology and RT-PCR in children, adolescents and adults. A database of the COVID-19 Tracking Program in school children was used. METHODS The data comprised sociodemographic and clinical variables, results of serological tests (IgM and IgG), and real-time-polymerase chain reaction (RT-PCR) results of IgM-positive individuals. The statistical analysis was performed with a 5% significance level. RESULTS Among 423 children, 107 (25.3%) exhibited seroprevalence with IgG, IgM or IgG/IgM; among 854 adolescents, 250 (29.2%) had positive serology; and among 282 adults, 59 (20.9%) were positive. The frequency of positivity on RT-PCR for SARS-CoV-2 was 3.5%, 3.6% and 6.0% in children, adolescents and adults, respectively. Children had a lower incidence of symptoms than adolescents (p = 0.001) and adults (p = 0.003); the most frequent were fever, ageusia, anosmia, headache, dry cough, sore throat, muscle pain, runny nose, dyspnoea, and diarrhoea. CONCLUSIONS The prevalence rate for all groups was 26.7% in serology and 4.04% in RT-PCR. Children had lower rates of IgM and fewer symptoms compared with adolescents and adults. The data suggest the potential for transmissibility in all age groups.
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Affiliation(s)
- Valdester Cavalcante Pinto Júnior
- Northeast Biotechnology Network, Graduate Program of Biotechnology, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil; Biotechnology and Molecular Biology Laboratory, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil.
| | | | | | | | - Arnaldo Solheiro Bezerra
- Northeast Biotechnology Network, Graduate Program of Biotechnology, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil; Biotechnology and Molecular Biology Laboratory, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil
| | - Daylana Régia de Sousa Dantas
- Northeast Biotechnology Network, Graduate Program of Biotechnology, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil; Biotechnology and Molecular Biology Laboratory, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil
| | - Cícero Matheus Lima Amaral
- Northeast Biotechnology Network, Graduate Program of Biotechnology, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil; Biotechnology and Molecular Biology Laboratory, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil
| | - Daniel Freire Lima
- Northeast Biotechnology Network, Graduate Program of Biotechnology, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil; Biotechnology and Molecular Biology Laboratory, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil
| | | | - Maria Izabel Florindo Guedes
- Biotechnology and Molecular Biology Laboratory, State University of Ceará, Campus do Itaperi, Fortaleza, CE, Brazil
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77
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Prognostic value of serum lactate dehydrogenase in hospitalized patients with Covid-19. REV ROMANA MED LAB 2021. [DOI: 10.2478/rrlm-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Background: Biochemical markers in COVID-19 remain to be defined. We analyzed the usefulness of LDH and ferritin in predicting outcome.
Methods: This retrospective study analyzed ferritin and LDH concentrations obtained during the first 11 days of hospitalization in COVID-19 patients. We compared the change in ferritin and LDH concentrations obtained on each day of hospital admission with respect to baseline values between patients with favorable and unfavorable outcomes. We used receiver operating curve analysis to determine cutoffs for predicting outcomes.
Results: We analyzed 387 patients. For determinations done on the 9th day, increases in LDH concentrations > 14.6% over the baseline yielded 80% positive predictive value, and a lack of increase yielded 96% negative predictive value for unfavorable outcomes. The change in ferritin concentration yielded lower predictive values.
Conclusion: The percentage of change in LDH with respect to the baseline on the 9th day of hospitalization can predict outcome..
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Drummond GB, Fischer D, Lees M, Bates A, Mann J, Arvind DK. Classifying signals from a wearable accelerometer device to measure respiratory rate. ERJ Open Res 2021; 7:00681-2020. [PMID: 33937389 PMCID: PMC8071973 DOI: 10.1183/23120541.00681-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background Automatic measurement of respiratory rate in general hospital patients is difficult. Patient movement degrades the signal and variation of the breathing cycle means that accurate observation for ≥60 s is needed for adequate precision. Methods We studied acutely ill patients recently admitted to a teaching hospital. Breath duration was measured from a triaxial accelerometer attached to the chest wall and compared with a signal from a nasal cannula. We randomly divided the patient records into a training (n=54) and a test set (n=7). We used machine learning to train a neural network to select reliable signals, automatically identifying signal features associated with accurate measurement of respiratory rate. We used the test records to assess the accuracy of the device, indicated by the median absolute difference between respiratory rates, provided by the accelerometer and by the nasal cannula. Results In the test set of patients, machine classification of the respiratory signal reduced the median absolute difference (interquartile range) from 1.25 (0.56–2.18) to 0.48 (0.30–0.78) breaths per min. 50% of the recording periods were rejected as unreliable and in one patient, only 10% of the signal time was classified as reliable. However, even only 10% of observation time would allow accurate measurement for 6 min in an hour of recording, giving greater reliability than nurse charting, which is based on much less observation time. Conclusion Signals from a body-mounted accelerometer yield accurate measures of respiratory rate, which could improve automatic illness scoring in adult hospital patients. A machine learning method was developed to classify sections of breathing records from acutely ill patients wearing a small wireless motion sensor. This would allow accurate and automatic measurement, recording, and charting of respiratory rate.https://bit.ly/301P8XW
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Affiliation(s)
- Gordon B Drummond
- Dept of Anaesthesia, Critical Care, and Pain Medicine, University of Edinburgh, Edinburgh, UK
| | - Darius Fischer
- Centre for Speckled Computing, School of Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Andrew Bates
- Centre for Speckled Computing, School of Informatics, University of Edinburgh, Edinburgh, UK
| | - Janek Mann
- Centre for Speckled Computing, School of Informatics, University of Edinburgh, Edinburgh, UK
| | - D K Arvind
- Centre for Speckled Computing, School of Informatics, University of Edinburgh, Edinburgh, UK
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Cori L, Curzio O, Adorni F, Prinelli F, Noale M, Trevisan C, Fortunato L, Giacomelli A, Bianchi F. Fear of COVID-19 for Individuals and Family Members: Indications from the National Cross-Sectional Study of the EPICOVID19 Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3248. [PMID: 33801074 PMCID: PMC8003842 DOI: 10.3390/ijerph18063248] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/08/2023]
Abstract
The study analyzed the association of the fear of contagion for oneself and for family members (FMs) during the first wave of the COVID-19 pandemic, with demographic and socioeconomic status (SES) and health factors. The study was performed within the EPICOVID19 web-based Italian survey, involving adults from April-June 2020. Out of 207,341 respondents, 95.9% completed the questionnaire (60% women with an average age of 47.3 vs. 48.9 years among men). The association between fear and demographic and SES characteristics, contacts with COVID-19 cases, nasopharyngeal swab, self-perceived health, flu vaccination, chronic diseases and specific symptoms was analyzed by logistic regression model; odds ratios adjusted for sex, age, education and occupation were calculated (aORs). Fear for FMs prevailed over fear for oneself and was higher among women than men. Fear for oneself decreased with higher levels of education and in those who perceived good health. Among those vaccinated for the flu, 40.8% responded they had feelings of fear for themselves vs. 34.2% of the not vaccinated. Fear increased when diseases were declared and it was higher when associated with symptoms such as chest pain, olfactory/taste disorders, heart palpitations (aORs > 1.5), lung or kidney diseases, hypertension, depression and/or anxiety. Trends in fear by region showed the highest percentage of positive responses in the southern regions. The knowledge gained from these results should be used to produce tailored messages and shared public health decisions.
