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Pozdnyakova O, Connell NT, Battinelli EM, Connors JM, Fell G, Kim AS. Clinical Significance of CBC and WBC Morphology in the Diagnosis and Clinical Course of COVID-19 Infection. Am J Clin Pathol 2021; 155:364-375. [PMID: 33269374 PMCID: PMC7799218 DOI: 10.1093/ajcp/aqaa231] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives To investigate the clinical significance of numeric and morphologic peripheral blood (PB) changes in coronavirus disease 2019 (COVID-19)–positive patients in predicting the outcome, as well as to compare these changes between critically ill COVID-19–positive and COVID-19–negative patients. Methods The study included 90 COVID-19–positive (51 intensive care unit [ICU] and 39 non-ICU) patients and 30 COVID-19–negative ICU patients. We collected CBC parameters (both standard and research) and PB morphologic findings, which were independently scored by two hematopathologists. Results All patients with COVID-19 demonstrated striking numeric and morphologic WBC changes, which were different between mild and severe disease states. More severe disease was associated with significant neutrophilia and lymphopenia, which was intensified in critically ill patients. Abnormal WBC morphology, most pronounced in monocytes and lymphocytes, was associated with more mild disease; the changes were lost with disease progression. Between COVID-19–positive and COVID-19–negative ICU patients, significant differences in morphology-associated research parameters were indicative of changes due to the severe acute respiratory syndrome coronavirus 2 virus, including higher RNA content in monocytes, lower RNA content in lymphocytes, and smaller hypogranular neutrophils. Conclusions Hospitalized patients with COVID-19 should undergo a comprehensive daily CBC with manual WBC differential to monitor for numerical and morphologic changes predictive of poor outcome and signs of disease progression.
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Affiliation(s)
- Olga Pozdnyakova
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Nathan T Connell
- Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Elisabeth M Battinelli
- Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jean M Connors
- Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Geoffrey Fell
- Department of Statistics, Dana Farber Cancer Institute, Boston, MA
| | - Annette S Kim
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
- Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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Mishra P, Parveen R, Bajpai R, Samim M, Agarwal NB. Impact of cardiovascular diseases on severity of COVID-19 patients:
A systematic review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ABSTRACT
Introduction: Coronavirus disease 2019 (COVID-19) cases are increasing rapidly worldwide. Similar
to Middle East respiratory syndrome where cardiovascular diseases were present in nearly 30% of cases,
the increased presence of cardiovascular comorbidities remains true for COVID-19 as well. The mechanism
of this association remains unclear at this time. Therefore, we reviewed the available literature and tried
to find the probable association between cardiovascular disease with disease severity and mortality in
COVID-19 patients.
Methods: We searched Medline (via PubMed) and Cochrane Central Register of Controlled Trials for
articles published until Sept 5, 2020. Nineteen articles were included involving 6,872 COVID-19 patients.
Results: The random-effect meta-analysis showed that cardiovascular disease was significantly associated
with severity and mortality for COVID-19: odds ratio (OR) 2.89, 95% confidence interval (CI) 1.98–4.21
for severity and OR 3.00, 95% CI 1.67–5.39 for mortality, respectively. Risk of COVID-19 severity was
higher in patients having diabetes, hypertension, chronic obstructive pulmonary disease, malignancy,
cerebrovascular disease and chronic kidney disease. Similarly, patients with diabetes, hypertension, chronic
liver disease, cerebrovascular disease and chronic kidney disease were at higher risk of mortality.
Conclusion: Our findings showed that cardiovascular disease has a negative effect on health status of
COVID-19 patients. However, large prevalence studies demonstrating the consequences of comorbid
cardiovascular disease are urgently needed to understand the extent of these concerning comorbidities.
Keywords: Cardiovascular disease, COVID-19, SARS-CoV-2
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Paliogiannis P, Mangoni AA, Cangemi M, Fois AG, Carru C, Zinellu A. Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis. Clin Exp Med 2021; 21:343-354. [PMID: 33511503 PMCID: PMC7842395 DOI: 10.1007/s10238-021-00686-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for the most threatening pandemic in modern history. The aim of this systematic review and meta-analysis was to investigate the associations between serum albumin concentrations and COVID-19 disease severity and adverse outcomes. A systematic literature search was conducted in PubMed, from inception to October 30, 2020. Sixty-seven studies in 19,760 COVID-19 patients (6141 with severe disease or poor outcome) were selected for analysis. Pooled results showed that serum albumin concentrations were significantly lower in patients with severe disease or poor outcome (standard mean difference, SMD: - 0.99 g/L; 95% CI, - 1.11 to - 0.88, p < 0.001). In multivariate meta-regression analysis, age (t = - 2.13, p = 0.043), publication geographic area (t = 2.16, p = 0.040), white blood cell count (t = - 2.77, p = 0.008) and C-reactive protein (t = - 2.43, p = 0.019) were significant contributors of between-study variance. Therefore, lower serum albumin concentrations are significantly associated with disease severity and adverse outcomes in COVID-19 patients. The assessment of serum albumin concentrations might assist with early risk stratification and selection of appropriate care pathways in this group.
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Affiliation(s)
- Panagiotis Paliogiannis
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Arduino Aleksander Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Michela Cangemi
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Alessandro Giuseppe Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Ciriaco Carru
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
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Maestre-Muñiz MM, Arias Á, Arias-González L, Angulo-Lara B, Lucendo AJ. Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain. J Clin Med 2021; 10:318. [PMID: 33467207 PMCID: PMC7830028 DOI: 10.3390/jcm10020318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Risk factors for in-hospital mortality from severe coronavirus disease 2019 (COVID-19) infection have been identified in studies mainly carried out in urban-based teaching hospitals. However, there is little data for rural populations attending community hospitals during the first wave of the pandemic. METHODS A retrospective, single-center cohort study was undertaken among inpatients at a rural community hospital in Spain. Electronic medical records of the 444 patients (56.5% males) admitted due to severe SARS-CoV-2 infection during 26 February 2020-31 May 2020 were reviewed. RESULTS Mean age was 71.2 ± 14.6 years (rank 22-98), with 69.8% over 65. At least one comorbidity was present in 410 patients (92.3%), with chronic obstructive pulmonary disease (COPD) present in 21.7%. Overall in-hospital mortality was 32%. Multivariate analysis of factors associated with death identified patients' age (with a cumulative effect per decade), COPD as a comorbidity, and respiratory insufficiency at the point of admission. No additional comorbid conditions proved significant. Among analytical values, increased serum creatinine, LDH > 500 mg/dL, thrombocytopenia (<150 × 109/per L), and lymphopenia (<1000 cells/µL) were all independently associated with mortality during admission. CONCLUSIONS Age remained the major determinant for COVID-19-caused mortality; COPD was the only comorbidity independently associated with in-hospital death, together with respiratory insufficiency and analytical markers at admission.
