151
|
Lapi F, Domnich A, Marconi E, Rossi A, Grattagliano I, Lagolio E, Medea G, Sessa A, Cricelli I, Icardi G, Cricelli C. Predicting the risk of severe COVID-19 outcomes in primary care: development and validation of a vulnerability index for equitable allocation of effective vaccines. Expert Rev Vaccines 2021; 21:377-384. [PMID: 34913796 DOI: 10.1080/14760584.2022.2019582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND General practitioners (GPs) need a valid, user-friendly tool to identify patients most vulnerable to COVID-19, especially in the hypothesis of a booster vaccine dose. The aim of this study was to develop and validate a GP-friendly prognostic index able to forecast severe COVID-19 outcomes in primary care. Indeed, no such prognostic score is as yet available in Italy. RESEARCH DESIGN AND METHODS In this retrospective cohort study, a representative sample of 47,868 Italian adults were followed up for 129,000 person-months. The study outcome was COVID-19-related hospitalization and/or death. Candidate predictors were chosen on the basis of systematic evidence and current recommendations. The model was calibrated by using Cox regression. Both internal and external validations were performed. RESULTS Age, sex and several clinical characteristics were significantly associated with severe outcomes. The final multivariable model explained 60% (95%CI 58-63%) of variance for COVID-19-related hospitalizations and/or deaths. The area under the receiver-operator curve (AUC) was 84% (95% CI: 83-85%). On applying the index to an external cohort, the AUC was 94% (95% CI: 93-95%). CONCLUSIONS This index is a reliable prognostic tool that can help GPs to prioritize their patients for preventive and therapeutic interventions.
Collapse
Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital - Irccs for Oncology and Neurosciences, Genoa, Italy
| | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Alessandro Rossi
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Erik Lagolio
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Gerardo Medea
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Aurelio Sessa
- Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Iacopo Cricelli
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Giancarlo Icardi
- Hygiene Unit, San Martino Policlinico Hospital - Irccs for Oncology and Neurosciences, Genoa, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
| |
Collapse
|
152
|
Morstead T, Zheng J, Sin NL, King DB, DeLongis A. Adherence to Recommended Preventive Behaviors During the COVID-19 Pandemic: The Role of Empathy and Perceived Health Threat. Ann Behav Med 2021; 56:381-392. [PMID: 34964460 PMCID: PMC8755323 DOI: 10.1093/abm/kaab107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Coping via empathic responding may play a role in preventive behavior engagement during the COVID-19 pandemic, and unlike trait empathy, is a potentially alterable target for changing health behavior. Purpose Our goal was to examine the role of empathic responding in preventive behavior engagement during the COVID-19 pandemic, independent of trait empathy and perceived threat of COVID-19. Methods Participants (N = 2,841) completed a baseline survey early in the pandemic, and a follow-up survey approximately 2 weeks later (M = 13.50 days, SD = 5.61). Preventive health behaviors, including physical distancing and hygiene practices, were assessed at both timepoints. Hierarchical linear regression examined the contributions of trait empathy, perceived threat of COVID-19, and empathic responding at baseline to preventive behaviors at follow-up. Results Controlling for baseline levels of preventive behaviors and demographic covariates, trait empathy and threat of COVID-19 at baseline were each independently associated with preventive behaviors at follow-up. An interaction between perceived threat and empathic responding indicated that those perceiving high threat of COVID-19 at baseline tended to report engaging in preventive behaviors at follow-up regardless of their levels of empathic responding, whereas for those reporting low levels of perceived threat, higher levels of empathic responding were associated with higher engagement in preventive behavior. Conclusions When perceived threat of COVID-19 was low, higher empathic responding was associated with increased engagement in preventive behaviors regardless of trait empathy, suggesting that empathic responding can serve as an actionable target for intervention to promote preventive behavior during the pandemic.
Collapse
Affiliation(s)
- Talia Morstead
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Jason Zheng
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Nancy L Sin
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - David B King
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Anita DeLongis
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
153
|
Di Bari M, Tonarelli F, Balzi D, Giordano A, Ungar A, Baldasseroni S, Onder G, Mechi MT, Carreras G. COVID-19, Vulnerability, and Long-Term Mortality in Hospitalized and Nonhospitalized Older Persons. J Am Med Dir Assoc 2021; 23:414-420.e1. [PMID: 34990587 PMCID: PMC8673732 DOI: 10.1016/j.jamda.2021.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 02/09/2023]
Abstract
Objective Studies suggesting that vulnerability increased short-term mortality in older patients with COVID-19 enrolled hospitalized patients and lacked COVID-negative comparators. Aim of this study was to examine the relationship between frailty and 1-year mortality in older patients with and without COVID-19, hospitalized and nonhospitalized. Design Cohort study. Setting and Participants Patients over 75 years old accessing the emergency departments (ED) were identified from the ED archives in Florence, Italy. Methods Vulnerability status was estimated with the Dynamic Silver Code (DSC). COVID-19 hospital discharges (HC+) were compared with non-COVID-19 discharges (HC-). Linkage with a national COVID-19 registry identified nonhospitalized ED visitors with (NHC+) or without COVID-19 (NHC-). Results In 1 year, 48.4% and 33.9% of 1745 HC+ and 15,846 HC- participants died (P < .001). Mortality increased from 27.5% to 64.0% in HC+ and from 19.9% to 51.1% in HC- across DSC classes I to IV, with HC+ vs HC- hazard ratios between 1.6 and 2.2. Out of 1039 NHC+ and 18,722 NHC- participants, 18% and 8.7% died (P < .001). Mortality increased from 14.2% to 46.7% in NHC+ and from 2.9% to 26% in NHC- across DSC; NHC+ vs NHC- hazard ratios decreased from 5.3 in class I to 2.0 in class IV. Conclusions and Implications In hospitalized older patients, mortality increases with vulnerability similarly in the presence and in the absence of COVID-19. In nonhospitalized patients, vulnerability-associated excess mortality is milder in individuals with than in those without COVID-19. The disease reduces survival even when background risk is low. Thus, apparently uncomplicated patients deserve closer clinical monitoring than commonly applied.
Collapse
Affiliation(s)
- Mauro Di Bari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Francesco Tonarelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Balzi
- Department of Epidemiology, Azienda USL Toscana Centro, Florence, Italy
| | - Antonella Giordano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Ungar
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Samuele Baldasseroni
- Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Italy
| | - M Teresa Mechi
- Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Carreras
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| |
Collapse
|
154
|
Older People in Germany During the COVID-19 Pandemic:The Least, the More, and the Most Affected. JOURNAL OF POPULATION AGEING 2021; 16:5-26. [PMID: 34925638 PMCID: PMC8666192 DOI: 10.1007/s12062-021-09352-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022]
Abstract
Older people have been identified as a particularly vulnerable group during the COVID-19 pandemic. However, the question of how older people actually fared during the COVID-19 pandemic has only been sporadically addressed. This article aims to partly fill this gap by classifying subgroups of older people using Latent Class Analysis. Indicators used are: risk perception, safety behavior, and well-being. To predict subgroup membership, age, gender, living arrangement, children, chronic illness, conflict, socioeconomic status, and migration history are controlled for. The data analyzed stem from a phone survey among 491 older people (75–100 years) in Germany conducted in September/October 2020. Results show that three subgroups of older people – the least, the more and the most affected – can be formed based on their risk perception, safety behavior, and well-being, indicating the usefulness of these three constructs for identifying and studying older people particularly affected by the COVID-19 pandemic and the measures taken to contain it.
Collapse
|
155
|
Goswami GG, Mahapatro M, Ali ARMM, Rahman R. Do Old Age and Comorbidity via Non-Communicable Diseases Matter for COVID-19 Mortality? A Path Analysis. Front Public Health 2021; 9:736347. [PMID: 34869152 PMCID: PMC8634945 DOI: 10.3389/fpubh.2021.736347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
This paper used Our World data for coronavirus disease-2019 (COVID-19) death count, test data, stringency, and transmission count and prepared a path model for COVID-19 deaths. We augmented the model with age structure-related variables and comorbidity via non-communicable diseases for 117 countries of the world for September 23, 2021, on a cross-section basis. A broad-based global quantitative study incorporating these two prominent channels with regional variation was unavailable in the existing literature. Old age and comorbidity were identified as two prime determinants of COVID-19 mortality. The path model showed that after controlling for these factors, one SD increase in the proportion of persons above 65, above 70, or of median age raised COVID-19 mortality by more than 0.12 SDs for 117 countries. The regional intensity of death is alarmingly high in South America, Europe, and North America compared with Oceania. After controlling for regions, the figure was raised to 0.213, which was even higher. For old age, the incremental coefficient was the highest for South America (0.564), and Europe (0.314), which were substantially higher than in Oceania. The comorbidity channel via non-communicable diseases illustrated that one SD increase in non-communicable disease intensity increased COVID-19 mortality by 0.132 for the whole sample. The regional figure for the non-communicable disease was 0.594 for South America and 0.358 for Europe compared with the benchmark region Oceania. The results were statistically significant at a 10% level of significance or above. This suggested that we should prioritize vaccinations for the elderly and people with comorbidity via non-communicable diseases like heart disease, cancer, chronic respiratory disease, and diabetes. Further attention should be given to South America and Europe, which are the worst affected regions of the world.
Collapse
Affiliation(s)
| | - Mausumi Mahapatro
- Department of History, Politics and Political Economy, Regis University, Denver, CO, United States
| | - A R M Mehrab Ali
- Aureolin Research, Consultancy and Expertise Development (ARCED) Foundation, Dhaka, Bangladesh
| | - Raisa Rahman
- Department of Economics, North South University, Dhaka, Bangladesh
| |
Collapse
|
156
|
Arabadjian ME, Reuter MC, Stepanovic A, Sherrid MV, Massera D. COVID-19 in Adults With Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2021; 8:745790. [PMID: 34859067 PMCID: PMC8630625 DOI: 10.3389/fcvm.2021.745790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Individuals with cardiovascular disease are considered high risk for severe COVID-19. However, the clinical impact of COVID-19 in patients with hypertrophic cardiomyopathy (HCM) is unknown. The purpose of this study was to describe the clinical course and outcomes of COVID-19 in patients with HCM. Methods: This retrospective observational study included adults with HCM and positive PCR/antibody test for SARS-CoV-2 at a large urban hospital system in the New York from January, 2020 to January, 2021. Results: Seventy individuals were included, with a mean (SD) age of 60.1 (15.1) years, 39 (55.7%) of whom were male, and 42 (60%) white. Forty-five (65.3%) patients had obstructive HCM. Hypertension and obesity (BMI ≥ 30) were present in 45 (64.3%) and 37 (52.9%) patients, and the prevalence of atrial fibrillation, obstructive sleep apnea and diabetes was high. Common symptoms of COVID-19 were fever, cough, shortness of breath and fatigue, affecting 33 (47.1%), 33 (47.1%), 28 (40.0%), and 28 (40.0%) patients, respectively. Fourteen (20%) patients were hospitalized. The majority (45 [64.3%] patients) recovered without intervention. Two patients had non-fatal pulmonary embolisms, 1 had atrial fibrillation requiring electrical cardioversion and 1 had acute decompensated heart failure. Three (4.3%) patients required mechanical ventilation, two of whom died (case fatality rate 2.9%). A total of 15 (21.4%) patients were asymptomatic. Conclusions: Our data suggest that in this diverse and high-risk group of patients with HCM, established risk factors for severe COVID-19, such as obesity, may be more important drivers of morbidity and mortality than the presence of HCM alone.