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Affiliation(s)
- Liliana Cori
- Department of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.C.); (F.B.)
| | - Olivia Curzio
- Department of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.C.); (F.B.)
| | - Fulvio Adorni
- Unit of Epidemiology, Institute of Biomedical Technologies, National Research Council, Segrate, 20157 Milan, Italy; (F.A.); (F.P.)
| | - Federica Prinelli
- Unit of Epidemiology, Institute of Biomedical Technologies, National Research Council, Segrate, 20157 Milan, Italy; (F.A.); (F.P.)
| | - Marianna Noale
- Institute of Neurosciences, National Research Council, 35127 Padova, Italy; (M.N.); (C.T.)
| | - Caterina Trevisan
- Institute of Neurosciences, National Research Council, 35127 Padova, Italy; (M.N.); (C.T.)
| | - Loredana Fortunato
- Epidemiology and Health Research Laboratory, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy;
| | - Andrea Giacomelli
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy;
| | - Fabrizio Bianchi
- Department of Environmental Epidemiology and Disease Registries, Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy; (L.C.); (F.B.)
- Institute for Research and Innovation in Biomedicine, National Research Council, 90148 Palermo, Italy
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80
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Limited Utility of Procalcitonin in Identifying Community-Associated Bacterial Infections in Patients Presenting with Coronavirus Disease 2019. Antimicrob Agents Chemother 2021; 65:AAC.02167-20. [PMID: 33495224 PMCID: PMC8097424 DOI: 10.1128/aac.02167-20] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/19/2021] [Indexed: 01/09/2023] Open
Abstract
The role of procalcitonin in identifying community-associated bacterial infections among patients with coronavirus disease 2019 is not yet established. In 2,443 patients with 148 bacterial coinfections, mean procalcitonin levels were significantly higher with any bacterial infection (13.16 ± 51.19 ng/ml; P = 0.0091) and with bacteremia (34.25 ± 85.01 ng/ml; P = 0.0125) than without infection (2.00 ± 15.26 ng/ml). The role of procalcitonin in identifying community-associated bacterial infections among patients with coronavirus disease 2019 is not yet established. In 2,443 patients of whom 148 had bacterial coinfections, mean procalcitonin levels were significantly higher with any bacterial infection (13.16 ± 51.19 ng/ml; P = 0.0091) and with bacteremia (34.25 ± 85.01 ng/ml; P = 0.0125) than without infection (2.00 ± 15.26 ng/ml). Procalcitonin (cutoff, 0.25 or 0.50 ng/ml) did not reliably identify bacterial coinfections but may be useful in excluding bacterial infection.
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81
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Yildirim OA, Poyraz K, Erdur E. Depression and anxiety in cancer patients before and during the SARS-CoV-2 pandemic: association with treatment delays. Qual Life Res 2021; 30:1903-1912. [PMID: 33635508 PMCID: PMC7907665 DOI: 10.1007/s11136-021-02795-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Pandemics can be associated with anxiety and depression in cancer patients who are undergoing treatment. In the present study, we aimed to perform a comparative evaluation of the conditions of cancer patients before and during the severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) pandemic using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) to detect the impact of the pandemic on treatment delays that are associated with anxiety and depression in cancer patients. In addition, the effect of public transport use on treatment delays was examined. METHODS BDI and BAI were administered to 595 breast, ovarian, colon and gastric cancer patients before and during the pandemic. The questionnaires were administered by the physician blindly, who was unaware of the delay of the patients. The number of days by which the patients delayed their treatment due to the fear of contamination were recorded retrospectively. Correlation analyses were performed between the obtained scores and treatment delays. RESULTS The depression and anxiety levels in cancer patients were found to increase during the pandemic (p = 0.000), and this increase was positively correlated with the disruption of their treatment (p = 0.000, r = 0.81). Depression and anxiety levels and treatment delays were higher in elderly patients (p = 0.021). Depression and anxiety were more pronounced in female patients (p = 0.000). Moreover, treatment delays were more common in patients who had to use public transportation (p = 0.038). CONCLUSION SARS-CoV-2 pandemic may increase anxiety and depression in cancer patients. This can cause patients to experience treatment delays due to concerns about becoming infected. At this point, if necessary, assistance should be obtained from psychiatric and public health experts.
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Affiliation(s)
- Ozgen Ahmet Yildirim
- Department of Internal Medicine, Division of Medical Oncology, Gazi Yasargil Training and Research Hospital, 21070, Diyarbakir, Turkey.
| | - Kerem Poyraz
- Department of Radiation Oncology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Erkan Erdur
- Department of Internal Medicine, Division of Medical Oncology, Gazi Yasargil Training and Research Hospital, 21070, Diyarbakir, Turkey
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Scotto R, Pinchera B, Perna F, Atripaldi L, Giaccone A, Sequino D, Zappulo E, Sardanelli A, Schiano Moriello N, Stanziola A, Bocchino M, Gentile I, Sanduzzi A. Serum KL-6 Could Represent a Reliable Indicator of Unfavourable Outcome in Patients with COVID-19 Pneumonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042078. [PMID: 33672761 PMCID: PMC7924557 DOI: 10.3390/ijerph18042078] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023]
Abstract
KL-6 is a sialoglycoprotein antigen which proved elevated in the serum of patients with different interstitial lung diseases, especially in those with a poorer outcome. Given that interstitial pneumonia is the most common presentation of SARS-CoV2 infection, we evaluated the prognostic role of KL-6 in patients with COVID-19 pneumonia. Patients with COVID-19 pneumonia were prospectively enrolled. Blood samples were collected at the time of enrolment (TOE) and on day 7 (T1). Serum KL-6 concentrations were measured by chemiluminescence enzyme immunoassay using a KL-6 antibody kit (LUMIPULSE G1200, Fujirebio) and the cut-off value was set at >1000 U/mL. Fifteen out of 34 enrolled patients (44.1%) died. Patients with unfavourable outcome showed significantly lower P/F ratio and higher IL-6 values and plasmatic concentrations of KL-6 at TOE compared with those who survived (median KL-6: 1188 U/mL vs. 260 U/mL, p < 0.001). KL-6 > 1000 U/mL resulted independently associated with death (aOR: 11.29, p < 0.05) with a positive predictive value of 83.3%. Our results suggest that KL-6 is a reliable indicator of pulmonary function and unfavourable outcome in patients with COVID-19 pneumonia. A KL-6 value > 1000 U/mL resulted independently associated with death and showed good accuracy in predicting a poorer outcome. KL-6 may thus represent a quick, inexpensive, and sensitive parameter to stratify the risk of severe respiratory failure and death.