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Affiliation(s)
- Modesto M. Maestre-Muñiz
- Department of Internal Medicine, Hospital General de Tomelloso, 13700 Ciudad Real, Spain; (M.M.M.-M.); (B.A.-L.)
| | - Ángel Arias
- Research Unit, Hospital General La Mancha Centro, Alcázar de San Juan, 13600 Ciudad Real, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - Laura Arias-González
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Ciudad Real, Spain;
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
| | - Basilio Angulo-Lara
- Department of Internal Medicine, Hospital General de Tomelloso, 13700 Ciudad Real, Spain; (M.M.M.-M.); (B.A.-L.)
| | - Alfredo J. Lucendo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Ciudad Real, Spain;
- Instituto de Investigación Sanitaria La Princesa, 28006 Madrid, Spain
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105
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Rojas-Marte G, Hashmi AT, Khalid M, Chukwuka N, Fogel J, Munoz-Martinez A, Ehrlich S, Akbar Waheed M, Sharma D, Sharma S, Aslam A, Siddiqui S, Agarwal C, Malyshev Y, Henriquez-Felipe C, Shani J. Outcomes in Patients With COVID-19 Disease and High Oxygen Requirements. J Clin Med Res 2021; 13:26-37. [PMID: 33613798 PMCID: PMC7869563 DOI: 10.14740/jocmr4405] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Approximately 19% of people infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) progress to severe or critical stages of the coronavirus disease 2019 (COVID-19) with a mortality rate exceeding 50%. We aimed to examine the characteristics, mortality rates, intubation rate, and length of stay (LOS) of patients hospitalized with COVID-19 disease with high oxygen requirements (critically ill). Methods We conducted a retrospective analysis in a single center in Brooklyn, New York. Adult hospitalized patients with confirmed COVID-19 disease and high oxygen requirements were included. We performed multivariate logistic regression analyses for statistically significant variables to reduce any confounding. Results A total of 398 patients were identified between March 19th and April 25th, 2020 who met the inclusion criteria, of which 247 (62.1%) required intubation. The overall mortality rate in our study was 57.3% (n = 228). The mean hospital LOS was 19.1 ± 17.4 days. Patients who survived to hospital discharge had a longer mean LOS compared to those who died during hospitalization (25.4 ± 22.03 days versus10.7 ± 1.74 days). In the multivariate analysis, increased age, intubation and increased lactate dehydrogenase (LDH) were each independently associated with increased odds of mortality. Diarrhea was associated with decreased mortality (OR 0.4; CI 0.16, 0.99). Obesity and use of vasopressors were each independently associated with increased intubation. Conclusions In patients with COVID-19 disease and high oxygen requirements, advanced age, intubation, and higher LDH levels were associated with increased mortality, while diarrhea was associated with decreased mortality. Gender, diabetes, and hypertension did not have any association with mortality or length of hospital stay.
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Affiliation(s)
- Geurys Rojas-Marte
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA.,Donald and Barbara Zucker School of Medicine at Hosftra/Northwell, Staten Island, NY, USA
| | | | - Mazin Khalid
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Nnamdi Chukwuka
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joshua Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | | | - Samantha Ehrlich
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Maham Akbar Waheed
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Dikshya Sharma
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Shaurya Sharma
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Awais Aslam
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Sabah Siddiqui
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Chirag Agarwal
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | - Yuri Malyshev
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, NY, USA
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106
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Pan F, Li L, Liu B, Ye T, Li L, Liu D, Ding Z, Chen G, Liang B, Yang L, Zheng C. A novel deep learning-based quantification of serial chest computed tomography in Coronavirus Disease 2019 (COVID-19). Sci Rep 2021; 11:417. [PMID: 33432072 PMCID: PMC7801482 DOI: 10.1038/s41598-020-80261-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/17/2020] [Indexed: 01/08/2023] Open
Abstract
This study aims to explore and compare a novel deep learning-based quantification with the conventional semi-quantitative computed tomography (CT) scoring for the serial chest CT scans of COVID-19. 95 patients with confirmed COVID-19 and a total of 465 serial chest CT scans were involved, including 61 moderate patients (moderate group, 319 chest CT scans) and 34 severe patients (severe group, 146 chest CT scans). Conventional CT scoring and deep learning-based quantification were performed for all chest CT scans for two study goals: (1) Correlation between these two estimations; (2) Exploring the dynamic patterns using these two estimations between moderate and severe groups. The Spearman's correlation coefficient between these two estimation methods was 0.920 (p < 0.001). predicted pulmonary involvement (CT score and percent of pulmonary lesions calculated using deep learning-based quantification) increased more rapidly and reached a higher peak on 23rd days from symptom onset in severe group, which reached a peak on 18th days in moderate group with faster absorption of the lesions. The deep learning-based quantification for COVID-19 showed a good correlation with the conventional CT scoring and demonstrated a potential benefit in the estimation of disease severities of COVID-19.
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Affiliation(s)
- Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bo Liu
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, No.523 Louguanshan Road, Changning District, Shanghai, 200000, China
- Hangzhou YITU Healthcare Technology Co., Ltd., Shanghai, 200000, China
| | - Tianhe Ye
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lingli Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dehan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Zezhen Ding
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, No.523 Louguanshan Road, Changning District, Shanghai, 200000, China
- Hangzhou YITU Healthcare Technology Co., Ltd., Shanghai, 200000, China
| | - Guangfeng Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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107
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Saksena S, Chattopadhyay P. Illuminating the immunopathology of SARS-CoV-2. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 100:33-41. [PMID: 33394568 DOI: 10.1002/cyto.b.21988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022]
Abstract
Over a remarkably short period of time, a great deal of knowledge about severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection has been acquired, through the focused and cooperative effort of the international scientific community. Much has become known about how the immune response is coordinated to fight infection, and how it becomes dysregulated in severe disease. In this review, we take an in-depth look at the many immune features associated with the host response to SARS-CoV2, as well as those that appear to mark severe disease.
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108
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García Santos JM, Plasencia Martínez JM, Fabuel Ortega P, Lozano Ros M, Sánchez Ayala MC, Pérez Hernández G, Menchón Martínez P. Radiology departments as COVID-19 entry-door might improve healthcare efficacy and efficiency, and emergency department safety. Insights Imaging 2021; 12:1. [PMID: 33398669 PMCID: PMC7781166 DOI: 10.1186/s13244-020-00954-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Background Possible COVID-19 pneumonia patients (ppCOVID-19) generally overwhelmed emergency departments (EDs) during the first COVID-19 wave. Home-confinement and primary-care phone follow-up was the first-level regional policy for preventing EDs to collapse. But when X-rays were needed, the traditional outpatient workflow at the radiology department was inefficient and potential interpersonal infections were of concern. We aimed to assess the efficiency of a primary-care high-resolution radiology service (pcHRRS) for ppCOVID-19 in terms of time at hospital and decision’s reliability.