Collapse
Affiliation(s)
- Milla E Arabadjian
- New York University Rory Meyers College of Nursing, New York, NY, United States
| | - Maria C Reuter
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Alexandra Stepanovic
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Daniele Massera
- Hypertrophic Cardiomyopathy Program, Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, United States
| |
Collapse
|
157
|
Tan WS, Wong A, Mahmalji W, Raza A. Is there still a role for digital rectal examination in the prostate cancer diagnostic pathway in the COVID-19 and post COVID-19 era? Aging Male 2021; 24:92-94. [PMID: 34319201 DOI: 10.1080/13685538.2020.1786047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Digital rectal examination (DRE) is routinely performed as part of a urology clinical assessment in patients with a clinical suspicion of prostate cancer. An abnormal DRE or a raised prostate specific antigen (PSA) level are part of the criteria for primary care referral to secondary care due to a suspicion of prostate cancer. The current Coronavirus-19 (COVID-19) pandemic has resulted in the rapid adoption of virtual consultations in the form of telephone or video consultations making clinical examination difficult. In the case of prostate cancer diagnostic pathways, often clinicians now rely on PSA measurements and MRI, where radiological services are available, without the requirement for a DRE. We discuss the limited role DRE has in the modern prostate cancer diagnostic pathway due to the widespread adoption of MRI particularly in the COVID-19 era.
Collapse
Affiliation(s)
- Wei Shen Tan
- Department of Urology, London North West University Healthcare NHS Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Anton Wong
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Wasim Mahmalji
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Asif Raza
- Department of Urology, London North West University Healthcare NHS Trust, London, UK
- School of Medicine, Imperial College London, London, UK
- Medical and Dental School, Plymouth University, Plymouth, UK
| |
Collapse
|
158
|
Decreased Life Expectancy among Older People during the COVID-19 Pandemic: A Public Health Issue. JORJANI BIOMEDICINE JOURNAL 2021. [DOI: 10.52547/jorjanibiomedj.9.4.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
159
|
Jamil M, Bhattacharya PK, Barman B, Topno N, Barman H, Nongpiur VN, War G, Hynniewta Y, Saikia B, Naku N. Clinical and Demographic Profile of COVID-19 Patients: A Tertiary Level Hospital-Based Study From Northeast India. Cureus 2021; 13:e18881. [PMID: 34820212 PMCID: PMC8600250 DOI: 10.7759/cureus.18881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objective The coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India. Materials and methods This was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. Results The study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratory-confirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death. Conclusion The COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.
Collapse
Affiliation(s)
- Md Jamil
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Prasanta K Bhattacharya
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Bhupen Barman
- Internal Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Noor Topno
- Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Himesh Barman
- Paediatrics, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Vijay N Nongpiur
- Department of TB and Respiratory Diseases, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Gwenette War
- Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Yasmeen Hynniewta
- Neurology, North Eastern Indira Gandhi Regional Institute of health and Medical Sciences, Shillong, IND
| | - Bishwajeet Saikia
- Department of Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| | - Narang Naku
- Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND
| |
Collapse
|
160
|
Mitrev LV, Banerjee A, Van Helmond N. Correlation of Country Characteristics and Government Response Measures With COVID-19 Mortality During the First Phase of the Global COVID-19 Pandemic: A Worldwide Ecological Study. Cureus 2021; 13:e18689. [PMID: 34790453 PMCID: PMC8584059 DOI: 10.7759/cureus.18689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction It is valuable to know if country demographic, educational, healthcare and other socioeconomic factors were correlated with the COVID-19 mortality rate during the initial phase of the coronavirus disease 2019 (COVID-19) worldwide pandemic (January 1st - August 31st, 2020). Similarly, it is worthwhile understanding whether a country’s geographic location or the measures instituted by governments, such as lockdowns and mask-wearing, were associated with an increased or decreased mortality rate. Materials and methods To assess these correlations, we conducted an ecologic study of 178 countries using time-matched data from the Social Progress Index (www.socialprogress.org, produced by the Social Progress Imperative), population data from the World Bank (data.worldbank.org), government response indices from Our World In Data (ourworldindata.org/policy-responses-covid), and COVID-19 mortality data from the Johns Hopkins University CSSE COVID-19 Data repository (github.com/CSSEGISandData/COVID-19), accessed on November 22nd, 2020. Pearson correlation coefficients were derived between potential predictors and countries’ COVID-19 population-adjusted crude mortality rates. Select variables were entered in a multivariable regression model. Countries with no data in the social progress index database or those with no COVID-19 cases were excluded (20 in total). Results The highest positive correlations were found between the proportion of the population older than 75 (Pearson correlation coefficient 0.321), country distance from the equator (0.267), gross domestic product per capita (0.218), health and wellness score (0.388), water and sanitation score (0.384), environmental quality (0.237), and the days between the first reported COVID-19 case and the initial government response (0.238). A previously unreported and unexpected negative correlation was found between gender parity in secondary education attainment and COVID-19 mortality (-0.290). Peak mask-wearing ranging from ‘recommended’ to ‘required outside the home at all times was extremely weakly correlated with lower COVID-19 mortality (-0.046). Conclusions Crude COVID-19 mortality rates during the first phase of the pandemic in 2020, during which no vaccine or specific treatment was available, were higher in wealthier countries that were further away from the equator and had a higher health and wellness score according to the Social Progress Imperative. They were also higher the longer governments delayed their initial response. Gender parity in secondary education and stringency of mask-wearing guidelines were correlated with lower mortality, though the latter correlation was extremely weak. Our findings are consistent with previously published correlations. The correlation between crude COVID-19 mortality rates and gender parity in secondary education has not been previously reported.
Collapse
Affiliation(s)
| | - Annesha Banerjee
- Medicine, Cooper Medical School of Rowan University, Camden, USA
| | | |
Collapse
|
161
|
[Summary of Evidence and Recommendations: Guidelines for Care of Critically Ill Adult Patients with COVID-19 in the AmericasSíntese de evidência e recomendações: guia para o cuidado de pacientes adultos em estado crítico com COVID-19 nas Américas]. Rev Panam Salud Publica 2021; 45:e128. [PMID: 34737770 PMCID: PMC8559665 DOI: 10.26633/rpsp.2021.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction In 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread around the world. Approximately 5% of infected patients are critical cases that require admission to the intensive care unit (ICU). In these patients, COVID-19 can be complicated by acute respiratory distress syndrome, septic shock, and multi-organ failure, including kidney and heart failure. Objective Summarize the recommendations included in the Guidelines for Care of Critically Ill Adult Patients with COVID-19 in the Americas, version 3, published by the Pan American Health Organization in 2021 to guide the management of critically ill adult patients with COVID-19 treated in the ICU, and address key aspects of implementation of the recommendations. Methodology The guidelines and their recommendations were summarized. In addition, a systematic search was carried out in Pubmed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature on studies carried out in the Region of the Americas, in order to identify barriers, facilitators, and implementation strategies. Results Forty-three recommendations are presented that address the identification of markers and risk factors for mortality, infection prevention and control, specimen collection, supportive care (ventilatory and hemodynamic), pharmacological treatment, early rehabilitation, use of imaging studies, prevention of complications, and discharge criteria for critical patients with COVID-19. Conclusions The recommendations seek to provide knowledge on the management of critical patients with COVID-19 and offer considerations for implementation of the recommendations in the Region.
Collapse
|
162
|
Katkat F, Kalyoncuoğlu M, Karahan S, Abanus H, Turhan Çağlar FN, Karabulut D, Varol S, Şahin İ, Erkalp K, Okuyan E. Does coexistence of fragmented QRS and cardiovascular disease have the ability to predict the mortality in hospitalized, critically ill patients with COVID-19? Anatol J Cardiol 2021; 25:803-810. [PMID: 34734814 DOI: 10.5152/anatoljcardiol.2021.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE In this study, we aimed to investigate the prognostic accuracy of the presence of fragmented QRS (fQRS) on baseline electrocardiogram on the adverse outcome in critical patients with coronavirus disease 2019 (COVID-19) with cardiovascular disease (CVD). METHODS The current study was retrospective designed and included 169 patients who were critically ill with COVID-19 and CVD (mean age of 62±15 years). The patients were grouped into those who died (non-survivor group) and those who survived (survivor group). RESULTS The non-survivors were older and more often had CVD (p=0.009), hypertension (p=0.046), diabetes (p=0.048), cancer (p=0.023), and chronic renal failure (p=0.001). Although the presence of fQRS on the basal electrocardiogram was more common in patients who died, this was not statistically significant (p=0.059). Furthermore, non-survivors had more frequent the coexistence of CVD and fQRS (p=0.029). In Model 1 multivariate regression analysis, CVD alone was not a predictor of mortality (p=0.078), whereas coexistence of CVD and fQRS was found to be an independent predictor of mortality in Model 2 analysis [hazard ratio (HR): 2.243; p=0.003]. Furthermore, older age (HR: 1.022; p=0.006 and HR: 1.023; p=0.005), cancer (HR: 1.912; p=0.021 and HR: 1.858; p=0.031), high SOFA score (HR: 1.177; p=0.003 and HR: 1.215; p<0.001), and increased CRP level (HR: 1.003; p=0.039 and HR: 1.003; p=0.027) independently predicted the mortality in both multivariate analysis models, respectively. CONCLUSION fQRS may be a useful and handy risk-stratification tool for clinical outcomes by identifying high-risk individuals, especially among those with CVD.