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Affiliation(s)
- Riccardo Scotto
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
- Correspondence:
| | - Francesco Perna
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Lidia Atripaldi
- Laboratory of Clinical Biochemistry, Monaldi Hospital, 80131 Naples, Italy;
| | - Agnese Giaccone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Davide Sequino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Emanuela Zappulo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Alessia Sardanelli
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Nicola Schiano Moriello
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Anna Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Marialuisa Bocchino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
- Staff of United Nations Educational, Scientific and Cultural Organization (UNESCO), Health Education and Sustainable Development, University Federico II of Naples, 80131 Naples, Italy
| | - Alessandro Sanduzzi
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
- Staff of United Nations Educational, Scientific and Cultural Organization (UNESCO), Health Education and Sustainable Development, University Federico II of Naples, 80131 Naples, Italy
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Validation of two severity scores as predictors for outcome in Coronavirus Disease 2019 (COVID-19). PLoS One 2021; 16:e0247488. [PMID: 33606842 PMCID: PMC7895342 DOI: 10.1371/journal.pone.0247488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/08/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An established objective and standardized reporting of clinical severity and disease progression in COVID-19 is still not established. We validated and compared the usefulness of two classification systems reported earlier-a severity grading proposed by Siddiqi and a system from the National Australian COVID-19 guideline. Both had not been validated externally and were now tested for their ability to predict complications. METHODS In this retrospective, single-centre observational study, patients hospitalized with confirmed COVID-19 across all severity stages were enrolled. The clinical severity was graded at admission and during hospitalization. Multivariate Cox regression was used to identify independent risk factors for mortality, a composite primary (mortality, incident acute respiratory distress syndrome, incident mechanical ventilation), a secondary endpoint (mortality, incident acute myocardial injury, incident venous thrombosis, pulmonary embolism or stroke) and progression of severity grades. RESULTS Of 109 patients 17 died, 31 and 48 developed the primary and secondary endpoint, respectively. Worsening of the severity grade by at least one stage occurred in 27 and 28 patients, respectively. Siddiqi and Australian classification were identified as independent predictors for the primary endpoint (adjusted hazard ratio (aHR) 2.30, p<0.001 and aHR 2.08, p<0.001), for the secondary endpoint (aHR 2.12, p<0.001 and aHR 1.79, p<0.001) and mortality (aHR 2.30, p = 0.071 and aHR 1.98, p = 0.017). Both classification systems showed very good agreement regarding initial grading and good agreement regarding progression of severity stages. CONCLUSIONS Standardized and objective severity grading is useful to unequivocally stratify patients presenting with COVID-19 for their individual risk of complications.
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Lee SC, Son KJ, Han CH, Park SC, Jung JY. Impact of COPD on COVID-19 prognosis: A nationwide population-based study in South Korea. Sci Rep 2021; 11:3735. [PMID: 33580190 PMCID: PMC7880985 DOI: 10.1038/s41598-021-83226-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
Underlying chronic respiratory disease may be associated with the severity of coronavirus disease 2019 (COVID-19). This study investigated the impact of chronic obstructive pulmonary disease (COPD) on the risk for respiratory failure and mortality in COVID-19 patients. A nationwide retrospective cohort study was conducted in 4610 patients (≥ 40 years old) infected with COVID-19 between January 20 and May 27, 2020, using data from the Ministry of Health and Welfare and Health Insurance Review and Assessment Service in Korea. The clinical course and various clinical features were compared between COPD and non-COPD patients, and the risks of respiratory failure and all-cause mortality in COPD patients were analyzed using a multivariate logistic regression model. Among 4610 COVID-19 patients, 4469 (96.9%) and 141 (3.1%) were categorized into the non-COPD and COPD groups, respectively. The COPD group had greater proportions of older (≥ 60 years old) (78.0% vs. 45.2%, P < 0.001) and male (52.5% vs. 36.6%, P < 0.001) patients than the non-COPD group. Relatively greater proportions of patients with COPD received intensive critical care (7.1% vs. 3.7%, P = 0.041) and mechanical ventilation (5.7% vs. 2.4%, P = 0.015). Multivariate analyses showed that COPD was not a risk factor for respiratory failure but was a significant independent risk factor for all-cause mortality (OR = 1.80, 95% CI 1.11–2.93) after adjustment for age, sex, and Charlson Comorbidity Index score. Among COVID-19 patients, relatively greater proportions of patients with COPD received mechanical ventilation and intensive critical care. COPD is an independent risk factor for all-cause mortality in COVID-19 patients in Korea.
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Affiliation(s)
- Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444, Republic of Korea.,Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Ju Son
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Biostatistics and Computing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444, Republic of Korea
| | - Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444, Republic of Korea.