Methods We assessed 849 consecutive ppCOVID-19 patients, 418 through the pcHRRS (home-confined ppCOVID-19 with negative—group 1- and positive—group 2-X-rays) and 431 arriving with respiratory symptoms to the ED by themselves (group 3). The pcHRRS provided X-rays and oximetry in an only-one-patient agenda. Radiologists made next-step decisions (group 1: pneumonia negative, home-confinement follow-up; group 2: pneumonia positive, ED assessment) according to X-ray results. We used ANOVA and Bonferroni correction, Student T, Chi2 tests to analyse changes in the ED workload, time-to-decision differences between groups, potential delays in patients acceding through the ED, and pcHRRS performance for deciding admission. Results The pcHRRS halved ED respiratory patients (49.2%), allowed faster decisions (group 1 vs. home-discharged group 2 and group 3 patients: 0:41 ± 1:05 h; 3:36 ± 2:58 h; 3:50 ± 3:16 h; group 1 vs. all group 2 and group 3 patients: 0:41 ± 1:05 h; 5.25 ± 3.08; 5:36 ± 4:36 h; group 2 vs. group 3 admitted patients: 5:27 ± 3:08 h vs. 7:42 ± 5:02 h; all p < 0.001) and prompted admission (84/93, 90.3%) while maintaining time response for ED patients. Conclusions Our pcHRRS may be a more efficient entry-door for ppCOVID-19 by decreasing ED patients and making expedited decisions while guaranteeing social distance.
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Affiliation(s)
- José M García Santos
- Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain.
| | - Juana M Plasencia Martínez
- Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain
| | - Pablo Fabuel Ortega
- Primary Care Health Center Vistabella-La Flota, 6th Health Area, Comunidad Autónoma de la Región de Murcia, Murcia, Spain
| | - Marina Lozano Ros
- Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain
| | - María Carmen Sánchez Ayala
- Primary Care Health Center Molina-Jesús Marín, 6th Health Area, Comunidad Autónoma de la Región de Murcia, Murcia, Spain
| | - Gloria Pérez Hernández
- Radiology Department, University General Hospital Morales Meseguer, C/ Marqués de Los Vélez, s/n., 30008, Murcia, Spain
| | - Pedro Menchón Martínez
- Neumology Section, University General Hospital Morales Meseguer, Murcia, Spain.,Medical Direction, 6th Health Area, Comunidad Autónoma de La Región de Murcia, University General Hospital Morales Meseguer, Murcia, Spain
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Leulseged TW, Maru EH, Hassen IS, Zewde WC, Chamiso NW, Abebe DS, Jagema TB, Banegyisa AB, Gezahegn MA, Tefera OS, Shiferaw WG, Admasu TT. Predictors of death in severe COVID-19 patients at millennium COVID-19 care center in Ethiopia: a case-control study. Pan Afr Med J 2021; 38:351. [PMID: 34367430 PMCID: PMC8308857 DOI: 10.11604/pamj.2021.38.351.28831] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION as the number of new cases and death due to COVID-19 is increasing, understanding the characteristics of severe COVID-19 patients and identifying characteristics that lead to death is a key to make an informed decision. In Ethiopia, as of September 27th 2020, a total of 72,700 cases and 1165 deaths were reported. Therefore, the study aimed to assess the determinants of death in severe COVID-19 patients admitted to millennium COVID-19 care center in Ethiopia. METHODS a case-control study of 147 severe COVID-19 patients (49 deaths and 98 discharged alive cases) was conducted from August to September 2020. A comparison of underlying characteristics between cases (death) and controls (alive) was assessed using a chi-square test and an independent t-test with a p-value of <0.05 considered as having a statistically significant difference. Multivariable binary logistic regression was used to identify predictors of severe COVID-19 outcome (alive vs death) where adjusted odds ratio (AOR), 95% confidence interval (CIs) for AOR, and P-values were used for testing significance and interpretation of results. RESULTS having diabetes mellitus (AOR= 3.257, 95%CI=1.348,7.867, p-value <0.001), fever (AOR=0.328, 95%CI= 0.123,0.878, p-value=0.027) and shortness of breath (AOR=4.034, 95%CI=1.481,10.988, p-value=0.006) were found to be significant predictors of death in severe COVID-19 patients. CONCLUSION the outcome of death in severe COVID-19 patients is found to be associated with exposures to being diabetic and having shortness of breath at admission. On the other hand, having a fever at admission was associated with a favorable outcome of being discharged alive.
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Affiliation(s)
- Tigist Workneh Leulseged
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Corresponding author: Tigist Workneh Leulseged, Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Endalkachew Hailu Maru
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ishmael Shemsedin Hassen
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wuletaw Chane Zewde
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Negat Woldehawariat Chamiso
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Daniel Simeneh Abebe
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tariku Bahiru Jagema
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abdi Bekele Banegyisa
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mesfin Abebe Gezahegn
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Oli Seyoum Tefera
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Wondmagegn Genaneh Shiferaw
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Teketel Tilahun Admasu
- Department of Internal Medicine, Millennium COVID-19 Care Center, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Ferrari F, Martins VM, Teixeira M, Santos RD, Stein R. COVID-19 and Thromboinflammation: Is There a Role for Statins? Clinics (Sao Paulo) 2021; 76:e2518. [PMID: 33787678 PMCID: PMC7955154 DOI: 10.6061/clinics/2021/e2518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus disease (COVID-19) showed increased morbidity and mortality rates and worse prognosis in individuals with underlying chronic diseases, especially cardiovascular disease and its risk factors, such as hypertension, diabetes, and obesity. There is also evidence of possible links among COVID-19, myocardial infarction, and stroke. Emerging evidence suggests a pro-inflammatory milieu and hypercoagulable state in patients with this infection. Despite anticoagulation, a large proportion of patients requiring intensive care may develop life-threatening thrombotic complications. Indeed, the levels of some markers of hemostatic activation, such as D-dimer, are commonly elevated in COVID-19, indicating potential risk of deep vein thrombosis and pulmonary thromboembolism. In this review, we critically examine and discuss aspects of hypercoagulability and inflammation in COVID-19 and the possible benefits of statins in this scenario, with emphasis on their underlying molecular mechanisms. Moreover, we present recommendations on the use of antiviral drugs in combination with statins.
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Affiliation(s)
- Filipe Ferrari
- Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | | | - Marcelo Teixeira
- Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Raul D. Santos
- Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- Unidade Clinica de Lipides, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ricardo Stein
- Programa de Pos-Graduacao em Cardiologia e Ciencias Cardiovasculares, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- *Corresponding author. E-mail:
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Zhao C, Bai Y, Wang C, Zhong Y, Lu N, Tian L, Cai F, Jin R. Risk factors related to the severity of COVID-19 in Wuhan. Int J Med Sci 2021; 18:120-127. [PMID: 33390780 PMCID: PMC7738952 DOI: 10.7150/ijms.47193] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: To evaluate the characteristics at admission of patients with moderate COVID-19 in Wuhan and to explore risk factors associated with the severe prognosis of the disease for prognostic prediction. Methods: In this retrospective study, moderate and severe disease was defined according to the report of the WHO-China Joint Mission on COVID-19. Clinical characteristics and laboratory findings of 172 patients with laboratory-confirmed moderate COVID-19 were collected when they were admitted to the Cancer Center of Wuhan Union Hospital between February 13, 2020 and February 25, 2020. This cohort was followed to March 14, 2020. The outcomes, being discharged as mild cases or developing into severe cases, were categorized into two groups. The data were compared and analyzed with univariate logistic regression to identify the features that differed significantly between the two groups. Based on machine learning algorithms, a further feature selection procedure was performed to identify the features that can contribute the most to the prediction of disease severity. Results: Of the 172 patients, 112 were discharged as mild cases, and 60 developed into severe cases. Four clinical characteristics and 18 laboratory findings showed significant differences between the two groups in the statistical test (P<0.01) and univariate logistic regression analysis (P<0.01). In the further feature selection procedure, six features were chosen to obtain the best performance in discriminating the two groups with a linear kernel support vector machine. The mean accuracy was 91.38%, with a sensitivity of 0.90 and a specificity of 0.94. The six features included interleukin-6, high-sensitivity cardiac troponin I, procalcitonin, high-sensitivity C-reactive protein, chest distress and calcium level. Conclusions: With the data collected at admission, the combination of one clinical characteristic and five laboratory findings contributed the most to the discrimination between the two groups with a linear kernel support vector machine classifier. These factors may be risk factors that can be used to perform a prognostic prediction regarding the severity of the disease for patients with moderate COVID-19 in the early stage of the disease.