Collapse
Affiliation(s)
- Fahrettin Katkat
- Department of Cardiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| | - Muhsin Kalyoncuoğlu
- Department of Cardiology, University of Health Sciences, Haseki Training and Research Hospital; İstanbul-Turkey
| | - Serkan Karahan
- Department of Cardiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| | - Hanife Abanus
- Department of Cardiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| | - Fatma Nihan Turhan Çağlar
- Department of Cardiology, University of Health Sciences, Bakırköy Sadi Konuk Training and Research Hospital; İstanbul-Turkey
| | - Dilay Karabulut
- Department of Cardiology, University of Health Sciences, Bakırköy Sadi Konuk Training and Research Hospital; İstanbul-Turkey
| | - Sinan Varol
- Department of Cardiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| | - İrfan Şahin
- Department of Cardiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| | - Kerem Erkalp
- Department of Anaesthesiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| | - Ertuğrul Okuyan
- Department of Cardiology, Division of Critical Care, University of Health Sciences, Bağcılar Training and Research Hospital; İstanbul-Turkey
| |
Collapse
|
163
|
Lami F, Rashak HA, Khaleel HA, Mahdi SG, Adnan F, Khader YS, Alhilfi RA, Lehlewa A. Iraq experience in handling the COVID-19 pandemic: implications of public health challenges and lessons learned for future epidemic preparedness planning. J Public Health (Oxf) 2021; 43:iii19-iii28. [PMID: 34651194 PMCID: PMC8660009 DOI: 10.1093/pubmed/fdab369] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/09/2021] [Accepted: 09/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Iraq has been exceptionally challenged by the COVID-19 pandemic due to the already exhausted healthcare system. Objectives To describe the epidemiological situation of COVID-19 in Iraq, the government’s response to the pandemic, and provide recommendations for further action. Methods A desk review of secondary data using the available reports on the epidemiological situation in Iraq as well as official governmental sources was conducted. Results The major surge in the number of COVID-19 cases occurred in the first week of June and continued to increase dramatically until mid-October when a significant decrease happened. With a few exceptions, the reproductive number R has been consistently above 1. Patients aged 30–39 years (25.6%) were the most affected, while those aged 60–69 years (26.7%) had the highest deaths rates. Iraq tried to contain the pandemic through several regulations: border control, enforcing curfew, mask-wearing, and social distancing, COVID-19 isolation centers, expanding lab capacity, contact tracing, as well as several supportive economic measures. However, the extent of implementing these regulations is questionable. Conclusion Additional administrative and scientific measures with special emphasis on handling mass gathering, coordination with media and better training of healthcare workers particularly on infection prevention and control.
Collapse
Affiliation(s)
- Faris Lami
- Department of Community and Family Medicine, College of Medicine, University of Baghdad, Baghdad 10047, Iraq
| | - Hiba Abdulrahman Rashak
- Surveillance Section, Communicable Diseases Control Center, Directorate of Public Health, Ministry of Health, Baghdad 10047, Iraq
| | - Hanan Abdulghafoor Khaleel
- Head of the Surveillance Section, Communicable Diseases Control Center, Directorate of Public Health, Ministry of Health, Baghdad 10047, Iraq
| | - Sinan Ghazi Mahdi
- Head of Communicable Diseases Control Center, Directorate of Public Health, Ministry of Health, Baghdad 10047, Iraq
| | - Firas Adnan
- Al-Karkh Health Directorate, Public Health Department, Ministry of Health, Baghdad 10047, Iraq
| | - Yousef S Khader
- Professor of Epidemiology, Medical Education and Biostatistics, Department of Community Medicine, Public Health and Family Medicine/Faculty of Medicine, Jordan University of Science & Technology, Irbid 22110, Jordan
| | - Riyadh A Alhilfi
- Directorate of Public Health, Ministry of Health, Baghdad 10047, Iraq
| | - Asaad Lehlewa
- Directorate of Public Health, Ministry of Health, Baghdad 10047, Iraq
| |
Collapse
|
164
|
Kim Y, Latz CA, DeCarlo CS, Lee S, Png CYM, Kibrik P, Sung E, Alabi O, Dua A. Relationship between blood type and outcomes following COVID-19 infection. Semin Vasc Surg 2021; 34:125-131. [PMID: 34642032 PMCID: PMC8286549 DOI: 10.1053/j.semvascsurg.2021.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023]
Abstract
Since the onset of the COVID-19 pandemic, a concentrated research effort has been undertaken to elucidate risk factors underlying viral infection, severe illness, and death. Recent studies have investigated the association between blood type and COVID-19 infection. This article aims to comprehensively review current literature and better understand the impact of blood type on viral susceptibility and outcomes.
Collapse
Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114
| | - Christopher A Latz
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114
| | - Charles S DeCarlo
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114
| | - Sujin Lee
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114
| | - Pavel Kibrik
- Division of Vascular Surgery, Langone Medical Center, New York University, Brooklyn, NY
| | - Eric Sung
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114
| | - Olamide Alabi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Wang 440, Boston, MA, 02114.
| |
Collapse
|
165
|
Cutler J, Nitschke JP, Lamm C, Lockwood PL. Older adults across the globe exhibit increased prosocial behavior but also greater in-group preferences. NATURE AGING 2021; 1:880-888. [PMID: 37118329 PMCID: PMC10154238 DOI: 10.1038/s43587-021-00118-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/11/2021] [Indexed: 04/30/2023]
Abstract
Population aging is a global phenomenon with substantial implications across society1,2. Prosocial behaviors-actions that benefit others-promote mental and physical health across the lifespan3,4 and can save lives during the COVID-19 pandemic. We examined whether age predicts prosociality in a preregistered global study (46,576 people aged 18-99 across 67 countries) using two acutely relevant measures: distancing during COVID-19 and willingness to donate to hypothetical charities. Age positively predicted prosociality on both measures, with increased distancing and donations among older adults. However, older adults were more in-group focused than younger adults in choosing who to help, making larger donations to national over international charities and reporting increased in-group preferences. In-group preferences helped explain greater national over international donations. Results were robust to several control analyses and internal replication. Our findings have vital implications for predicting the social and economic impacts of aging populations, increasing compliance with public health measures and encouraging charitable donations.
Collapse
Affiliation(s)
- Jo Cutler
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Jonas P Nitschke
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Claus Lamm
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Patricia L Lockwood
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Christ Church, University of Oxford, Oxford, UK.
| |
Collapse
|
166
|
Cardenas J, Roach J, Kopelowicz A. Prevalence of COVID 19 Positive Cases Presenting to a Psychiatric Emergency Room. Community Ment Health J 2021; 57:1240-1243. [PMID: 33770308 PMCID: PMC7994956 DOI: 10.1007/s10597-021-00816-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/12/2021] [Indexed: 01/07/2023]
Abstract
To explore the prevalence of SARS-CoV2 infection in the psychiatric emergency room setting. A Cross-sectional retrospective chart review was used to determine the point-prevalence of SARS-CoV2 infection and the characteristics of those infected. Of the patients tested for SARS-CoV2, 23/1057 (2.2%) were positive. Most of these patients were homeless (living on the street) or came from congregate living settings. The high percentage of SARS-CoV2 positive psychiatric patients coming from congregate living settings stresses the importance of asymptomatic screening in this vulnerable population.
Collapse
Affiliation(s)
- Jeffrey Cardenas
- Olive View UCLA Medical Center, 14445 Olive View Dr. Cottage H1, Sylmar, CA USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Janine Roach
- Olive View UCLA Medical Center, 14445 Olive View Dr. Cottage H1, Sylmar, CA USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Alex Kopelowicz
- Olive View UCLA Medical Center, 14445 Olive View Dr. Cottage H1, Sylmar, CA USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA USA
| |
Collapse
|
167
|
Teng C, Thampy U, Bae JY, Cai P, Dixon RAF, Liu Q, Li P. Identification of Phenotypes Among COVID-19 Patients in the United States Using Latent Class Analysis. Infect Drug Resist 2021; 14:3865-3871. [PMID: 34584430 PMCID: PMC8464321 DOI: 10.2147/idr.s331907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/31/2021] [Indexed: 01/31/2023] Open
Abstract
Background Coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) is a heterogeneous disorder with a complex pathogenesis. Recent studies from Spain and France have indicated that underlying phenotypes may exist among patients admitted to the hospital with COVID-19. Whether those same phenotypes exist in the United States (US) remains unclear. Using latent class analysis (LCA), we sought to determine whether clinical phenotypes exist among patients admitted for COVID-19. Methods We reviewed the charts of adult patients who were hospitalized primarily for COVID-19 at Greenwich Hospital and performed LCA using variables based on patient demographics and comorbidities. To further examine the reliability and replicability of the clustering results, we repeated LCA on the cohort of patients who died during hospitalization for COVID-19. Results Two phenotypes were identified in patients admitted for COVID-19 (N = 483). According to phenotype, patients were designated as cluster 1 (C1) or cluster 2 (C2). C1 (n = 193) consisted of older individuals with more comorbidities and a higher mortality rate (25.4% vs 8.97%, p < 0.001) than patients in C2. C2 (n = 290) consisted of younger individuals who were more likely to be obese, male, and nonwhite, with higher levels of the inflammatory markers C-reactive protein and alanine aminotransferase. When we performed LCA on the cohort of patients who died during hospitalization for COVID-19 (n = 75), we found that the distribution of patient baseline characteristics and comorbidities was similar to that of the entire cohort of patients admitted for COVID-19. Conclusion Using LCA, we identified two clinical phenotypes of patients who were admitted to our hospital for COVID-19. These findings may reflect different pathophysiologic processes that lead to moderate to severe COVID-19 and may be useful for identifying treatment targets and selecting patients with severe COVID-19 disease for future clinical trials.
Collapse
Affiliation(s)
- Catherine Teng
- Department of Medicine, Yale New Haven Health - Greenwich Hospital, Greenwich, CT, USA
| | - Unnikrishna Thampy
- Department of Medicine, Yale New Haven Health - Greenwich Hospital, Greenwich, CT, USA
| | - Ju Young Bae
- Department of Medicine, Yale New Haven Health - Greenwich Hospital, Greenwich, CT, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Richard A F Dixon
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Qi Liu
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
168
|
Jayant K, Reccia I, Bachul PJ, Al-Salmay Y, Pyda JS, Podda M, Perez-Gutierrez A, Dor FJMF, Becker Y, di Sabato D, LaMattina J, Barth R, Fung J, Witkowski P. The Impact of COVID-19 on Kidney Transplant Recipients in Pre-Vaccination and Delta Strain Era: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:4533. [PMID: 34640552 PMCID: PMC8509345 DOI: 10.3390/jcm10194533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 01/08/2023] Open
Abstract
Herein, we performed a meta-analysis of published clinical outcomes of corona virus disease 2019 (COVID-19) in hospitalized kidney transplant recipients. A systematic database search was conducted between December 1, 2019 and April 20, 2020. We analyzed 48 studies comprising 3137 kidney transplant recipients with COVID-19. Fever (77%), cough (65%), dyspnea (48%), and gastrointestinal symptoms (28%) were predominant on hospital admission. The most common comorbidities were hypertension (83%), diabetes mellitus (34%), and cardiac disease (23%). The pooled prevalence of acute respiratory distress syndrome and acute kidney injury were 58% and 48%, respectively. Invasive ventilation and dialysis were required in 24% and 22% patients, respectively. In-hospital mortality rate was as high as 21%, and increased to over 50% for patients in intensive care unit (ICU) or requiring invasive ventilation. Risk of mortality in patients with acute respiratory distress syndrome (ARDS), on mechanical ventilation, and ICU admission was increased: OR = 19.59, OR = 3.80, and OR = 13.39, respectively. Mortality risk in the elderly was OR = 3.90; however, no such association was observed in terms of time since transplantation and gender. Fever, cough, dyspnea, and gastrointestinal symptoms were common on admission for COVID-19 in kidney transplant patients. Mortality was as high as 20% and increased to over 50% in patients in ICU and required invasive ventilation.