| | - Ji Ye Jung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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85
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Evaluation of serum ferritin for prediction of severity and mortality in COVID-19- A cross sectional study. Ann Med Surg (Lond) 2021; 63:102163. [PMID: 33614024 PMCID: PMC7879065 DOI: 10.1016/j.amsu.2021.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background Ferritin even though widely recognized as a representative of total body iron stores, its prognostic utility is linked with COVID-19. This study was aimed at evaluation of the association of ferritin with severity in Coronavirus disease 2019 (COVID-19), hospitalized patients and to test the hypothesis that it is an independent predictor of mortality. Material and methods This study was conducted at Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi. Medical records of all in-patients including both genders, and all age groups with documented COVID-19 from 1st March to 10th August 2020 were reviewed. The subjects were divided into two categories severe and non-severe COVID-19; and survivors and non-survivors. The details were recorded on a pre-structured performa. Between-group differences were tested using the Mann–Whitney's U-test. The receiver operating characteristic curve was plotted for ferritin with severity and mortality. A binary logistic regression was used to identify variables independently associated with mortality. The data was analyzed using Statistical Package for the Social Sciences (SPSS). Results A total of 336 in patients were reviewed as declared COVID-19 positive during the study duration, and 157 were included in the final analysis including 108 males and 49 females. Statistically significant difference in ferritin was found in the two categories based on severity and mortality. Binary logistic regression showed ferritin to be an independent predictor of all-cause mortality supplemented with an AUC of 0.69 on ROC analysis. Conclusions Serum ferritin concentration is a promising predictor of mortality in COVID-19 cases. Serum Ferritin was evaluated as a prognostic biomarker in COVID-19 Statistically significant difference in ferritin was found in the two categories based on severity and mortality. Ferritin was found to be an independent predictor of all-cause mortality
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86
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Faghih Dinevari M, Somi MH, Sadeghi Majd E, Abbasalizad Farhangi M, Nikniaz Z. Anemia predicts poor outcomes of COVID-19 in hospitalized patients: a prospective study in Iran. BMC Infect Dis 2021; 21:170. [PMID: 33568084 PMCID: PMC7875447 DOI: 10.1186/s12879-021-05868-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are limited number of studies with controversial findings regarding the association between anemia at admission and coronavirus disease 2019 (COVID-19) outcomes. Therefore, in this research, we aimed to investigate the prospective association between anemia and COVID-19 outcomes in hospitalized patients in Iran. METHODS In this prospective study, the data of 1274 consecutive patients hospitalized due to COVID-19 were statistically analyzed. All biomarkers, including hemoglobin and high-sensitivity C-reactive protein (hs-CRP) levels were measured using standard methods. Anemia was defined as a hemoglobin (Hb) concentration of less than 13 g/dL and 12 g/dL in males and females, respectively. Assessing the association between anemia and COVID-19 survival in hospitalized patients was our primary endpoint. RESULTS The mean age of the participants was 64.43 ± 17.16 years, out of whom 615 (48.27%) were anemic subjects. Patients with anemia were significantly older (P = 0.02) and had a higher frequency of cardiovascular diseases, hypertension, kidney disease, diabetes, and cancer (P < 0.05). The frequency of death (anemic: 23.9% vs. nonanemic: 13.8%), ICU admission (anemic: 27.8% vs. nonanemic:14.71%), and ventilator requirement (anemic: 35.93% vs. nonanemic: 20.63%) were significantly higher in anemic patients than in nonanemic patients (P < 0.001). According to the results of regression analysis, after adjusting for significant covariate in the univariable model, anemia was independently associated with mortality (OR: 1.68, 95% CI: 1.10, 2.57, P = 0.01), ventilator requirement (OR: 1.74, 95% CI: 1.19, 2.54, P = 0.004), and the risk of ICU admission (OR: 2.06, 95% CI: 1.46, 2.90, P < 0.001). CONCLUSION The prevalence of anemia in hospitalized patients with COVID-19 was high and was associated with poor outcomes of COVID-19.
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Affiliation(s)
- Masood Faghih Dinevari
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Sadeghi Majd
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Association between Clinical Characteristics and Laboratory Findings with Outcome of Hospitalized COVID-19 Patients: A Report from Northeast Iran. Interdiscip Perspect Infect Dis 2021; 2021:5552138. [PMID: 33628234 PMCID: PMC7874843 DOI: 10.1155/2021/5552138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) was first discovered in December 2019 in China and has rapidly spread worldwide. Clinical characteristics, laboratory findings, and their association with the outcome of patients with COVID-19 can be decisive in management and early diagnosis. Data were obtained retrospectively from medical records of 397 hospitalized COVID-19 patients between February and May 2020 in Imam Reza Hospital, northeast Iran. Clinical and laboratory features were evaluated among survivors and nonsurvivors. The correlation between variables and duration of hospitalization and admission to the intensive care unit (ICU) was determined. Male sex, age, hospitalization duration, and admission to ICU were significantly related to mortality rate. Headache was a more common feature in patients who survived (p=0.017). It was also related to a shorter stay in the hospital (p=0.032) as opposed to patients who experienced chest pain (p=0.033). Decreased levels of consciousness and dyspnea were statistically more frequent in nonsurvivors (p=0.003 and p=0.011, respectively). Baseline white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were significantly higher in nonsurvivors (p < 0.001). Patients with higher WBC and CRP levels were more likely to be admitted to ICU (p=0.009 and p=0.001, respectively). Evaluating clinical and laboratory features can help clinicians find ways for risk stratifying patients and even make predictive tools. Chest pain, decreased level of consciousness, dyspnea, and increased CRP and WBC levels seem to be the most potent predictors of severe prognosis.
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88
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Kiss S, Gede N, Hegyi P, Németh D, Földi M, Dembrovszky F, Nagy B, Juhász MF, Ocskay K, Zádori N, Molnár Z, Párniczky A, Hegyi PJ, Szakács Z, Pár G, Erőss B, Alizadeh H. Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19: a systematic review and meta-analysis. Med Microbiol Immunol 2021; 210:33-47. [PMID: 33219397 PMCID: PMC7679241 DOI: 10.1007/s00430-020-00696-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023]
Abstract
Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMDALC = - 0.35 × 109/L [CI - 0.43, - 0.27], p < 0.001, I2 = 94.2%; < 0.8 × 109/L, ORALC = 3.74 [CI 1.77, 7.92], p = 0.001, I2 = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention.
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Affiliation(s)
- Szabolcs Kiss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Mária Földi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Bettina Nagy
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Márk Félix Juhász
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Klementina Ocskay
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University for Medical Sciences, Poznan, Poland
| | - Andrea Párniczky
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Péter Jenő Hegyi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Hussain Alizadeh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.
- First Department of Medicine, University of Szeged, Szeged, Hungary.
- Division of Hematology, First Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary.