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Affiliation(s)
- Chen Zhao
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
| | - Yan Bai
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
| | - Cencen Wang
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
| | - Yanyan Zhong
- Huazhong University of Science and Technology Hostipal. Luoyu Road 1037, Wuhan, 430074, P.R China
| | - Na Lu
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
| | - Li Tian
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
| | - Fucheng Cai
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
| | - Runming Jin
- Department of Pediatric, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Road, Wuhan, 430022, P.R. China
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Kaftan AN, Hussain MK, Algenabi AA, Naser FH, Enaya MA. Predictive Value of C-reactive Protein, Lactate Dehydrogenase, Ferritin and D-dimer Levels in Diagnosing COVID-19 Patients: a Retrospective Study. Acta Inform Med 2021; 29:45-50. [PMID: 34012213 PMCID: PMC8116078 DOI: 10.5455/aim.2021.29.45-50] [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] [Indexed: 01/08/2023] Open
Abstract
Background: Since December 2019. millions of people in the world have been affected with the novel Coronavirus disease-2019 (COVID-19) pandemic, and high economic impact has affect many countries especially low socioeconomic one like Iraq due to the high cost and limited availability of RT-PCR for diagnosis of COVID-19, so there should be predictive low cost easily available laboratory tests that can be used before proceeding to the high cost techniques. Objective: In this retrospective study we aimed to evaluate the diagnostic accuracy of CRP, ferritin, LDH and D-dimer in predicting positive cases of COVID-19 in Iraq. Methods: It is a retrospective observational cohort study based on STARD guidelines to determine the diagnostic accuracy of (CRP, LDH, ferritin and D dimer) for COVID-19 of electronic medical records of private medical center in Najaf city, at which 566 individuals were recruited. The investigated subjects were either in close contact with previously COVID-19 positive patients or have one or more symptoms of COVID-19. They were categorized into 2 groups, 205 subjects diagnosed with RT-PCR as COVID-19 negative, and 361 COVID-19 positive patients, results of study variables of the cohort were recruited from the medical records. Results: Combining of these parameters had the following findings: CRP + ferritin; AUC: 0.77 with 55% sensitivity and 97% specificity, Ferritin + LDH; AUC: 0.83 with 65% sensitivity and 92% specificity, CRP+LDH; AUC: 0.78 with 56% sensitivity and 98% specificity, CRP + LDH + ferritin; AUC: 0.85, with 73% sensitivity and 88% specificity, CRP + LDH + ferritin + D dimer; AUC: 0.85 75% sensitivity and 87% specificity. Conclusion: Combination of routine laboratory biomarkers (CRP, LDH and ferritin ±D dimer) can be used to predict the diagnosis of COVID-19 with an accepted sensitivity and specificity before proceeding to definitive diagnosis by RT-PCR.
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Affiliation(s)
- Ahmed N Kaftan
- Biochemistry Department, Faculty of Medicine, Kufa University, Najaf, Iraq
| | - Majid K Hussain
- Biochemistry Department, Faculty of Medicine, Kufa University, Najaf, Iraq
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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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Mejía F, Medina C, Cornejo E, Morello E, Vásquez S, Alave J, Schwalb A, Málaga G. Oxygen saturation as a predictor of mortality in hospitalized adult patients with COVID-19 in a public hospital in Lima, Peru. PLoS One 2020; 15:e0244171. [PMID: 33370364 PMCID: PMC7769479 DOI: 10.1371/journal.pone.0244171] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/06/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Peru is among the top ten countries with the highest number of coronavirus disease 2019 (COVID-19) cases worldwide. The aim of the study was to describe the clinical features of hospitalized adult patients with COVID-19 and to determine the prognostic factors associated with in-hospital mortality. METHODS We conducted a retrospective cohort study among adult patients with COVID-19 admitted to Hospital Cayetano Heredia; a tertiary care hospital in Lima, Peru. The primary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression was used to identify factors independently associated with in-hospital mortality. RESULTS A total of 369 patients (median age 59 years [IQR:49-68]; 241 (65.31%) male) were included. Most patients (68.56%) reported at least one comorbidity; more frequently: obesity (42.55%), diabetes mellitus (21.95%), and hypertension (21.68%). The median duration of symptoms prior to hospital admission was 7 days (IQR: 5-10). Reported in-hospital mortality was 49.59%. By multiple Cox regression, oxygen saturation (SaO2) values of less than 90% on admission correlated with mortality, presenting 1.86 (95%CI: 1.02-3.39), 4.44 (95%CI: 2.46-8.02) and 7.74 (95%CI: 4.54-13.19) times greater risk of death for SaO2 of 89-85%, 84-80% and <80%, respectively, when compared to patients with SaO2 >90%. Additionally, age >60 years was associated with 1.88 times greater mortality. CONCLUSIONS Oxygen saturation below 90% on admission is a strong predictor of in-hospital mortality in patients with COVID-19. In settings with limited resources, efforts to reduce mortality in COVID-19 should focus on early identification of hypoxemia and timely access to hospital care.