Collapse
Affiliation(s)
- Kumar Jayant
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Piotr J. Bachul
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Yaser Al-Salmay
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Jordan S. Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
| | - Mauro Podda
- Department of Emergency Surgery, Azienda Ospedaliero-Universitaria Di Cagliari, University Hospital Policlinico Duilio Casula, 09124 Cagliari, Italy;
| | - Angelica Perez-Gutierrez
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK;
| | - Yolanda Becker
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Diego di Sabato
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - John LaMattina
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Rolf Barth
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - John Fung
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| | - Piotr Witkowski
- Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL 60637, USA; (K.J.); (P.J.B.); (Y.A.-S.); (A.P.-G.); (Y.B.); (D.d.S.); (J.L.); (R.B.); (J.F.)
| |
Collapse
|
169
|
Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
Collapse
Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| |
Collapse
|
170
|
Bakaloudi DR, Chourdakis M. A critical update on the role of mild and serious vitamin D deficiency prevalence and the COVID-19 epidemic in Europe. Nutrition 2021; 93:111441. [PMID: 34492624 PMCID: PMC8321689 DOI: 10.1016/j.nut.2021.111441] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 12/19/2022]
Abstract
Objectives Coronavirus disease 2019 (COVID-19) has emerged as a pandemic, affecting nearly 180 million people worldwide as of June 22, 2021. Previous studies have examined the association between the mean vitamin D (Vit D) concentration of each country and COVID-19 infection and mortality rate in European countries. The aim of the present study was to critically evaluate the relationship between prevalence of mild and severe Vit D deficiency in each country and COVID-19 infection, recovery, and mortality using updated data and a different methodological approach. Methods Information on Vit D concentration or deficiency for each country was retrieved through a literature search. COVID-19 infections and mortalities per million people and total recoveries, as of June 22, 2021, were obtained. The associations between Vit D deficiency and COVID-19 infection, recovery, and mortality were explored using correlation coefficients and scatterplots. Results Non-significant correlations were observed between both number of COVID-19 infections (r = 0.363, P = 0.116) and number of recoveries (r = 0.388, P = 0.091) and the prevalence of mild Vit D deficiency (<50 nmol/L). Similarly, non-significant correlations were observed between both infections (r = 0.215, P = 0.392) and recoveries (r = 0.242, P = 0.332) and the prevalence of severe Vit D deficiency (<30 nmol/L). Significant correlations were found between COVID-19 mortality and prevalence of both mild Vit D deficiency (r = 0.634, P = 0.003) and severe Vit D deficiency (r = 0.538, P = 0.021). Conclusions The prevalence of neither mild nor severe Vit D deficiency was associated with the number of COVID-19 infections in European countries. Thus, it is an important parameter to consider when implementing preventive measures to face COVID-19.
Collapse
Affiliation(s)
- Dimitra Rafailia Bakaloudi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki, Greece.
| |
Collapse
|
171
|
Treskova-Schwarzbach M, Haas L, Reda S, Pilic A, Borodova A, Karimi K, Koch J, Nygren T, Scholz S, Schönfeld V, Vygen-Bonnet S, Wichmann O, Harder T. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med 2021; 19:212. [PMID: 34446016 PMCID: PMC8390115 DOI: 10.1186/s12916-021-02058-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. METHODS Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. RESULTS In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2-2.0 (CI range 1.1-2.8)), obesity (OR range 1.5-1.75 (CI range 1.1-2.3)), heart failure (HR range 1.3-3.3 (CI range 0.9-8.2)), COPD (HR range 1.12-2.2 (CI range 1.1-3.2)) and dementia (HR range 1.4-7.7 (CI range 1.2-39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2-5.9 (CI range 0.9-27.7)) and active cancer (OR range 1.6-4.7 (CI range 0.5-14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3-2.2)). GRADE certainty was moderate to high for most associations. CONCLUSION Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.
Collapse
Affiliation(s)
| | - Laura Haas
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sarah Reda
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Antonia Pilic
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Anna Borodova
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Kasra Karimi
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Judith Koch
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Teresa Nygren
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Stefan Scholz
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sabine Vygen-Bonnet
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| |
Collapse
|
172
|
Dessie ZG, Zewotir T. Mortality-related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis 2021; 21:855. [PMID: 34418980 PMCID: PMC8380115 DOI: 10.1186/s12879-021-06536-3] [Citation(s) in RCA: 376] [Impact Index Per Article: 125.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/11/2021] [Indexed: 01/10/2023] Open
Abstract
Background Mortality rates of coronavirus disease-2019 (COVID-19) continue to rise across the world. The impact of several risk factors on coronavirus mortality has been previously reported in several meta‐analyses limited by small sample sizes. In this systematic review, we aimed to summarize available findings on the association between comorbidities, complications, smoking status, obesity, gender, age and D-dimer, and risk of mortality from COVID-19 using a large dataset from a number of studies.
Method Electronic databases including Google Scholar, Cochrane Library, Web of Sciences (WOS), EMBASE, Medline/PubMed, COVID-19 Research Database, and Scopus, were systematically searched till 31 August 2020. We included all human studies regardless of language, publication date or region. Forty-two studies with a total of 423,117 patients met the inclusion criteria. To pool the estimate, a mixed-effect model was used. Moreover, publication bias and sensitivity analysis were evaluated. Results The findings of the included studies were consistent in stating the contribution of comorbidities, gender, age, smoking status, obesity, acute kidney injury, and D-dimer as a risk factor to increase the requirement for advanced medical care. The analysis results showed that the pooled prevalence of mortality among hospitalized patients with COVID-19 was 17.62% (95% CI 14.26–21.57%, 42 studies and 423,117 patients). Older age has shown increased risk of mortality due to coronavirus and the pooled odds ratio (pOR) and hazard ratio (pHR) were 2.61 (95% CI 1.75–3.47) and 1.31 (95% CI 1.11–1.51), respectively. A significant association were found between COVID-19 mortality and male (pOR = 1.45; 95% CI 1.41–1.51; pHR = 1.24; 95% CI 1.07–1.41), and current smoker (pOR = 1.42; 95% CI 1.01–1.83). Furthermore, risk of mortality among hospitalized COVID-19 patients is highly influenced by patients with Chronic Obstructive Pulmonary Disease (COPD), Cardiovascular Disease (CVD), diabetes, hypertension, obese, cancer, acute kidney injury and increase D-dimer. Conclusion Chronic comorbidities, complications, and demographic variables including acute kidney injury, COPD, diabetes, hypertension, CVD, cancer, increased D-dimer, male gender, older age, current smoker, and obesity are clinical risk factors for a fatal outcome associated with coronavirus. The findings could be used for disease’s future research, control and prevention.
Collapse
Affiliation(s)
- Zelalem G Dessie
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa. .,College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
173
|
Graham EL, Khaja S, Caban-Martinez AJ, Smith DL. Firefighters and COVID-19: An Occupational Health Perspective. J Occup Environ Med 2021; 63:e556-e563. [PMID: 34138822 PMCID: PMC8327761 DOI: 10.1097/jom.0000000000002297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | - Saeed Khaja
- Advocate Lutheran General Hospital, Park Ridge, IL
- Hanover Park Fire Department, Hanover Park, IL
| | - Alberto J Caban-Martinez
- Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Denise L Smith
- First Responder Health and Safety Laboratory, Department of Health and Human Physiological Sciences, Skidmore College, Saratoga Springs, NY
| |
Collapse
|
174
|
Tang G, Zhang L, Huang W, Wei Z. Could Immunonutrition Help in the Fight against COVID-19 in Cancer Patient? Nutr Cancer 2021; 74:1203-1212. [PMID: 34309463 DOI: 10.1080/01635581.2021.1957128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The rapid and widespread global pandemic of 2019 coronavirus disease (COVID-19) has had unprecedented negative health and economic impacts. Immune responses play a key role in the development of COVID-19, including the disruption of immune balance and cytokine storms caused by excessive inflammatory responses. Due to the effects of cancer itself and treatment, patients often accompanied by immunosuppression appear to be a susceptible population for COVID-19. Worryingly, COVID-19 with cancer is associated with a poor prognosis. Cancer patients are a vulnerable group, threatened by COVID-19, finding a way to combat COVID-19 for them is urgent. Immunonutrition is closely related to balance and strong immune function. Supplementary immunonutrition can improve the immune function and inflammatory response of cancer patients after surgery, which provides evidence for the role of immunonutrition in combating COVID-19. We reviewed possible mechanisms of immunonutrition against COVID-19, including enhancing immune cell function, increasing immune cell count, ameliorating excessive inflammatory response, and regulating gut microbiota. Immunonutrition supplementation in cancer patients may be beneficial to enhance immune function in the early stage of COVID-19 infection and control excessive inflammatory response in the late stage. Therefore, immunonutrition is a potential strategy for the prevention and treatment of COVID-19 in cancer.
Collapse
Affiliation(s)
- Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Linyu Zhang
- Department of Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Wang Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengqiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
175
|
Lim JK, Park B, Park J, Choi KJ, Jung CY, Kim YH, Kim JY, Moon S, Lee YH, Lee J. Impact of Computed Tomography-Quantified Emphysema Score on Clinical Outcome in Patients with COVID-19. Int J Gen Med 2021; 14:3327-3333. [PMID: 34285557 PMCID: PMC8285278 DOI: 10.2147/ijgm.s317295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is considered a risk factor for poor outcomes in patients with coronavirus disease 2019 (COVID-19). However, data on the prognostic impact of radiological emphysema extent on patients with COVID-19 are limited. Thus, this study aimed to examine whether computed tomography (CT)-quantified emphysema score is associated with a worse clinical outcome in patients with COVID-19. Methods Volumetric quantitative analyses of CT images were performed to obtain emphysema scores in COVID-19 patients admitted to four tertiary referral hospitals in Daegu, South Korea, between February 18 and March 25, 2020. Patients were divided into three groups according to emphysema score (emphysema score ≤1%, 1%< emphysema score ≤5%, and emphysema score >5%). Results A total of 146 patients with confirmed SARS-CoV-2 infection were included. The median emphysema score was 1.0% (interquartile range, 0.5–1.8%). Eight patients (6%) had a previous COPD diagnosis. Eighty (55%), 55 (38%), and 11 (8%) patients had emphysema scores ≤1%, between 1% and 5%, and >5%, respectively. The number of patients who received oxygen therapy two weeks after admission was significantly higher in the group with emphysema scores >5% than in other groups (p=0.025). The frequency of deaths was three (27%) in the group with emphysema scores >5% and tended to be higher than that in other groups. Multivariate analysis revealed that age, COPD, and serum lactate dehydrogenase levels were associated with a greater risk of in-hospital mortality in patients with COVID-19. Conclusion The current study demonstrated that patients with CT-quantified emphysema scores >5% tended to progress to severe disease over time; however, they did not exhibit an increased risk of mortality in our COVID-19 cohort. Further studies with consideration of both emphysema extent and airflow limitation degree are warranted.