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89
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Development of a Predictive Model for Mortality in Hospitalized Patients With COVID-19. Disaster Med Public Health Prep 2021; 16:1398-1406. [PMID: 33413721 PMCID: PMC8007955 DOI: 10.1017/dmp.2021.8] [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] [Indexed: 12/15/2022]
Abstract
Introduction: Early identification of patients with novel corona virus disease 2019 (COVID-19) who may be at high mortality risk is of great importance. Methods: In this retrospective study, we included all patients with COVID-19 at Huanggang Central Hospital from January 23 to March 5, 2020. Data on clinical characteristics and outcomes were compared between survivors and nonsurvivors. Univariable and multivariable logistic regression were used to explore risk factors associated with in-hospital death. A nomogram was established based on the risk factors selected by multivariable analysis. Results: A total of 150 patients were enrolled, including 31 nonsurvivors and 119 survivors. The multivariable logistic analysis indicated that increasing the odds of in-hospital death associated with higher Sequential Organ Failure Assessment score (odds ratio [OR], 3.077; 95% confidence interval [CI]: 1.848-5.122; P < 0.001), diabetes (OR, 10.474; 95% CI: 1.554-70.617; P = 0.016), and lactate dehydrogenase greater than 245 U/L (OR, 13.169; 95% CI: 2.934-59.105; P = 0.001) on admission. A nomogram was established based on the results of the multivariable analysis. The AUC of the nomogram was 0.970 (95% CI: 0.947-0.992), showing good accuracy in predicting the risk of in-hospital death. Conclusions: This finding would facilitate the early identification of patients with COVID-19 who have a high-risk for fatal outcome.
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90
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Marin BG, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, Salazar-Mather TP, Dumenco L, Savaria MC, Aung SN, Flanigan T, Michelow IC. Predictors of COVID-19 severity: A literature review. Rev Med Virol 2021; 31:1-10. [PMID: 32845042 PMCID: PMC7855377 DOI: 10.1002/rmv.2146] [Citation(s) in RCA: 471] [Impact Index Per Article: 157.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is a rapidly evolving global emergency that continues to strain healthcare systems. Emerging research describes a plethora of patient factors-including demographic, clinical, immunologic, hematological, biochemical, and radiographic findings-that may be of utility to clinicians to predict COVID-19 severity and mortality. We present a synthesis of the current literature pertaining to factors predictive of COVID-19 clinical course and outcomes. Findings associated with increased disease severity and/or mortality include age > 55 years, multiple pre-existing comorbidities, hypoxia, specific computed tomography findings indicative of extensive lung involvement, diverse laboratory test abnormalities, and biomarkers of end-organ dysfunction. Hypothesis-driven research is critical to identify the key evidence-based prognostic factors that will inform the design of intervention studies to improve the outcomes of patients with COVID-19 and to appropriately allocate scarce resources.
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Affiliation(s)
| | - Ghazal Aghagoli
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Katya Lavine
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Lanbo Yang
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Emily J. Siff
- Department of Cognitive, Linguistic, & Psychological Sciences, Brown University, Providence, Rhode Island
| | - Silvia S. Chiang
- Department of Pediatrics, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
| | - Thais P. Salazar-Mather
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Office of Medical Education and Continuous Quality Improvement, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Luba Dumenco
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Office of Medical Education and Continuous Quality Improvement, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michael C Savaria
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Su N. Aung
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Timothy Flanigan
- Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ian C. Michelow
- Department of Pediatrics, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Center for International Health Research, Rhode Island Hospital, Providence, Rhode Island
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91
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Ahmed S, Jafri L, Hoodbhoy Z, Siddiqui I. Prognostic Value of Serum Procalcitonin in COVID-19 Patients: A Systematic Review. Indian J Crit Care Med 2021; 25:77-84. [PMID: 33603306 PMCID: PMC7874291 DOI: 10.5005/jp-journals-10071-23706] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This study is aimed at reviewing the published literature on the prognostic role of serum procalcitonin (PCT) in COVID-19 cases. DATA RETRIEVAL We systematically reviewed the literature available on PubMed, MEDLINE, LitCovid NLM, and WHO: to assess the utility of PCT in prognosis of coronavirus disease. Scrutiny for eligible studies comprising articles that have evaluated the prognostic utility of PCT and data compilation was undertaken by two separate investigators. Original articles in human subjects reporting the prognostic role of PCT in adult COVID-19 patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized to assess the strength of evidence. Results were reported as narrative syntheses. RESULTS Out of the total 426 citations, 52 articles passed through screening. The quality of evidence and methodology of included studies was overall acceptable. The total sample size of the studies comprised of 15,296 COVID-19-positive subjects. Majority of the studies were from China, i.e., 40 (77%). The PCT cut-off utilized was 0.05 ng/mL by 18 (35%) studies, followed by 0.5 ng/mL by 9 (17.5%). Eighty five percent (n = 44) studies reported statistically significant association (p value < 0.05) between PCT and severity. CONCLUSION Procalcitonin appears as a promising prognostic biomarker of COVID-19 progression in conjunction with the clinical context. HOW TO CITE THIS ARTICLE Ahmed S, Jafri L, Hoodbhoy Z, Siddiqui I. Prognostic Value of Serum Procalcitonin in COVID-19 Patients: A Systematic Review. Indian J Crit Care Med 2021;25(1):77-84.
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Affiliation(s)
- Sibtain Ahmed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Lena Jafri
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Siddiqui
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
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Elezagic D, Johannis W, Burst V, Klein F, Streichert T. Venous blood gas analysis in patients with COVID-19 symptoms in the early assessment of virus positivity. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Objectives
Coronavirus disease 2019 (COVID-19) is currently a worldwide major health threat. Recognizing hypoxia in patients early on can have a considerable effect on therapy success and survival rate.
Methods
We collected data using a standard blood gas analyzer from 50 patients and analyzed measurements of partial pressure of carbon dioxide-pCO2, partial pressure of oxygen-pO2 and oxygen saturation-sO2, bicarbonate concentrations-HCO3− as well as ionized calcium concentrations. We further examined PCR test results for SARS-CoV-2 of the patients and analyzed differences between patients tested positive and those tested negative for the virus.
Results
Venous pCO2 was significantly higher whereas pO2 and sO2 were significantly lower in patients who tested positive for SARS-CoV-2. The pH, and ionized calcium concentrations of patients tested positive for the virus were significantly lower than in those tested negative.
Conclusions
Symptomatic SARS-CoV-2-positive patients upon admission to the emergency room exhibit lower venous blood levels of oxygen, pH, and calcium and higher levels of carbon dioxide compared to symptomatic SARS-CoV-2-negative patients. This blood gas analysis constellation could help in identifying SARS-CoV-2-positive patients more rapidly and identifying early signs of hypoxia.