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Affiliation(s)
- Fernando Mejía
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
- * E-mail:
| | - Carlos Medina
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | - Enrique Cornejo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Hospital Cayetano Heredia, Lima, Peru
| | | | | | - Jorge Alave
- Hospital Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Unión, Lima, Peru
| | - Alvaro Schwalb
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Sheth JU, Narayanan R. Response to comments on: Retinal vein occlusion in COVID 19: A novel entity. Indian J Ophthalmol 2020; 69:193-194. [PMID: 33323641 PMCID: PMC7926125 DOI: 10.4103/ijo.ijo_3221_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Jay U Sheth
- Department of Vitreoretinal Services, Surya Eye Institute and Research Center, Mumbai, Maharashtra; Clinical Research Lead, Chaitanya Eye Hospital and Research Center, Trivandrum, Kerala, India
| | - Raja Narayanan
- General Secretary, Vitreoretinal Society of India; Suven Clinical Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Sheth JU, Narayanan R, Goyal J, Goyal V. Response to comments on: Retinal vein occlusion in COVID-19: A novel entity. Indian J Ophthalmol 2020; 69:195-196. [PMID: 33323643 PMCID: PMC7926163 DOI: 10.4103/ijo.ijo_3319_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jay U Sheth
- Department of Vitreoretinal Services, Surya Eye Institute and Research Center, Mumbai, Maharashtra; Clinical Research Lead, Chaitanya Eye Hospital and Research Center, Trivandrum, Kerala, India
| | - Raja Narayanan
- General Secretary, Vitreoretinal Society of India; Suven Clinical Research Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Goyal
- Department of Vitreoretinal Services, Surya Eye Institute and Research Center, Mumbai, Maharashtra, India
| | - Vinod Goyal
- Department of Vitreoretinal Services, Surya Eye Institute and Research Center, Mumbai, Maharashtra, India
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Sosa-Hernández VA, Torres-Ruíz J, Cervantes-Díaz R, Romero-Ramírez S, Páez-Franco JC, Meza-Sánchez DE, Juárez-Vega G, Pérez-Fragoso A, Ortiz-Navarrete V, Ponce-de-León A, Llorente L, Berrón-Ruiz L, Mejía-Domínguez NR, Gómez-Martín D, Maravillas-Montero JL. B Cell Subsets as Severity-Associated Signatures in COVID-19 Patients. Front Immunol 2020; 11:611004. [PMID: 33343585 PMCID: PMC7744304 DOI: 10.3389/fimmu.2020.611004] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background SARS-CoV-2 infection represents a global health problem that has affected millions of people. The fine host immune response and its association with the disease course have not yet been fully elucidated. Consequently, we analyze circulating B cell subsets and their possible relationship with COVID-19 features and severity. Methods Using a multiparametric flow cytometric approach, we determined B cell subsets frequencies from 52 COVID-19 patients, grouped them by hierarchical cluster analysis, and correlated their values with clinical data. Results The frequency of CD19+ B cells is increased in severe COVID-19 compared to mild cases. Specific subset frequencies such as transitional B cell subsets increase in mild/moderate cases but decrease with the severity of the disease. Memory B compartment decreased in severe and critical cases, and antibody-secreting cells are increased according to the severity of the disease. Other non-typical subsets such as double-negative B cells also showed significant changes according to disease severity. Globally, these differences allow us to identify severity-associated patient clusters with specific altered subsets. Finally, respiratory parameters, biomarkers of inflammation, and clinical scores exhibited correlations with some of these subpopulations. Conclusions The severity of COVID-19 is accompanied by changes in the B cell subpopulations, either immature or terminally differentiated. Furthermore, the existing relationship of B cell subset frequencies with clinical and laboratory parameters suggest that these lymphocytes could serve as potential biomarkers and even active participants in the adaptive antiviral response mounted against SARS-CoV-2.
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Affiliation(s)
- Víctor A Sosa-Hernández
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Jiram Torres-Ruíz
- Departamento de Atención Institucional Continua y Urgencias, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rodrigo Cervantes-Díaz
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sandra Romero-Ramírez
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - José C Páez-Franco
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David E Meza-Sánchez
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Guillermo Juárez-Vega
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Pérez-Fragoso
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Vianney Ortiz-Navarrete
- Departamento de Biomedicina Molecular, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Alfredo Ponce-de-León
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luis Llorente
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Laura Berrón-Ruiz
- Unidad de Investigación en Inmunodeficiencias, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - Nancy R Mejía-Domínguez
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Diana Gómez-Martín
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José L Maravillas-Montero
- Red de Apoyo a la Investigación, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Luo L, Fu M, Li Y, Hu S, Luo J, Chen Z, Yu J, Li W, Dong R, Yang Y, Tu L, Xu X. The potential association between common comorbidities and severity and mortality of coronavirus disease 2019: A pooled analysis. Clin Cardiol 2020; 43:1478-1493. [PMID: 33026120 PMCID: PMC7675427 DOI: 10.1002/clc.23465] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUD The association between underlying comorbidities and cardiac injury and the prognosis in coronavirus disease 2019 (COVID-19) patients was assessed in this study. HYPOTHESIS The underlying comorbidities and cardiac injury may be associated with the prognosis in COVID-19 patients. METHODS A systematic search was conducted in PubMed, EMBASE, Web of science, and The Cochrane library from December 2019 to July 2020. The odds ratio (OR) and 95% confidence intervals (95% CI) were used to estimate the probability of comorbidities and cardiac injury in COVID-19 patients with or without severe type, or in survivors vs nonsurvivors of COVID-19 patients. RESULTS A total of 124 studies were included in this analysis. A higher risk for severity was observed in COVID-19 patients with comorbidities. The pooled result in patients with hypertension (OR 2.57, 95% CI: 2.12-3.11), diabetes (OR 2.54, 95% CI: 1.89-3.41), cardiovascular diseases (OR 3.86, 95% CI: 2.70-5.52), chronic obstractive pulmonary disease (OR 2.71, 95% CI: 1.98-3.70), chronic kidney disease (OR 2.20, 95% CI: 1.27-3.80), and cancer (OR 2.42, 95% CI: 1.81-3.22) respectively. All the comorbidities presented a higher risk of mortality. Moreover, the prevalence of acute cardiac injury is higher in severe group than in nonsevere group, and acute cardiac injury is associated with an increased risk for in-hospital mortality. CONCLUSION Comorbidities and acute cardiac injury are closely associated with poor prognosis in COVID-19 patients. It is necessary to continuously monitor related clinical indicators of organs injury and concern comorbidities in COVID-19 patients.
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Affiliation(s)
- Liman Luo
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Division of Cardiology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Menglu Fu
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Yuanyuan Li
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Shuiqing Hu
- Division of Cardiology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jinlan Luo
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Zhihui Chen
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jing Yu
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Wenhua Li
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Ruolan Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yan Yang
- Division of Endocrinology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Ling Tu
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Xizhen Xu
- Division of Cardiology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
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A Cytokine Circus with a Viral Ringleader: SARS-CoV-2-Associated Cytokine Storm Syndromes. Trends Mol Med 2020; 26:1078-1085. [PMID: 33051104 PMCID: PMC7524648 DOI: 10.1016/j.molmed.2020.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
An unbridled host immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is likely to underlie severe cases of the disease and has been labeled a 'cytokine storm syndrome' (CSS). Here, we emphasize that categorization of syndromes triggered by a completely novel pathogen based on other seemingly similar, but potentially distinct, known entities is an inherently risky endeavor.