Collapse
Affiliation(s)
- Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byunggeon Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jongmin Park
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Keum-Ju Choi
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Chi-Young Jung
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Young Hwan Kim
- Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jin Young Kim
- Department of Radiology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Sungjun Moon
- Department of Radiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Yong Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| |
Collapse
|
176
|
Schlesinger S, Neuenschwander M, Lang A, Pafili K, Kuss O, Herder C, Roden M. Risk phenotypes of diabetes and association with COVID-19 severity and death: a living systematic review and meta-analysis. Diabetologia 2021; 64:1480-1491. [PMID: 33907860 PMCID: PMC8079163 DOI: 10.1007/s00125-021-05458-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/17/2021] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS Diabetes has been identified as a risk factor for poor prognosis of coronavirus disease-2019 (COVID-19). The aim of this study is to identify high-risk phenotypes of diabetes associated with COVID-19 severity and death. METHODS This is the first edition of a living systematic review and meta-analysis on observational studies investigating phenotypes in individuals with diabetes and COVID-19-related death and severity. Four different databases were searched up to 10 October 2020. We used a random effects meta-analysis to calculate summary relative risks (SRR) with 95% CI. The certainty of evidence was evaluated by the GRADE tool. RESULTS A total of 22 articles, including 17,687 individuals, met our inclusion criteria. For COVID-19-related death among individuals with diabetes and COVID-19, there was high to moderate certainty of evidence for associations (SRR [95% CI]) between male sex (1.28 [1.02, 1.61], n = 10 studies), older age (>65 years: 3.49 [1.82, 6.69], n = 6 studies), pre-existing comorbidities (cardiovascular disease: 1.56 [1.09, 2.24], n = 8 studies; chronic kidney disease: 1.93 [1.28, 2.90], n = 6 studies; chronic obstructive pulmonary disease: 1.40 [1.21, 1.62], n = 5 studies), diabetes treatment (insulin use: 1.75 [1.01, 3.03], n = 5 studies; metformin use: 0.50 [0.28, 0.90], n = 4 studies) and blood glucose at admission (≥11 mmol/l: 8.60 [2.25, 32.83], n = 2 studies). Similar, but generally weaker and less precise associations were observed between risk phenotypes of diabetes and severity of COVID-19. CONCLUSIONS/INTERPRETATION Individuals with a more severe course of diabetes have a poorer prognosis of COVID-19 compared with individuals with a milder course of disease. To further strengthen the evidence, more studies on this topic that account for potential confounders are warranted. REGISTRATION PROSPERO registration ID CRD42020193692.
Collapse
Affiliation(s)
- Sabrina Schlesinger
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany.
| | - Manuela Neuenschwander
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
| | - Alexander Lang
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kalliopi Pafili
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Centre for Health and Society, Faculty of Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Christian Herder
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Roden
- German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital, Heinrich-Heine University, Düsseldorf, Germany
| |
Collapse
|
177
|
Development and Validation of a Multivariable Predictive Model for Mortality of COVID-19 Patients Demanding High Oxygen Flow at Admission to ICU: AIDA Score. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6654388. [PMID: 34257816 PMCID: PMC8245230 DOI: 10.1155/2021/6654388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023]
Abstract
Introduction Risk stratification is an important aspect of COVID-19 management, especially in patients admitted to ICU as it can provide more useful consumption of health resources, as well as prioritize critical care services in situations of overwhelming number of patients. Materials and Methods A multivariable predictive model for mortality was developed using data solely from a derivation cohort of 160 COVID-19 patients with moderate to severe ARDS admitted to ICU. The regression coefficients from the final multivariate model of the derivation study were used to assign points for the risk model, consisted of all significant variables from the multivariate analysis and age as a known risk factor for COVID-19 patient mortality. The newly developed AIDA score was arrived at by assigning 5 points for serum albumin and 1 point for IL-6, D dimer, and age. The score was further validated on a cohort of 304 patients admitted to ICU due to the severe form of COVID-19. Results The study population included 160 COVID-19 patients admitted to ICU in the derivation and 304 in the validation cohort. The mean patient age was 66.7 years (range, 20–93 years), with 68.1% men and 31.9% women. Most patients (76.8%) had comorbidities with hypertension (67.7%), diabetes (31.7), and coronary artery disease (19.3) as the most frequent. A total of 316 patients (68.3%) were treated with mechanical ventilation. Ninety-six (60.0%) in the derivation cohort and 221 (72.7%) patients in the validation cohort had a lethal outcome. The population was divided into the following risk categories for mortality based on the risk model score: low risk (score 0–1) and at-risk (score > 1). In addition, patients were considered at high risk with a risk score > 2. By applying the risk model to the validation cohort (n = 304), the positive predictive value was 78.8% (95% CI 75.5% to 81.8%); the negative predictive value was 46.6% (95% CI 37.3% to 56.2%); the sensitivity was 82.4% (95% CI 76.7% to 87.1%), and the specificity was 41.0% (95% CI 30.3% to 52.3%). The C statistic was 0.863 (95% CI 0.805-0.921) and 0.665 (95% CI 0.598-0.732) in the derivation and validation cohorts, respectively, indicating a high discriminative value of the proposed score. Conclusion In the present study, AIDA score showed a valuable significance in estimating the mortality risk in patients with the severe form of COVID-19 disease at admission to ICU. Further external validation on a larger group of patients is needed to provide more insights into the utility of this score in everyday practice.
Collapse
|
178
|
Karaaslan Y, Mete O, Karadag M, Ozer Kaya D, Toprak Celenay S. An investigation of potential coronaphobia-related factors in adults and sleep quality relations. Sleep Med 2021; 84:356-361. [PMID: 34246043 DOI: 10.1016/j.sleep.2021.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/01/2021] [Accepted: 06/11/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND The study aimed to investigate potential coronaphobia-related factors in adults and to assess the relationship between coronaphobia and sleep quality. METHODS This cross-sectional study was conducted in 1262 participants. The Covid-19 Phobia Scale (C19P-S) and Jenkins Sleep Scale (JSS) were used to measure outcomes. Univariate and multivariate logistic regression analyses were constructed to determine risk factors for coronaphobia. Pearson correlation coefficient was used to assess the correlation between C19P-S and JSS. RESULTS The following risk factors were found to be associated with coronaphobia: gender, marital status, presence of chronic disease, staying home, and sleep disturbances. Female gender (OR = 2.23 and OR = 2.12), being married (OR = 1.31 and OR = 1.45), chronic disease status (OR = 1.39 and OR = 1.27), staying home (OR = 1.72 and OR = 1.35) and sleep disturbances (OR = 2.63 and OR = 2.49) were found to be associated with the likelihood of having a higher coronaphobia score (p < 0.05). Weak positive correlations were found between C19P-S and its subscales and JSS scores (p < 0.001). CONCLUSIONS Female gender, being married, having chronic diseases, staying home, and having sleep disturbances were found to be risk factors for having high coronaphobia scores. Moreover, the severity of coronaphobia was associated with sleep disturbances. These results should be considered in the management of coronaphobia.
Collapse
Affiliation(s)
- Yasemin Karaaslan
- Beykent University, School of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
| | - Oguzhan Mete
- Ankara Yildirim Beyazit University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Mehmet Karadag
- Hatay Mustafa Kemal University, Medicine Faculty, Department of Biostatistics, Hatay, Turkey
| | - Derya Ozer Kaya
- Izmir Katip Celebi University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Seyda Toprak Celenay
- Ankara Yildirim Beyazit University, Health Sciences Faculty, Department of Physiotherapy and Rehabilitation, Ankara, Turkey.
| |
Collapse
|
179
|
Lozano-Sanchez F, Ursu R, Di-Stefano AL, Ducray F, Younan N, Touat M, Groh M, Agguini H, Belin C, Garnier L, Delattre JY, Carpentier A, Idbaih A. Descriptive and retrospective analysis of diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the pandemic. Neurooncol Adv 2021; 3:vdab078. [PMID: 34396128 PMCID: PMC8360904 DOI: 10.1093/noajnl/vdab078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Little is known about diffuse glioma patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). Methods We performed a descriptive and retrospective analysis of 41 diffuse glioma patients with symptomatic SARS-CoV2 infection during the first wave of the COVID-19 pandemic. Results Confusion with or without fever was the most common neurological symptom (32%) supporting SARS-CoV2 testing in glioma patients with acute and unexplained confusion. Sixteen patients (39%) died after a median delay of 13 days. While multiple clinical, biological, and pathological features, COVID-19- or diffuse glioma-related, at hospital admission appeared to have a pejorative prognostic impact, none was significantly associated with death. Oncological treatments were interrupted at COVID-19 diagnosis and re-initiated with a median delay of 30 days after the end of COVID-19 symptoms. Conclusions Interestingly, our retrospective study describes for the first time the characteristics of a cohort of diffuse glioma patients with symptomatic COVID-19. Diffuse glioma patients with poorly symptomatic COVID-19 did not come to the attention of physicians and were not enrolled in the study skewing the denominator for prognostic analysis. Further studies are warranted to specify prognosis of overall population of diffuse glioma patients with COVID-19, including asymptomatic patients, and interactions of prognostic factors of both COVID-19 and diffuse gliomas.
Collapse
Affiliation(s)
- Fernando Lozano-Sanchez
- Service Neurology 2 - Mazarin, Assistance Public-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| | - Renata Ursu
- Department of Neurology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris University, Paris, France
| | | | - Francois Ducray
- Cancerology Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity department, Transcriptome Diversity in Stem Cells laboratory, Lyon, France.,Lyon University, Université Claude Bernard Lyon 1, Lyon, France.,Service of Neuro-oncology, Hospices Civils de Lyon, Groupement Hospitalier Est, Neurology Hospital, Lyon, France
| | - Nadia Younan
- Service Neurology 2 - Mazarin, Assistance Public-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| | - Mehdi Touat
- Service Neurology 2 - Mazarin, Assistance Public-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| | - Matthieu Groh
- Department of Internal Medicine, Foch Hospital, F-92151 Suresnes, France
| | - Hanane Agguini
- Department of Neurology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris University, Paris, France
| | - Catherine Belin
- Department of Neurology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris University, Paris, France
| | - Luois Garnier
- Cancerology Research Center of Lyon, INSERM U1052, CNRS UMR 5286, Cancer Cell Plasticity department, Transcriptome Diversity in Stem Cells laboratory, Lyon, France.,Lyon University, Université Claude Bernard Lyon 1, Lyon, France.,Service of Neuro-oncology, Hospices Civils de Lyon, Groupement Hospitalier Est, Neurology Hospital, Lyon, France
| | - Jean-Yves Delattre
- Service Neurology 2 - Mazarin, Assistance Public-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| | - Antoine Carpentier
- Department of Neurology, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris University, Paris, France
| | - Ahmed Idbaih
- Service Neurology 2 - Mazarin, Assistance Public-Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne University, Paris, France
| |
Collapse
|
180
|
Rocha SQ, Avelino-Silva VI, Tancredi MV, Jamal LF, Ferreira PRA, Tayra A, Ferreira PM, Carvalhanas T, Domingues CSB, Souza RA, Gianna MC, Kalichman AO, Leite OHM, Souza TNL, Gomes E Costa DA, Furtado JJD, Costa AF. COVID-19 and HIV/AIDS in a cohort study in Sao Paulo, Brazil: outcomes and disparities by race and schooling. AIDS Care 2021; 34:832-838. [PMID: 34082616 DOI: 10.1080/09540121.2021.1936444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Studies describing characteristics and outcomes of COVID-19 among people living with HIV are currently limited, lacking detailed evaluation of the interplay among demographics, HIV-related variables, and comorbidities on COVID-19 outcomes. This retrospective cohort study describes mortality rates overall and according to demographic characteristics and explores predictors of admission to intensive care unit and death among 255 persons living with HIV with severe acute respiratory syndrome and confirmed SARS-CoV-2 infection in the State of Sao Paulo, Brazil. We found that the overall mortality rate was 4.1/1,000 person-days, with a case-fatality of 34%. Higher rates occurred among older adults, Black/Mixed skin color/race patients, and those with lower schooling. In a multivariable analysis adjusted for age, sex, CD4 count, viral load and number of comorbidities, skin color/race, and schooling remained significantly associated with higher mortality. Although tenofovir use was more frequent among survivors in the univariable analysis, we failed to find a statistically significant association between tenofovir use and survival in the multivariable analysis. Our findings suggest that social vulnerabilities related to both HIV and COVID-19 significantly impact the risk of death, overtaking traditional risk factors such as age, sex, CD4 count, and comorbidities.