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Affiliation(s)
- Dzemal Elezagic
- Faculty of Medicine and University Hospital Cologne , Institute for Clinical Chemistry, University of Cologne , Cologne , Germany
| | - Wibke Johannis
- Faculty of Medicine and University Hospital Cologne , Institute for Clinical Chemistry, University of Cologne , Cologne , Germany
| | - Volker Burst
- Emergency Department , Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
- Department II of Internal Medicine and Center for Molecular Medicine Cologne , Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | - Florian Klein
- Laboratory of Experimental Immunology , Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
- German Center for Infection Research, Partner Site Bonn-Cologne , Cologne , Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne , Cologne , Germany
- Faculty of Medicine , University of Cologne , Cologne , Germany
| | - Thomas Streichert
- Faculty of Medicine and University Hospital Cologne , Institute for Clinical Chemistry, University of Cologne , Cologne , Germany
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93
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Recinella G, Marasco G, Tufoni M, Brizi M, Evangelisti E, Maestri L, Fusconi M, Calogero P, Magalotti D, Zoli M. Clinical Role of Lung Ultrasound for the Diagnosis and Prognosis of Coronavirus Disease Pneumonia in Elderly Patients: A Pivotal Study. Gerontology 2020; 67:78-86. [PMID: 33271558 PMCID: PMC7801997 DOI: 10.1159/000512209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022] Open
Abstract
Background Lung ultrasound (LUS) showed a promising role in the diagnosis and monitoring of patients hospitalized for novel coronavirus disease (COVID-19). However, no data are available on its role in elderly patients. Aims The aim of this study was to evaluate the diagnostic and prognostic role of LUS in elderly patients hospitalized for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pneumonia. Methods Consecutive elderly patients (age >65 years) hospitalized for COVID-19 were enrolled. Demographics, laboratory, comorbidity, and the clinical features of the patients were collected. All patients underwent LUS on admission to the ward. LUS characteristics have been analyzed. Uni- and multivariate analyses to evaluate predictors for in-hospital death were performed. Results Thirty-seven hospitalized elderly patients (19 men) with a diagnosis of SARS-CoV-2 infection were consecutively enrolled. The median age was 82 years (interquartile range 74.5–93.5). Ultrasound alterations were found in all patients enrolled; inhomogeneous interstitial syndrome with spared areas (91.9%) and pleural alterations (100%) were the most frequent findings. At univariate analysis, LUS score (hazard ratio [HR] 1.168, 95% CI 1.049–1.301) and pleural effusions (HR 3.995, 95% CI 1.056–15.110) were associated with in-hospital death. At multivariate analysis, only LUS score (HR 1.168, 95% CI 1.049–1.301) was independelty associated with in-hospital death. The LUS score's best cutoff for distinguishing patients experiencing in-hospital death was 17 (at multivariate analysis LUS score ≥17, HR 4.827, 95% CI 1.452–16.040). In-hospital death was significantly different according to the LUS score cutoff of 17 (p = 0.0046). Conclusion LUS could play a role in the diagnosis and prognosis in elderly patients hospitalized for SARS-CoV-2 infection.
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Affiliation(s)
- Guerino Recinella
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy,
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mara Brizi
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eleonora Evangelisti
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lorenzo Maestri
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marco Fusconi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Calogero
- Acute Geriatric Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Donatella Magalotti
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Marco Zoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, Bologna, Italy
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94
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Hodges G, Pallisgaard J, Schjerning Olsen AM, McGettigan P, Andersen M, Krogager M, Kragholm K, Køber L, Gislason GH, Torp-Pedersen C, Bang CN. Association between biomarkers and COVID-19 severity and mortality: a nationwide Danish cohort study. BMJ Open 2020; 10:e041295. [PMID: 33268425 PMCID: PMC7712929 DOI: 10.1136/bmjopen-2020-041295] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/23/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the association between common biomarkers, death and intensive care unit (ICU) admission in patients with COVID-19. DESIGN Retrospective cohort study. From electronic national registry data, we used Cox analysis and bootstrapping to evaluate associations between baseline levels of biomarkers and standardised absolute risks of death/ICU admission, adjusted for age and gender. SETTING All hospitals in Denmark. PARTICIPANTS 1310 patients aged ≥18 years admitted to hospital with COVID-19 from 27th of February to 1st of May 2020, with available biochemistry data. MAIN OUTCOME MEASURES A composite of death/ICU admission occurring within 30 days. RESULTS Of the 1310 patients admitted to hospital (54.6% men; median age 73.6 years), 352 (26.9%) experienced the composite endpoint and 263 (20.1%) died. For the composite endpoint, the absolute risks for moderately and severely elevated C reactive protein (CRP) were significantly higher, 21.5% and 39.2%, respectively, compared with 5.0% for those with normal CRP. Moderately and severely elevated leucocytes were significantly higher, 34.5% and 46.6% risk, respectively, compared with 23.2% for those with normal leucocytes. Moderately and severely decreased estimated glomerular filtration rates (eGFR) were significantly higher, 41.5% and 45.9% risk, respectively, compared with 30.4% for those with normal/mildly decreased eGFR. Normal and elevated ureas were significantly higher, 22.3% and 40.6% risk, respectively, compared with 7.3% for those with low urea. Elevated D-dimer was significantly higher, 31.8% risk, compared with 17.5% for those with normal D-dimer. Moderately and severely elevated troponins were significantly higher, 27.7% and 57.3% risk, respectively, compared with 9.4% for those with normal troponin. Elevated procalcitonin was significantly higher, 52.1% risk, compared with 28.0% for those with normal procalcitonin. CONCLUSION In this nationwide study of patients admitted with COVID-19, elevated levels of CRP, leucocytes, procalcitonin, urea, troponins and D-dimer, and low levels of eGFR were associated with higher standardised absolute risk of death/ICU admission within 30 days.