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Pivonello R, Auriemma RS, Pivonello C, Isidori AM, Corona G, Colao A, Millar RP. Sex Disparities in COVID-19 Severity and Outcome: Are Men Weaker or Women Stronger? Neuroendocrinology 2020; 111:1066-1085. [PMID: 33242856 PMCID: PMC7900484 DOI: 10.1159/000513346] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health issue which has profound effects on most aspects of societal well-being, including physical and mental health. A plethora of studies globally have suggested the existence of a sex disparity in the severity and outcome of COVID-19 patients, mainly due to mechanisms of virus infection, immune response to the virus, development of systemic inflammation, and consequent systemic complications, particularly thromboembolism. Epidemiological data report a sex difference in the severity of COVID-19, with a more favorable course of the disease in women compared to men regardless of age, although the rate of SARS-CoV-2 infection seems to be similar in both sexes. Sex hormones, including androgens and estrogens, may not only impact virus entry and load, but also shape the clinical manifestations, complications, and ultimately the outcome of the disease. The current review comprehensively summarizes the current literature on sex disparities in susceptibility and outcome of COVID-19 as well as the literature underpinning the pathophysiological and molecular mechanisms, which may provide a rationale to a sex disparity. These mechanisms include sex hormone influence on factors that facilitate virus entry and priming, immune and inflammatory response, as well as coagulation and thrombosis diathesis. Based on present evidence, women appear to be relatively protected from COVID-19 because of a more effective immune response and a less pronounced systemic inflammation, with consequent moderate clinical manifestations of the disease, together with a lesser predisposition to thromboembolism. Conversely, men appear to be particularly susceptible to COVID-19 because of a less effective immune response with consequent severe clinical manifestations of the disease, together with a greater predisposition to thromboembolism. In the elderly, generally characterized by the phenomenon of inflammaging, sex disparities in overall mortality following SARS-CoV-2 infection are even more palpable as elderly men appear to be more prone to severe COVID-19 because of a greater predisposition to infections, a weaker immune defense, and an enhanced thrombotic state compared to women. The information revealed from the review highlights potential novel therapeutic approaches employing the administration of hormonal or antihormonal therapy in combination with antiviral drugs in COVID-19 patients.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli, Naples, Italy,
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy,
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Annamaria Colao
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Naples, Italy
| | - Robert P Millar
- Centre for Neuroendocrinology, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Neurosciences Institute and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Dubey N, Podder P, Pandey D. Knowledge of COVID-19 and Its Influence on Mindfulness, Cognitive Emotion Regulation and Psychological Flexibility in the Indian Community. Front Psychol 2020; 11:589365. [PMID: 33281687 PMCID: PMC7689361 DOI: 10.3389/fpsyg.2020.589365] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/13/2020] [Indexed: 12/18/2022] Open
Abstract
The current global pandemic caused by COVID-19 has brought about an immense effect on the mental health of the general public. Considering the escalation in number of cases, mankind is facing a myriad of psychological problems, ranging from those related to taking precautions and maintaining safety to the ones caused by separation and bereavement. The current study aims to explore whether there is a significant difference between individuals with excellent, good, fair and vague knowledge of COVID-19 with respect to depression, anxiety, stress, level of mindfulness, specific cognitive emotion regulation strategies and psychological flexibility; to find out whether there is any significant relationship among these variables; and to determine whether knowledge of COVID-19, level of mindfulness, specific cognitive emotion regulation strategies and psychological flexibility are significant predictors of depression, anxiety and stress in the sample of the current study. The sample consisted of 402 individuals selected from the community following the research criteria. Data was collected using digital consent form, information schedule and questionnaires, from 3rd May to 13th May, 2020. The questionnaires consisted of a semi-structured interview schedule to assess knowledge of COVID-19, Depression, Anxiety and Stress Scale - 21, Five Facet Mindfulness Questionnaire-Short Form, Cognitive Emotion Regulation Questionnaire-Short version and Acceptance and Action Questionnaire-II. The data was statistically analyzed using analysis of variance test, correlational analysis and linear regression. The findings show that significant differences were present among individuals having varying degrees of knowledge of COVID-19 with respect to anxiety, level of mindfulness and psychological flexibility. Significant relationships were found to be present among the variables of the present study, having differing trends brought forward by the COVID-19 crisis. Certain socio-demographic characteristics and study variables were found to significantly predict the existing levels of depression, anxiety and stress in the current sample. The study suggests the necessity to formulate and implement appropriate mindfulness-based therapeutic interventions to address the mental health concerns arising as a result of the pandemic.
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Affiliation(s)
- Neha Dubey
- Department of Applied Psychology, University of Calcutta, Kolkata, India
- Apollo Gleneagles Hospitals, Kolkata, India
| | - Priyanka Podder
- Department of Psychology, University of Calcutta, Kolkata, India
- Mental Health Foundation, Kolkata, India
| | - Dinkar Pandey
- Department of Computer Science and Technology (CST), IIEST Shibpur, Howrah, India
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Katzenschlager S, Zimmer AJ, Gottschalk C, Grafeneder J, Seitel A, Maier-Hein L, Benedetti A, Larmann J, Weigand MA, McGrath S, Denkinger CM. Can we predict the severe course of COVID-19 - a systematic review and meta-analysis of indicators of clinical outcome? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.09.20228858. [PMID: 33200148 PMCID: PMC7668761 DOI: 10.1101/2020.11.09.20228858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background COVID-19 has been reported in over 40million people globally with variable clinical outcomes. In this systematic review and meta-analysis, we assessed demographic, laboratory and clinical indicators as predictors for severe courses of COVID-19. Methods We systematically searched multiple databases (PubMed, Web of Science Core Collection, MedRvix and bioRvix) for publications from December 2019 to May 31st 2020. Random-effects meta-analyses were used to calculate pooled odds ratios and differences of medians between (1) patients admitted to ICU versus non-ICU patients and (2) patients who died versus those who survived. We adapted an existing Cochrane risk-of-bias assessment tool for outcome studies. Results Of 6,702 unique citations, we included 88 articles with 69,762 patients. There was concern for bias across all articles included. Age was strongly associated with mortality with a difference of medians (DoM) of 13.15 years (95% confidence interval (CI) 11.37 to 14.94) between those who died and those who survived. We found a clinically relevant difference between non-survivors and survivors for C-reactive protein (CRP; DoM 69.10, CI 50.43 to 87.77), lactate dehydrogenase (LDH; DoM 189.49, CI 155.00 to 223.98), cardiac troponin I (cTnI; DoM 21.88, CI 9.78 to 33.99) and D-Dimer (DoM 1.29mg/L, CI 0.9 - 1.69). Furthermore, cerebrovascular disease was the co-morbidity most strongly associated with mortality (Odds Ratio 3.45, CI 2.42 to 4.91) and ICU admission (Odds Ratio 5.88, CI 2.35 to 14.73). Discussion This comprehensive meta-analysis found age, cerebrovascular disease, CRP, LDH and cTnI to be the most important risk-factors in predicting severe COVID-19 outcomes and will inform decision analytical tools to support clinical decision-making.
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Affiliation(s)
| | - Alexandra J. Zimmer
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Claudius Gottschalk
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Juergen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Benedetti
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sean McGrath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Claudia M. Denkinger
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), partner site Heidelberg
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Mesas AE, Cavero-Redondo I, Álvarez-Bueno C, Sarriá Cabrera MA, Maffei de Andrade S, Sequí-Dominguez I, Martínez-Vizcaíno V. Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions. PLoS One 2020; 15:e0241742. [PMID: 33141836 PMCID: PMC7608886 DOI: 10.1371/journal.pone.0241742] [Citation(s) in RCA: 150] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors. METHODS A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed. RESULTS The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8). CONCLUSION The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients. PROSPERO REGISTRATION NUMBER CRD42020176595.