Collapse
Affiliation(s)
- S Q Rocha
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - V I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - M V Tancredi
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - L F Jamal
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - P R A Ferreira
- Disciplina de Infectologia, Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - A Tayra
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - P M Ferreira
- Centro de Vigilância Epidemiológica - São Paulo (CVE), São Paulo, Brazil
| | - T Carvalhanas
- Centro de Vigilância Epidemiológica - São Paulo (CVE), São Paulo, Brazil
| | - C S B Domingues
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - R A Souza
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - M C Gianna
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - A O Kalichman
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| | - O H M Leite
- Faculdade de Medicina do ABC - Centro Universitário Saúde do ABC (FM-ABC) Santo Andre, Brazil
| | - T N L Souza
- Instituto de Infectologia Emílio Ribas - SES/SP (IIER), São Paulo, Brazil
| | - D A Gomes E Costa
- Hospital do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil
| | | | - A F Costa
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil.,Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | -
- Centro de Referência e Treinamento DST/Aids - São Paulo (CRT-DST/Aids) Sao Paulo, Brazil
| |
Collapse
|
181
|
Orsi A, Domnich A, Pace VD, Ricucci V, Caligiuri P, Bottiglieri L, Vagge R, Cavalleri MA, Orlandini F, Bruzzone B, Icardi G. Outbreak of SARS-CoV-2 Lineage 20I/501Y.V1 in a Nursing Home Underlines the Crucial Role of Vaccination in Both Residents and Staff. Vaccines (Basel) 2021; 9:591. [PMID: 34199663 PMCID: PMC8228066 DOI: 10.3390/vaccines9060591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/30/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Elderly residents in nursing homes are at very high risk of life-threatening COVID-19-related outcomes. In this report, an epidemiological and serological investigation of a SARS-CoV-2 outbreak in an Italian nursing home is described. Among the residents, all but one (19/20) were regularly vaccinated against SARS-CoV-2. In mid-February 2021, a non-vaccinated staff member of the nursing home was diagnosed with the SARS-CoV-2 infection. Following the outbreak investigation, a total of 70% (14/20) of residents aged 77-100 years were found positive. The phylogenetic analysis showed that the outbreak was caused by the SARS-CoV-2 variant of concern 202012/01 (the so-called "UK variant"). However, all but one positive subjects (13/14) were fully asymptomatic. The only symptomatic patient was a vaccinated 86-year-old female with a highly compromised health background and deceased approximately two weeks later. The subsequent serological investigation showed that the deceased patient was the only vaccinated subject that did not develop the anti-spike protein antibody response, therefore being likely a vaccine non-responder. Although the available mRNA SARS-CoV-2 vaccine was not able to prevent several asymptomatic infections, it was able to avert most symptomatic disease cases caused by the SARS-CoV-2 variant of concern 202012/01 in nursing home residents.
Collapse
Affiliation(s)
- Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (A.O.); (G.I.)
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| | - Alexander Domnich
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| | - Vanessa De Pace
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| | - Valentina Ricucci
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| | - Patrizia Caligiuri
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| | - Livio Bottiglieri
- Laboratory Medicine, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy;
| | - Rosanna Vagge
- Local Health Unit 4, 16043 Chiavari, Italy; (R.V.); (M.A.C.); (F.O.)
| | | | | | - Bianca Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy; (A.O.); (G.I.)
- Hygiene Unit, San Martino Policlinico Hospital-IRCCS for Oncology and Neurosciences, 16132 Genoa, Italy; (V.D.P.); (V.R.); (P.C.); (B.B.)
| |
Collapse
|
182
|
Corona G, Pizzocaro A, Vena W, Rastrelli G, Semeraro F, Isidori AM, Pivonello R, Salonia A, Sforza A, Maggi M. Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:275-296. [PMID: 33616801 PMCID: PMC7899074 DOI: 10.1007/s11154-021-09630-8] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
The presence of SARS-CoV-2 was officially documented in Europe at the end of February 2020. Despite many observations, the real impact of COVID-19 in the European Union (EU), its underlying factors and their contribution to mortality and morbidity outcomes were never systematically investigated. The aim of the present work is to provide an overview and a meta-analysis of main predictors and of country differences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-associated mortality rate (MR) in hospitalized patients. Out of 3714 retrieved articles, 87 studies were considered, including 35,486 patients (mean age 60.9 ± 8.2 years) and 5867 deaths. After adjustment for confounders, diabetes mellitus was the best predictors of MR in an age- and sex-dependent manner, followed by chronic pulmonary obstructive diseases and malignancies. In both the US and Europe, MR was higher than that reported in Asia (25[20;29] % and 20[17;23] % vs. 13[10;17]%; both p < 0.02). Among clinical parameters, dyspnea, fatigue and myalgia, along with respiratory rate, emerged as the best predictors of MR. Finally, reduced lymphocyte and platelet count, along with increased D-dimer levels, all significantly contributed to increased mortality. The optimization of glucose profile along with an adequate thrombotic complications preventive strategy must become routine practice in diseased SARS-CoV-2 infected patients.
Collapse
Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2 - 40133, Bologna, Italy.
| | - Alessandro Pizzocaro
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Walter Vena
- Unit of Endocrinology, Diabetology and Medical Andrology, IRCSS, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulia Rastrelli
- Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Bologna, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome - Policlinico Umberto I Hospital, Rome, Italy
| | - Rosario Pivonello
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Unità Di Andrologia E Medicina Della Riproduzione E Della SessualitàMaschile E Femminile, Università Federico II Di Napoli, Naples, Italy
- Staff of UNESCO, Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Alessandra Sforza
- Endocrinology Unit, Medical Department, Azienda Usl Bologna Maggiore-Bellaria Hospital, Largo Nigrisoli, 2 - 40133, Bologna, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| |
Collapse
|
183
|
Zhang Y, Luo W, Li Q, Wang X, Chen J, Song Q, Tu H, Ren R, Li C, Li D, Zhao J, McGoogan JM, Shan D, Li B, Zhang J, Dong Y, Jin Y, Mao S, Qian M, Lv C, Zhu H, Wang L, Xiao L, Xu J, Yin D, Zhou L, Li Z, Shi G, Dong X, Guan X, Gao GF, Wu Z, Feng Z. Risk Factors for Death Among the First 80 543 COVID-19 Cases in China: Relationships Between Age, Underlying Disease, Case Severity, and Region. Clin Infect Dis 2021; 74:630-638. [PMID: 34043784 PMCID: PMC8244662 DOI: 10.1093/cid/ciab493] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Knowledge of COVID-19 epidemiology remains incomplete and crucial questions persist. We aimed to examine risk factors for COVID-19 death. METHODS A total of 80 543 COVID-19 cases reported in China, nationwide, through April 8, 2020 were included. Risk factors for death were investigated by Cox proportional hazards regression and stratified analyses. RESULTS Overall national case fatality ratio (CFR) was 5.64%. Risk factors for death were older age (≥80: adjusted hazard ratio [aHR]=12.58, 95% confidence interval [CI]=6.78-23.33), presence of underlying disease (aHR=1.33, CI=1.19-1.49), worse case severity (severe: aHR=3.86, CI=3.15-4.73; critical: aHR=11.34, CI=9.22-13.95), and near-epicenter region (Hubei: aHR=2.64, CI=2.11-3.30; Wuhan: aHR=6.35, CI=5.04-8.00). CFR increased from 0.35% (30-39 years) to 18.21% (≥70 years) without underlying disease. Regardless of age, CFR increased from 2.50% for no underlying disease to 7.72% for 1, 13.99% for 2, and 21.99% for ≥3. CFR increased with worse case severity from 2.80% (mild), to 12.51% (severe) and 48.60% (critical) regardless of region. Compared to other regions, CFR was much higher in Wuhan regardless of case severity (mild: 3.83% versus 0.14% in Hubei and 0.03% elsewhere; moderate: 4.60% versus 0.21% and 0.06%; severe: 15.92% versus 5.84% and 1.86%; and critical: 58.57% versus 49.80% and 18.39%). CONCLUSIONS Older patients regardless of underlying disease and patients with underlying disease regardless of age were at elevated risk of death. Higher death rates near the outbreak epicenter and during the surge of cases reflect the deleterious effects of allowing health systems to become overwhelmed.