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Affiliation(s)
- Gethin Hodges
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Jannik Pallisgaard
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Anne-Marie Schjerning Olsen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- The Danish Heart Foundation, Department of Research, Copenhagen, Denmark
| | - Patricia McGettigan
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mikkel Andersen
- Unit of Clinical Biostatistics and Epidemiology and Department of Cardiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - Maria Krogager
- Unit of Clinical Biostatistics and Epidemiology and Department of Cardiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
- Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
- The Danish Heart Foundation, Department of Research, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Denmark Regional Hospital & Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Investigation and Cardiology, North Zealand Hospital, Hillerød, Denmark
| | - Casper N Bang
- The Danish Heart Foundation, Department of Research, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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95
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Liu W, Liu Y, Xu Z, Jiang T, Kang Y, Zhu G, Chen Z. Clinical characteristics and predictors of the duration of SARS-CoV-2 viral shedding in 140 healthcare workers. J Intern Med 2020; 288:725-736. [PMID: 32959400 PMCID: PMC7537050 DOI: 10.1111/joim.13160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Epidemiological and clinical features of patients with COVID-19 have been reported, but none of them focused on medical staff, and few predictors of the duration of viral shedding have been reported. It is urgent to help healthcare workers prevent and recover quickly from the coronavirus disease 2019 (COVID-19). METHODS We enrolled 140 medical workers with COVID-19 in Wuhan. Epidemiological, demographic, clinical, laboratory, radiological treatment and clinical outcome data were collected, and predictors of the duration of viral shedding were explored through multivariable linear regression analysis. RESULTS The medical staff with COVID-19 presented mild clinical symptoms and showed a low frequency of abnormal laboratory indicators. All the medical staff were cured and discharged, of whom 96 (68.6%) were female, 39 (27.9%) had underlying diseases, the median age was 36.0 years, and 104 (74.3%) were infected whilst working in hospital. The median duration of viral shedding was 25.0 days (IQR:20.0-30.0). Multivariable linear regression analysis showed reducing viral shedding duration was associated with receiving recombinant human interferon alpha (rIFN-α) treatment, whilst the prolonged duration of viral shedding correlated with the use of glucocorticoid treatment, the durations from the first symptom to hospital admission and the improvement in chest computed tomography (CT) evidence. Moreover, infected healthcare workers with lymphocytes less than 1.1 × 109 /L on admission had prolonged viral shedding. CONCLUSION Medical staff with timely medical interventions show milder clinical features. Glucocorticoid treatment and lymphocytes less than 1.1 × 109/L are associated with prolonged viral shedding. Early admission and rIFN-α treatment help shorten the duration of viral shedding.
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Affiliation(s)
- W Liu
- From the, Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Y Liu
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Z Xu
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - T Jiang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y Kang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - G Zhu
- From the, Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Z Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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96
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Soysal A, Gönüllü E, Arslan H, Kibar BS, Pop S, Yurttaş GN, Demirbacak H, Ünal F, Öktem S, Atıcı S, Yücel Şen AD, Karabayır N, Karaböcüoğlu M. Comparison of Clinical and Laboratory Features and Treatment Options of 237 Symptomatic and Asymptomatic Children Infected with SARS-CoV-2 in the Early Phase of the COVID-19 Pandemic in Turkey. Jpn J Infect Dis 2020; 74:273-279. [PMID: 33250495 DOI: 10.7883/yoken.jjid.2020.781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about the therapeutic use of hydroxychloroquine in pediatric patients with coronavirus disease 2019 (COVID-19). Here, we retrospectively retrieved data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive pediatric patients from 20 hospitals in 8 Turkish cities. We obtained epidemiological, clinical, and laboratory features of the patients, as well as the drugs used for treating COVID-19. A total of 237 nasopharyngeal swab SARS-CoV-2 PCR-positive children were included in the study from March 26, 2020 to June 20, 2020. The mean age of asymptomatic children (118 ± 62 months) was higher than that of symptomatic children (89 ± 69 months). Symptomatic children had significantly lower mean lymphocyte counts and higher mean CRP, D-dimer, procalcitonin, and LDH levels than asymptomatic children in the univariate analysis. Among 156 children, 78 (50%), 15, 44, and 21 were treated with a hydroxychloroquine-containing regimen, hydroxychloroquine + azithromycin + oseltamivir, hydroxychloroquine + azithromycin, and hydroxychloroquine alone, respectively. Among 156 patients who received medical treatment, 90 (58%) underwent pre- and/or post-treatment electrocardiogram (ECG). However, none of them had ECG abnormalities or required hydroxychloroquine discontinuation due to adverse drug reactions.
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Affiliation(s)
- Ahmet Soysal
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
| | - Erdem Gönüllü
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
| | | | | | | | | | | | - Füsun Ünal
- Medipol University, Department of Pediatrics, Turkey
| | - Sedat Öktem
- Medipol University, Department of Pediatrics, Turkey
| | - Serkan Atıcı
- Okan University Hospital, Division of Pediatric Infectious Diseases, Turkey
| | | | | | - Metin Karaböcüoğlu
- Memorial Ataşehir Hospital, Division of Pediatric Infectious Diseases, Turkey
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97
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Singh N, Anchan RK, Besser SA, Belkin MN, Cruz MD, Lee L, Yu D, Mehta N, Nguyen AB, Alenghat FJ. High sensitivity Troponin-T for prediction of adverse events in patients with COVID-19. Biomarkers 2020; 25:626-633. [PMID: 32981387 PMCID: PMC7711742 DOI: 10.1080/1354750x.2020.1829056] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND High sensitivity cardiac troponin-T (hs-TnT) has been associated with mortality in patients hospitalized with COVID-19. We aimed to determine if hs-TnT levels and their timing are independent predictors of adverse events in these patients. DESIGN Retrospective chart review was performed for all patients hospitalized at our institution between 23 March 2020 and 13 April 2020 who were found to be COVID-19-positive. Clinical, demographic, and laboratory variables including initial and peak hs-TnT were recorded. Univariable and multivariable analyses were completed for a primary composite endpoint of in-hospital death, intubation, need for critical care, or cardiac arrest. RESULTS In the 276 patients analysed, initial hs-TnT above the median (≥17 ng/L) was associated with increased length of stay, need for vasoactive medications, and death, along with the composite endpoint (OR 3.92, p < 0.001). Multivariable analysis demonstrated that elevated initial hs-TnT was independently associated with the primary endpoint (OR 2.92, p = 0.01). Late-peaking hs-TnT (OR 2.19 for each additional day until peak, p < 0.001) was also independently associated with the composite endpoint. CONCLUSIONS In patients hospitalized with COVID-19, hs-TnT identifies patients at high risk for adverse in-hospital events, and trends of hs-TnT over time, particularly during the first day, provide additional prognostic information.