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Affiliation(s)
- Arthur Eumann Mesas
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brasil
| | - Iván Cavero-Redondo
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Selma Maffei de Andrade
- Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brasil
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
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Hasan SS, Capstick T, Ahmed R, Kow CS, Mazhar F, Merchant HA, Zaidi STR. Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 14:1149-1163. [PMID: 32734777 PMCID: PMC7544968 DOI: 10.1080/17476348.2020.1804365] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis is one of the main causes of high mortality in patients with COVID-19 (novel coronavirus disease 2019). We systematically reviewed mortality in COVID-19 patients with ARDS and the potential role of systemic corticosteroids in COVID-19 patients. METHODS Electronic databases and country-specific healthcare databases were searched to identify relevant studies/reports. The quality assessment of individual studies was conducted using the Newcastle-Ottawa Scale. Country-specific proportion of individuals with COVID-19 who developed ARDS and reported death were combined in a random-effect meta-analysis to give a pooled mortality estimate of ARDS. RESULTS The overall pooled mortality estimate among 10,815 ARDS cases in COVID-19 patients was 39% (95% CI: 23-56%). The pooled mortality estimate for China was 69% (95% CI: 67-72%). In Europe, the highest mortality estimate among COVID-19 patients with ARDS was reported in Poland (73%; 95% CI: 58-86%) while Germany had the lowest mortality estimate (13%; 95% CI: 2-29%) among COVID-19 patients with ARDS. The median crude mortality rate of COVID-19 patients with reported corticosteroid use was 28.0% (lower quartile: 13.9%; upper quartile: 53.6%). CONCLUSIONS The high mortality in COVID-19 associated ARDS necessitates a prompt and aggressive treatment strategy which includes corticosteroids. Most of the studies included no information on the dosing regimen of corticosteroid therapy, however, low-dose corticosteroid therapy or pulse corticosteroid therapy appears to have a beneficial role in the management of severely ill COVID-19 patients.
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Affiliation(s)
- Syed Shahzad Hasan
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
- CONTACT Syed Shahzad Hasan University of Huddersfield, Queensgate, Huddersfield, West Yorkshire HD1 3DH, UK
| | - Toby Capstick
- Leeds Teaching Hospitals NHS Trust, St. James’s University Hospital, Leeds, UK
| | - Raees Ahmed
- Healing Lungs, HCA Conroe Hospital, Critical Care Unit, Conroe, TE, USA
| | - Chia Siang Kow
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Faizan Mazhar
- Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco”, University Hospital, Università Di Milano, Milan, Italy
| | - Hamid a Merchant
- School of Applied Sciences, University of Huddersfield, Huddersfield, UK
| | - Syed Tabish Razi Zaidi
- School of Healthcare, University of Leeds, Leeds, & Leeds Teaching Hospitals Trust, Leeds, UK
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125
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Liu L, Zheng Y, Cai L, Wu W, Tang S, Ding Y, Liu W, Kou G, Xiong Z, Wang S, Zheng S. Neutrophil-to-lymphocyte ratio, a critical predictor for assessment of disease severity in patients with COVID-19. Int J Lab Hematol 2020; 43:329-335. [PMID: 33099889 DOI: 10.1111/ijlh.13374] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/13/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Monitoring of laboratory indicators is important for predicting changes in disease severity and clinical outcomes. We aimed to identify the critical predictors that can effectively assess the disease conditions of patients with COVID-19 by analyzing the clinical characteristics and laboratory findings of patients with SARS-CoV-2 infection. METHODS All consecutive patients (n = 294) with confirmed SARS-CoV-2 infection admitted to the General Hospital of Central Theater Command of the PLA from February 6 to February 21, 2020, were enrolled. These patients were divided into the severe group and the nonsevere group according to disease severity during hospitalization. RESULTS The median neutrophil-to-lymphocyte ratio (NLR) value of the severe patients was dramatically higher than that of the nonsevere patients (10.4 vs 2.6; P < .001). The NLR value equal to 5 was a boundary value worthy of reference, because more than 80% severe patients had an NLR value greater than 5 and over 80% nonsevere patients had an NLR value less than 5. The NLR value of these COVID-19 patients was positively and respectively correlated with the values of C-reactive protein (R = .5921, P < .001), lactate dehydrogenase (R = .4509, P < .001), procalcitonin (R = .5504, P < .001), fibrinogen (R = .4710, P < .001), and D-dimers (R = .4425, P < .001). However, the NLR value was merely and positively correlated with the interleukin-6 value (R = .3594, P < .05), but had no correlations with the values of interleukin-10, interleukin-4, interleukin-17, interferon-γ, and tumor necrosis factor-α (P > .05). DISCUSSION Neutrophil-to-lymphocyte ratio is a critical predictor for assessment of disease severity in patients with COVID-19, and it has a close relation with the laboratory indicators related to disease conditions.
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Affiliation(s)
- Lei Liu
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Yaqiong Zheng
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Liping Cai
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Wanlei Wu
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Shi Tang
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Yinjuan Ding
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Wanbing Liu
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Guomei Kou
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Zhou Xiong
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
| | - Shengdian Wang
- CAS Key Laboratory of Infection and Immunity, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Shangen Zheng
- Department of Transfusion Medicine, General Hospital of Central Theater Command of the PLA, Wuhan, China
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126
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Fei F, Smith JA, Cao L. Clinical laboratory characteristics in patients with suspected COVID-19: One single-institution experience. J Med Virol 2020; 93:1665-1671. [PMID: 32946118 PMCID: PMC7537084 DOI: 10.1002/jmv.26527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/10/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has become a worldwide pandemic. The aim of the study is to investigate the demographic, clinical, and laboratory characteristics in suspected COVID-19 patients in our institution. METHODS In this retrospective study, we investigated suspected COVID-19 patients admitted to the University of Alabama at Birmingham with a request for an interleukin-6 send-out test, from March 28 to June 27, 2020. Patients' demographic, clinical, and laboratory characteristics were collected by chart review. RESULTS Fifty patients suspected with COVID-19 were included in our study, of whom 24 patients were positive with severe acute respiratory syndrome coronavirus-2 infection and 26 were negative. During the observation period, 30 patients were discharged, 17 died during hospitalization, and three remained in hospital. Compared to non-COVID-19 patients, COVID-19 patients had older age, more comorbidities, and elevated levels of inflammation markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum ferritin, and lactate dehydrogenase (LDH). However, there was no significant difference in laboratory data between survivors and nonsurvivors in COVID-19 patients in our study. CONCLUSION This study indicated that potential risk factors of older age, multiple comorbidities, and high levels of ESR, CRP, serum ferritin, and LDH could help the clinician to identify potential COVID-19 patients. However, this data needs to be further validated in a larger population.