Collapse
Affiliation(s)
- Yanping Zhang
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Wei Luo
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Qun Li
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Xijie Wang
- Peking University, 5 Yiheyuan Rd, Haidian District, Beijing 100871, China
| | - Jin Chen
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Qinfeng Song
- Peking University, 5 Yiheyuan Rd, Haidian District, Beijing 100871, China
| | - Hong Tu
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Ruiqi Ren
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Chao Li
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Dan Li
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Jing Zhao
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Jennifer M McGoogan
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Duo Shan
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Bing Li
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Jingxue Zhang
- Peking University, 5 Yiheyuan Rd, Haidian District, Beijing 100871, China
| | - Yanhui Dong
- Peking University, 5 Yiheyuan Rd, Haidian District, Beijing 100871, China
| | - Yu Jin
- Peking University, 5 Yiheyuan Rd, Haidian District, Beijing 100871, China
| | - Shuai Mao
- Peking University, 5 Yiheyuan Rd, Haidian District, Beijing 100871, China
| | - Menbao Qian
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Chao Lv
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Huihui Zhu
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Limin Wang
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Lin Xiao
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Juan Xu
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Dapeng Yin
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Lei Zhou
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Zhongjie Li
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Guoqing Shi
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Xiaoping Dong
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Xuhua Guan
- Hubei Center for Disease Control and Prevention, 6 North Zuodaoquan, Hongshan District, Wuhan 430079, China
| | - George F Gao
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Zunyou Wu
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| | - Zijian Feng
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing 102206, China
| |
Collapse
|
184
|
Postintubation Decline in Oxygen Saturation Index Predicts Mortality in COVID-19: A Retrospective Pilot Study. Crit Care Res Pract 2021; 2021:6682944. [PMID: 34136282 PMCID: PMC8162249 DOI: 10.1155/2021/6682944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/11/2021] [Indexed: 01/25/2023] Open
Abstract
Background Acute respiratory failure from COVID-19 pneumonia is a major cause of death after SARS-CoV-2 infection. We investigated whether PaO2/FiO2, oxygenation index (OI), SpO2/FiO2, and oxygen saturation index (OSI), commonly used to assess the severity of acute respiratory distress syndrome (ARDS), can predict mortality in mechanically ventilated COVID-19 patients. Methods In this single-centered retrospective pilot study, we enrolled 68 critically ill mechanically ventilated adult patients with confirmed COVID-19. Physiological variables were recorded on the day of intubation (day 0) and postintubation days 3 and 7. The association between physiological parameters, PaO2/FiO2, OI, SpO2/FiO2, and OSI with mortality was assessed using multiple variable logistic regression analysis. Receiver operating characteristic analysis was conducted to evaluate the performance of the predictive models. Results The ARDS severity indices were not statistically different on the day of intubation, suggesting similar baseline conditions in nonsurviving and surviving patients. However, these indices were significantly worse in the nonsurviving as compared to surviving patients on postintubation days 3 and 7. On intubation day 3, PaO2/FiO2 was 101.0 (61.4) in nonsurviving patients vs. 140.2 (109.6) in surviving patients, p=0.004, and on day 7 106.3 (94.2) vs. 178.0 (69.3), p < 0.001. OI was 135.0 (129.7) in nonsurviving vs. 84.8 (86.1) in surviving patients (p=0.003) on day 3 and 150.0 (118.4) vs. 61.5 (46.7) (p < 0.001) on day 7. OSI was 12.0 (11.7) vs. 8.0 (10.0) (p=0.006) on day 3 and 14.7 (13.2) vs. 6.5 (5.4) (p < 0.001) on day 7. Similarly, SpO2/FiO2 was 130 (90) vs. 210 (90) (p=0.003) on day 3 and 130 (90) vs. 230 (50) (p < 0.001) on day 7, while OSI was 12.0 (11.7) vs. 8.0 (10.0) (p=0.006) on day 3 and 14.7 (13.2) vs. 6.5 (5.4) (p < 0.001) on day 7 in the nonsurviving and surviving patients, respectively. All measures were independently associated with hospital mortality, with significantly greater odds ratios observed on day 7. The area under the receiver operating characteristic curve (AUC) for mortality prediction was greatest on intubation day 7 (AUC = 0.775, 0.808, and 0.828 for PaO2/FiO2, OI, SpO2/FiO2, and OSI, respectively). Conclusions Decline in oxygenation indices after intubation is predictive of mortality in COVID-19 patients. This time window is critical to the outcome of these patients and a possible target for future interventions. Future large-scale studies to confirm the prognostic value of the indices in COVID-19 patients are warranted.
Collapse
|
185
|
Alvarez-Risco A, Del-Aguila-Arcentales S, Yáñez JA. Telemedicine in Peru as a Result of the COVID-19 Pandemic: Perspective from a Country with Limited Internet Access. Am J Trop Med Hyg 2021; 105:6-11. [PMID: 33999847 PMCID: PMC8274764 DOI: 10.4269/ajtmh.21-0255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/17/2021] [Indexed: 01/18/2023] Open
Abstract
The COVID-19 pandemic contributed to the worldwide implementation of telemedicine because of the need for medical care for patients, especially those with chronic diseases. This perspective paper presents the current situation of telemedicine in Peru, showing advances in regulation, cases of successful implementation, and the current challenges. Access to health should be available to all, and more efforts need to be implemented to offer access to the internet to achieve high-quality telemedicine to all the vulnerable groups in Peru.
Collapse
Affiliation(s)
- Aldo Alvarez-Risco
- Universidad de Lima, Facultad de Ciencias Empresariales y Económicas, Carrera de Negocios Internacionales, Lima, Perú
| | | | - Jaime A. Yáñez
- Universidad Peruana de Ciencias Aplicadas, Facultad de Educación, Carrera de Educación y Gestión del Aprendizaje
- Teoma Global, Gerencia Corporativa de Asuntos Científicos y Regulatorios, Lima, Peru
| |
Collapse
|
186
|
Mubarik S, Liu X, Eshak ES, Liu K, Liu Q, Wang F, Shi F, Wen H, Bai J, Yu C, Cao J. The Association of Hypertension With the Severity of and Mortality From the COVID-19 in the Early Stage of the Epidemic in Wuhan, China: A Multicenter Retrospective Cohort Study. Front Med (Lausanne) 2021; 8:623608. [PMID: 34055822 PMCID: PMC8149896 DOI: 10.3389/fmed.2021.623608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/12/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Hypertension may affect the prognosis of COVID-19 illness. We analyzed the epidemiological and clinical characteristics associated with the disease severity and mortality in hypertensive vs. non-hypertensive deceased COVID-19 patients. Methods: We included all the deceased patients with laboratory-confirmed COVID-19 admitted to >200 health facilities in Wuhan between December 1 and February 24, 2020. The median survival time in COVID-19 patients with and without hypertension, the association of hypertension with the disease severity, and the risk factors associated with the COVID-19 mortality stratified by the hypertension status were assessed using the Kaplan-Meier survival analysis, logistic regression, and Cox proportional regression, respectively before and after the propensity score-matching (PS) for age and sex. Results: The prevalence of hypertension in the studied 1,833 COVID-19 patients was 40.5%. Patients with hypertension were more likely to have severe COVID-19 illness than patients without hypertension; the PS-matched multivariable-adjusted odds ratio (95% CI) was 2.44 (1.77–3.08). Moreover, the median survival time in the hypertension group was 3–5 days shorter than the non-hypertension group. There was a 2-fold increased risk of COVID-19 mortality in the hypertension group compared with the non-hypertension group; the PS-matched multivariable-adjusted hazard ratio (HR) = 2.04 (1.61–2.72), and the significant increased risk of COVID-19 mortality in the moderate vs. mild COVID-19 illness was confined to patients with hypertension. Additionally, the history and the number of underlying chronic diseases, occupation, and residential location showed stronger associations with the COVID-19 mortality among patients with hypertension than patients without hypertension. Conclusion: Hypertension was associated with the severity and mortality of COVID-19 illness.
Collapse
Affiliation(s)
- Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiaoxue Liu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Ehab S Eshak
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan.,Public Health and Community Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Keyang Liu
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qing Liu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Fang Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China.,Global Health Institute, Wuhan University, Wuhan, China
| | - Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| |
Collapse
|
187
|
Shi L, Xu J, Xiao W, Wang Y, Jin Y, Chen S, Duan G, Yang H, Wang Y. Asthma in patients with coronavirus disease 2019: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2021; 126:524-534. [PMID: 33609770 PMCID: PMC7889465 DOI: 10.1016/j.anai.2021.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is unclear whether asthma has an influence on contracting coronavirus disease 2019 (COVID-19) or having worse outcomes from COVID-19 disease. OBJECTIVE To explore the prevalence of asthma in patients with COVID-19 and the relationship between asthma and patients with COVID-19 with poor outcomes. METHODS The pooled prevalence of asthma in patients with COVID-19 and corresponding 95% confidence interval (CI) were estimated. The pooled effect size (ES) was used to evaluate the association between asthma and patients with COVID-19 with poor outcomes. RESULTS The pooled prevalence of asthma in patients with COVID-19 worldwide was 8.3% (95% CI, 7.6-9.0) based on 116 articles (119 studies) with 403,392 cases. The pooled ES based on unadjusted effect estimates revealed that asthma was not associated with reduced risk of poor outcomes in patients with COVID-19 (ES, 0.91; 95% CI, 0.78-1.06). Similarly, the pooled ES based on unadjusted effect estimates revealed that asthma was not associated with the reduced risk of mortality in patients with COVID-19 (ES, 0.88; 95% CI, 0.73-1.05). However, the pooled ES based on adjusted effect estimates indicated that asthma was significantly associated with reduced risk of mortality in patients with COVID-19 (ES 0.80, 95% CI 0.74-0.86). CONCLUSION The pooled prevalence of asthma in patients with COVID-19 was similar to that in the general population, and asthma might be an independent protective factor for the death of patients with COVID-19, which suggests that we should pay high attention to patients co-infected asthma and COVID-19 and take locally tailored interventions and treatment. Further well-designed studies with large sample sizes are required to verify our findings.
Collapse
Affiliation(s)
- Li Shi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jie Xu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Wenwei Xiao
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ying Wang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China.
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
| |
Collapse
|
188
|
Predictors of Mortality in Critically Ill COVID-19 Patients Demanding High Oxygen Flow: A Thin Line between Inflammation, Cytokine Storm, and Coagulopathy. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6648199. [PMID: 33968298 PMCID: PMC8081622 DOI: 10.1155/2021/6648199] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 03/06/2021] [Indexed: 12/13/2022]
Abstract
Introduction Mortality among critically ill COVID-19 patients remains relatively high despite different potential therapeutic modalities being introduced recently. The treatment of critically ill patients is a challenging task, without identified credible predictors of mortality. Methods We performed an analysis of 160 consecutive patients with confirmed COVID-19 infection admitted to the Respiratory Intensive Care Unit between June 23, 2020, and October 2, 2020, in University Hospital Center Bezanijska kosa, Belgrade, Serbia. Patients on invasive, noninvasive ventilation and high flow oxygen therapy with moderate to severe ARDS, according to the Berlin definition of ARDS, were selected for the study. Demographic data, past medical history, laboratory values, and CT severity score were analyzed to identify predictors of mortality. Univariate and multivariate logistic regression models were used to assess potential predictors of mortality in critically ill COVID-19 patients. Results The mean patient age was 65.6 years (range, 29–92 years), predominantly men, 68.8%. 107 (66.9%) patients were on invasive mechanical ventilation, 31 (19.3%) on noninvasive, and 22 (13.8%) on high flow oxygen therapy machine. The median total number of ICU days was 10 (25th to 75th percentile: 6–18), while the median total number of hospital stay was 18 (25th to 75th percentile: 12–28). The mortality rate was 60% (96/160). Univariate logistic regression analysis confirmed the significance of age, CRP, and lymphocytes at admission to hospital, serum albumin, D-dimer, and IL-6 at admission to ICU, and CT score. Serum albumin, D-dimer, and IL-6 at admission to ICU were independently associated with mortality in the final multivariate analysis. Conclusion In the present study of 160 consecutive critically ill COVID-19 patients with moderate to severe ARDS, IL-6, serum albumin, and D-dimer at admission to ICU, accompanied by chest CT severity score, were marked as independent predictors of mortality.