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Affiliation(s)
- Nikhil Singh
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Rajeev K. Anchan
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Stephanie A. Besser
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Mark N. Belkin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Mark D. Cruz
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Linda Lee
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Dongbo Yu
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Natasha Mehta
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Ann B. Nguyen
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Francis J. Alenghat
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, 60637, USA
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98
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Mirani M, Favacchio G, Carrone F, Betella N, Biamonte E, Morenghi E, Mazziotti G, Lania AG. Impact of Comorbidities and Glycemia at Admission and Dipeptidyl Peptidase 4 Inhibitors in Patients With Type 2 Diabetes With COVID-19: A Case Series From an Academic Hospital in Lombardy, Italy. Diabetes Care 2020; 43:3042-3049. [PMID: 33023989 DOI: 10.2337/dc20-1340] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes may unfavorably influence the outcome of coronavirus disease 19 (COVID-19), but the determinants of this effect are still poorly understood. In this monocentric study, we aimed at evaluating the impact of type 2 diabetes, comorbidities, plasma glucose levels, and antidiabetes medications on the survival of COVID-19 patients. RESEARCH DESIGN AND METHODS This was a case series involving 387 COVID-19 patients admitted to a single center in the region of Lombardy, the epicenter of the severe acute respiratory syndrome coronavirus 2 pandemic in Italy, between 20 February and 9 April 2020. Medical history, pharmacological treatments, laboratory findings, and clinical outcomes of patients without diabetes and patients with type 2 diabetes were compared. Cox proportional hazards analysis was applied to investigate risk factors associated with mortality. RESULTS Our samples included 90 patients (23.3%) with type 2 diabetes, who displayed double the mortality rate of subjects without diabetes (42.3% vs. 21.7%, P < 0.001). In spite of this, after correction for age and sex, risk of mortality was significantly associated with a history of hypertension (adjusted hazard ratio [aHR] 1.84, 95% CI 1.15-2.95; P = 0.011), coronary artery disease (aHR 1.56, 95% CI 1.04-2.35; P = 0.031), chronic kidney disease (aHR 2.07, 95% CI 1.27-3.38; P = 0.003), stroke (aHR 2.09, 95% CI 1.23-3.55; P = 0.006), and cancer (aHR 1.57, 95% CI 1.08-2.42; P = 0.04) but not with type 2 diabetes (P = 0.170). In patients with diabetes, elevated plasma glucose (aHR 1.22, 95% CI 1.04-1.44, per mmol/L; P = 0.015) and IL-6 levels at admission (aHR 2.47, 95% CI 1.28-4.78, per 1-SD increase; P = 0.007) as well as treatment with insulin (aHR 3.05, 95% CI 1.57-5.95; P = 0.001) and β-blockers (aHR 3.20, 95% CI 1.50-6.60; P = 0.001) were independently associated with increased mortality, whereas the use of dipeptidyl peptidase 4 inhibitors was significantly and independently associated with a lower risk of mortality (aHR 0.13, 95% CI 0.02-0.92; P = 0.042). CONCLUSIONS Plasma glucose levels at admission and antidiabetes drugs may influence the survival of COVID-19 patients affected by type 2 diabetes.
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Affiliation(s)
- Marco Mirani
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giuseppe Favacchio
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Flaminia Carrone
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Nazarena Betella
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Emilia Biamonte
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Gherardo Mazziotti
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Gerardo Lania
- Endocrinology and Diabetology Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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99
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Brunetta E, Folci M, Bottazzi B, De Santis M, Gritti G, Protti A, Mapelli SN, Bonovas S, Piovani D, Leone R, My I, Zanon V, Spata G, Bacci M, Supino D, Carnevale S, Sironi M, Davoudian S, Peano C, Landi F, Di Marco F, Raimondi F, Gianatti A, Angelini C, Rambaldi A, Garlanda C, Ciccarelli M, Cecconi M, Mantovani A. Macrophage expression and prognostic significance of the long pentraxin PTX3 in COVID-19. Nat Immunol 2020; 22:19-24. [PMID: 33208929 DOI: 10.1038/s41590-020-00832-x] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023]
Abstract
Long pentraxin 3 (PTX3) is an essential component of humoral innate immunity, involved in resistance to selected pathogens and in the regulation of inflammation1-3. The present study was designed to assess the presence and significance of PTX3 in Coronavirus Disease 2019 (COVID-19)4-7. RNA-sequencing analysis of peripheral blood mononuclear cells, single-cell bioinformatics analysis and immunohistochemistry of lung autopsy samples revealed that myelomonocytic cells and endothelial cells express high levels of PTX3 in patients with COVID-19. Increased plasma concentrations of PTX3 were detected in 96 patients with COVID-19. PTX3 emerged as a strong independent predictor of 28-d mortality in multivariable analysis, better than conventional markers of inflammation, in hospitalized patients with COVID-19. The prognostic significance of PTX3 abundance for mortality was confirmed in a second independent cohort (54 patients). Thus, circulating and lung myelomonocytic cells and endothelial cells are a major source of PTX3, and PTX3 plasma concentration can serve as an independent strong prognostic indicator of short-term mortality in COVID-19.
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Affiliation(s)
- Enrico Brunetta
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Folci
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | | | - Giuseppe Gritti
- Unit of Hematology, Azienda Ospedaliera Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Protti
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Stefanos Bonovas
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Daniele Piovani
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberto Leone
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Ilaria My
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Veronica Zanon
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | | | - Monica Bacci
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Domenico Supino
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Silvia Carnevale
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marina Sironi
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | | | - Clelia Peano
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Institute of Genetic and Biomedical Research, UoS Milan, National Research Council, Milan, Italy
| | - Francesco Landi
- Unit of Hematology, Azienda Ospedaliera Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Fabiano Di Marco
- Unit of Pneumology, Azienda Ospedaliera Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Federico Raimondi
- Unit of Pneumology, Azienda Ospedaliera Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Unit of Pathology, Azienda Ospedaliera Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Unit of Hematology, Azienda Ospedaliera Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy. .,Department of Oncology & Hemato-Oncology, University of Milan, Milan, Italy.
| | - Cecilia Garlanda
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | | | - Maurizio Cecconi
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Alberto Mantovani
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy. .,Department of Biomedical Sciences, Humanitas University, Milan, Italy. .,The William Harvey Research Institute, Queen Mary University of London, London, UK.
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100
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Contribution of CT Features in the Diagnosis of COVID-19. Can Respir J 2020; 2020:1237418. [PMID: 33224361 PMCID: PMC7670585 DOI: 10.1155/2020/1237418] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/19/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
The outbreak of novel coronavirus disease 2019 (COVID-19) first occurred in Wuhan, Hubei Province, China, and spread across the country and worldwide quickly. It has been defined as a major global health emergency by the World Health Organization (WHO). As this is a novel virus, its diagnosis is crucial to clinical treatment and management. To date, real-time reverse transcription-polymerase chain reaction (RT-PCR) has been recognized as the diagnostic criterion for COVID-19. However, the results of RT-PCR can be complemented by the features obtained in chest computed tomography (CT). In this review, we aim to discuss the diagnosis and main CT features of patients with COVID-19 based on the results of the published literature, in order to enhance the understanding of COVID-19 and provide more detailed information regarding treatment.
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