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Affiliation(s)
- Fei Fei
- Department of Pathology, The University of Alabama, Birmingham, Alabama, USA
| | - John A Smith
- Department of Pathology, The University of Alabama, Birmingham, Alabama, USA
| | - Liyun Cao
- Department of Pathology, The University of Alabama, Birmingham, Alabama, USA
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127
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Fu T, Deng M, Wang X, Yang F. Predictor of poor prognosis of COVID-19 patients - liver injury. Expert Rev Gastroenterol Hepatol 2020; 14:873-876. [PMID: 32643980 DOI: 10.1080/17474124.2020.1793670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tian Fu
- Department of Gastroenterology, Third Xiangya Hospital, Central South University , Changsha, P.R. China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer , Changsha, P.R. China
| | - Minzi Deng
- Department of Gastroenterology, Third Xiangya Hospital, Central South University , Changsha, P.R. China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer , Changsha, P.R. China
| | - Xiaoyan Wang
- Department of Gastroenterology, Third Xiangya Hospital, Central South University , Changsha, P.R. China.,Hunan Key Laboratory of Nonresolving Inflammation and Cancer , Changsha, P.R. China
| | - Fei Yang
- Xiangya School of Public Health, Central South University , Changsha, P.R. China
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128
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Lu Q, Wang Z, Yin Y, Zhao Y, Tao P, Zhong P. Association of Peripheral Lymphocyte and the Subset Levels With the Progression and Mortality of COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2020; 7:558545. [PMID: 33102499 PMCID: PMC7546210 DOI: 10.3389/fmed.2020.558545] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/28/2020] [Indexed: 01/23/2023] Open
Abstract
Current evidence is controversial in the association between peripheral lymphocyte levels and the progression and mortality of Corona Virus Disease 2019 (COVID-19), and this meta-analysis aimed to clarify the association. A systematic search was conducted in public databases to identify all relevant studies, and the study-specific odds ratio (OR) and 95% confidence intervals (CI) were pooled. Finally, 16 studies were identified with a total of 1,873 progressive COVID-19 cases and 5,177 stable COVID-19 cases. In COVID-19 progression, lymphocyte levels showed a significant negative correlation (OR: 0.68, 95% CI: 0.51-0.89), but it was not significant in the subsets of CD3+ T cells (OR: 0.97, 95% CI: 0.93-1.02), CD4+ T cells (OR: 0.93, 95% CI: 0.80-1.08), CD8+ T cells (OR: 0.96, 95% CI: 0.92-1.00), B cells (OR: 0.98, 95% CI: 0.92-1.04), or NK cells (OR: 0.80, 95% CI: 0.61-1.04). In COVID-19 mortality, lymphocyte levels showed a significant negative correlation (OR: 0.41, 95% CI: 0.20-0.85), but it was not significant in the subsets of CD3+ T cells (OR: 0.95, 95% CI: 0.86-1.05), CD4+ T cells (OR: 1.06, 95% CI: 0.86-1.31), CD8+ T cells (OR: 0.38, 95% CI: 0.14-1.01), B cells (OR: 0.98, 95% CI: 0.92-1.04), or NK cells (OR: 0.80, 95% CI: 0.61-1.04). In conclusion, current evidence suggests a significant negative association of peripheral lymphocyte levels with COVID-19 progression and mortality, but it was not significant in the subsets of CD3+ T cells, CD4+ T cells, CD8+ T cells, B cells, and NK cells.
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Affiliation(s)
- Qun Lu
- Department of Laboratory Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhengyin Wang
- Department of Laboratory Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuan Yin
- Department of Laboratory Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanrong Zhao
- Department of Laboratory Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Tao
- Department of Laboratory Medicine, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping Zhong
- Department of Infectious Diseases, Shanghai Traditional Chinese Medicine-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Berzuini C, Hannan C, King A, Vail A, O'Leary C, Brough D, Galea J, Ogungbenro K, Wright M, Pathmanaban O, Hulme S, Allan S, Bernardinelli L, Patel HC. Value of dynamic clinical and biomarker data for mortality risk prediction in COVID-19: a multicentre retrospective cohort study. BMJ Open 2020; 10:e041983. [PMID: 32967887 PMCID: PMC7513423 DOI: 10.1136/bmjopen-2020-041983] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/03/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Being able to predict which patients with COVID-19 are going to deteriorate is important to help identify patients for clinical and research practice. Clinical prediction models play a critical role in this process, but current models are of limited value because they are typically restricted to baseline predictors and do not always use contemporary statistical methods. We sought to explore the benefits of incorporating dynamic changes in routinely measured biomarkers, non-linear effects and applying 'state-of-the-art' statistical methods in the development of a prognostic model to predict death in hospitalised patients with COVID-19. DESIGN The data were analysed from admissions with COVID-19 to three hospital sites. Exploratory data analysis included a graphical approach to partial correlations. Dynamic biomarkers were considered up to 5 days following admission rather than depending solely on baseline or single time-point data. Marked departures from linear effects of covariates were identified by employing smoothing splines within a generalised additive modelling framework. SETTING 3 secondary and tertiary level centres in Greater Manchester, the UK. PARTICIPANTS 392 hospitalised patients with a diagnosis of COVID-19. RESULTS 392 patients with a COVID-19 diagnosis were identified. Area under the receiver operating characteristic curve increased from 0.73 using admission data alone to 0.75 when also considering results of baseline blood samples and to 0.83 when considering dynamic values of routinely collected markers. There was clear non-linearity in the association of age with patient outcome. CONCLUSIONS This study shows that clinical prediction models to predict death in hospitalised patients with COVID-19 can be improved by taking into account both non-linear effects in covariates such as age and dynamic changes in values of biomarkers.
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Affiliation(s)
- Carlo Berzuini
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Cathal Hannan
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Andrew King
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Andy Vail
- Centre for Biostatistics, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Claire O'Leary
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - David Brough
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - James Galea
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Kayode Ogungbenro
- Department of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Megan Wright
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Omar Pathmanaban
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospitals NHS Trust, Salford, UK
| | - Sharon Hulme
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Stuart Allan
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Luisa Bernardinelli
- Department of Brain and Behavioural Sciences, The University of Pavia, Pavia, Italy
| | - Hiren C Patel
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospitals NHS Trust, Salford, UK
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130
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Sanz-Sánchez J, Vrachatis DA, Reimers B, Deftereos SG, Kallikourdis M, Vicenzi M, Giannopoulos G, Giotaki SG, Tousoulis D, Ferrante G, Condorelli G, Stefanini GG. Impact of myocardial injury on mortality in patients with COVID-19: a meta-analysis. Hellenic J Cardiol 2020; 62:253-255. [PMID: 32781301 PMCID: PMC7832942 DOI: 10.1016/j.hjc.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jorge Sanz-Sánchez
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dimitrios A Vrachatis
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bernhard Reimers
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Spyridon G Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Kallikourdis
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Cardiovascular Disease Unit, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - George Giannopoulos
- Department of Cardiology, General Hospital of Athens "G.Gennimatas", Athens, Greece
| | - Sotiria G Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Giuseppe Ferrante
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gianluigi Condorelli
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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