Collapse
|
189
|
COVID-19: Direct and Indirect Mechanisms of Statins. Int J Mol Sci 2021; 22:ijms22084177. [PMID: 33920709 PMCID: PMC8073792 DOI: 10.3390/ijms22084177] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/10/2021] [Accepted: 04/16/2021] [Indexed: 02/07/2023] Open
Abstract
The virus responsible for the current COVID-19 pandemic is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a new virus with high infectivity and moderate mortality. The major clinical manifestation of COVID-19 is interstitial pneumonia, which may progress to acute respiratory distress syndrome (ARDS). However, the disease causes a potent systemic hyperin-flammatory response, i.e., a cytokine storm or macrophage activation syndrome (MAS), which is associated with thrombotic complications. The complexity of the disease requires appropriate intensive treatment. One of promising treatment is statin administration, these being 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors that exert pleiotropic anti-inflammatory effects. Recent studies indicate that statin therapy is associated with decreased mortality in COVID-19, which may be caused by direct and indirect mechanisms. According to literature data, statins can limit SARS-CoV-2 cell entry and replication by inhibiting the main protease (Mpro) and RNA-dependent RNA polymerase (RdRp). The cytokine storm can be ameliorated by lowering serum IL-6 levels; this can be achieved by inhibiting Toll-like receptor 4 (TLR4) and modulating macrophage activity. Statins can also reduce the complications of COVID-19, such as thrombosis and pulmonary fibrosis, by reducing serum PAI-1 levels, attenuating TGF-β and VEGF in lung tissue, and improving endothelial function. Despite these benefits, statin therapy may have side effects that should be considered, such as elevated creatinine kinase (CK), liver enzyme and serum glucose levels, which are already elevated in severe COVID-19 infection. The present study analyzes the latest findings regarding the benefits and limitations of statin therapy in patients with COVID-19.
Collapse
|
190
|
Nijman G, Wientjes M, Ramjith J, Janssen N, Hoogerwerf J, Abbink E, Blaauw M, Dofferhoff T, van Apeldoorn M, Veerman K, de Mast Q, ten Oever J, Hoefsloot W, Reijers MH, van Crevel R, van de Maat JS. Risk factors for in-hospital mortality in laboratory-confirmed COVID-19 patients in the Netherlands: A competing risk survival analysis. PLoS One 2021; 16:e0249231. [PMID: 33770140 PMCID: PMC7997038 DOI: 10.1371/journal.pone.0249231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/14/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To date, survival data on risk factors for COVID-19 mortality in western Europe is limited, and none of the published survival studies have used a competing risk approach. This study aims to identify risk factors for in-hospital mortality in COVID-19 patients in the Netherlands, considering recovery as a competing risk. METHODS In this observational multicenter cohort study we included adults with PCR-confirmed SARS-CoV-2 infection that were admitted to one of five hospitals in the Netherlands (March to May 2020). We performed a competing risk survival analysis, presenting cause-specific hazard ratios (HRCS) for the effect of preselected factors on the absolute risk of death and recovery. RESULTS 1,006 patients were included (63.9% male; median age 69 years, IQR: 58-77). Patients were hospitalized for a median duration of 6 days (IQR: 3-13); 243 (24.6%) of them died, 689 (69.9%) recovered, and 74 (7.4%) were censored. Patients with higher age (HRCS 1.10, 95% CI 1.08-1.12), immunocompromised state (HRCS 1.46, 95% CI 1.08-1.98), who used anticoagulants or antiplatelet medication (HRCS 1.38, 95% CI 1.01-1.88), with higher modified early warning score (MEWS) (HRCS 1.09, 95% CI 1.01-1.18), and higher blood LDH at time of admission (HRCS 6.68, 95% CI 1.95-22.8) had increased risk of death, whereas fever (HRCS 0.70, 95% CI 0.52-0.95) decreased risk of death. We found no increased mortality risk in male patients, high BMI or diabetes. CONCLUSION Our competing risk survival analysis confirms specific risk factors for COVID-19 mortality in a the Netherlands, which can be used for prediction research, more intense in-hospital monitoring or prioritizing particular patients for new treatments or vaccination.
Collapse
Affiliation(s)
- Gerine Nijman
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maike Wientjes
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Jordache Ramjith
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nico Janssen
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- Centre of Expertise in Mycology, Radboud University Medical Centre, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Jacobien Hoogerwerf
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Evertine Abbink
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marc Blaauw
- Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands
| | - Ton Dofferhoff
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marjan van Apeldoorn
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Karin Veerman
- Department of Internal Medicine, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jaap ten Oever
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wouter Hoefsloot
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monique H. Reijers
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Pulmonary Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josephine S. van de Maat
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
- Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Centre, Nijmegen, The Netherlands
- * E-mail:
| |
Collapse
|
191
|
Gazzaz ZJ. Diabetes and COVID-19. Open Life Sci 2021; 16:297-302. [PMID: 33817321 PMCID: PMC8010370 DOI: 10.1515/biol-2021-0034] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 01/09/2023] Open
Abstract
Several factors are linked with a higher risk of mortality from Coronavirus disease-19 (COVID-19), including male gender, increased age, hypertension, diabetes mellitus, obesity, cardiovascular diseases, chronic obstructive pulmonary disease, and cancer. Hyperglycemic COVID-19 patients have severe clinical problems, increased ICU admittance, machine-driven ventilation, and a substantial rise in inflammatory markers. Among all patients, those with diabetes or hyperglycemia have a two- to four-fold increase in mortality and severity of COVID-19 than those without diabetes. The primary cause of mortality in COVID-19 patients with diabetes is compromised immune response to viral infections. Increased blood sugar level probably affects intracellular degradation of bacteria, neutrophil chemotaxis, and phagocytosis, thus improving viral binding affinity and entry and decreasing virus clearance. In addition, it has significant effects on the proteins by inducing glycosylation and altering the composition of complements, and glycosylation renders cells susceptible to viral inflammation and damage. The treatment of COVID-19 in patients with diabetes requires an integrated team approach to minimize the risk of medical complications and mortality. Moreover, physicians should adopt proactive strategies to care for persons with comorbidities. This strategy would help reduce the frequency of complications and mortality among patients and load on the healthcare system.
Collapse
Affiliation(s)
- Zohair Jamil Gazzaz
- Department of Internal Medicine, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah 21577, Saudi Arabia
| |
Collapse
|
192
|
Shao Y, Ahmed A, Liappis AP, Faselis C, Nelson SJ, Zeng-Treitler Q. Understanding Demographic Risk Factors for Adverse Outcomes in COVID-19 Patients: Explanation of a Deep Learning Model. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:181-200. [PMID: 33681695 PMCID: PMC7914049 DOI: 10.1007/s41666-021-00093-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 01/10/2023]
Abstract
This study was to understand the impacts of three key demographic variables, age, gender, and race, on the adverse outcome of all-cause hospitalization or all-cause mortality in patients with COVID-19, using a deep neural network (DNN) analysis. We created a cohort of Veterans who were tested positive for COVID-19, extracted data on age, gender, and race, and clinical characteristics from their electronic health records, and trained a DNN model for predicting the adverse outcome. Then, we analyzed the association of the demographic variables with the risks of the adverse outcome using the impact scores and interaction scores for explaining DNN models. The results showed that, on average, older age and African American race were associated with higher risks while female gender was associated with lower risks. However, individual-level impact scores of age showed that age was a more impactful risk factor in younger patients and in older patients with fewer comorbidities. The individual-level impact scores of gender and race variables had a wide span covering both positive and negative values. The interaction scores between the demographic variables showed that the interaction effects were minimal compared to the impact scores associated with them. In conclusion, the DNN model is able to capture the non-linear relationship between the risk factors and the adverse outcome, and the impact scores and interaction scores can help explain the complicated non-linear effects between the demographic variables and the risk of the outcome.
Collapse
Affiliation(s)
- Yijun Shao
- Washington DC VA Medical Center, Washington, DC USA
- George Washington University, Washington, DC USA
| | - Ali Ahmed
- Washington DC VA Medical Center, Washington, DC USA
- George Washington University, Washington, DC USA
- Georgetown University, Washington, DC USA
| | - Angelike P. Liappis
- Washington DC VA Medical Center, Washington, DC USA
- George Washington University, Washington, DC USA
| | - Charles Faselis
- Washington DC VA Medical Center, Washington, DC USA
- George Washington University, Washington, DC USA
| | | | - Qing Zeng-Treitler
- Washington DC VA Medical Center, Washington, DC USA
- George Washington University, Washington, DC USA
| |
Collapse
|
193
|
Jayant K, Reccia I, Virdis F, Pyda JS, Bachul PJ, di Sabato D, Barth RN, Fung J, Baker T, Witkowski P. COVID-19 in hospitalized liver transplant recipients: An early systematic review and meta-analysis. Clin Transplant 2021; 35:e14246. [PMID: 33555058 PMCID: PMC7995098 DOI: 10.1111/ctr.14246] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 01/08/2023]
Abstract
Adverse clinical outcomes related to SARS‐CoV‐2 infection among liver transplant (LTx) recipients remain undefined. We performed a meta‐analysis to determine the pooled prevalence of outcomes among hospitalized LTx recipients with COVID‐19. A database search of literature published between December 1, 2019, and November 20, 2020, was performed per PRISMA guidelines. Twelve studies comprising 517 hospitalized LTx recipients with COVID‐19 were analyzed. Common presenting symptoms were fever (71%), cough (62%), dyspnea (48%), and diarrhea (28%). Approximately 77% (95% CI, 61%‐93%) of LTx recipients had a history of liver cirrhosis. The most prevalent comorbidities were hypertension (55%), diabetes (45%), and cardiac disease (21%). In‐hospital mortality was 20% (95% CI, 13%‐28%) and rose to 41% (95% CI, 19%‐63%) (P < 0.00) with ICU admission. Additional subgroup analysis demonstrated a higher mortality risk in the elderly (>60‐65 years) (OR 4.26; 95% CI, 2.14‐8.49). There was no correlation in respect to sex or time since transplant. In summary, LTx recipients with COVID‐19 had a high prevalence of dyspnea and gastrointestinal symptoms. In‐hospital mortality was comparable to non‐transplant populations with similar comorbidities but appeared to be less than what is reported elsewhere for cirrhotic patients (26%‐40%). Importantly, the observed high case fatality in the elderly could be due to age‐associated comorbidities.
Collapse
Affiliation(s)
- Kumar Jayant
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Isabella Reccia
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Jordan S Pyda
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Piotr J Bachul
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Diego di Sabato
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Rolf N Barth
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - John Fung
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Talia Baker
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Piotr Witkowski
- The Transplantation Institute, Department of Surgery, University of Chicago, Chicago, IL, USA
| |
Collapse
|
194
|
Merkin AG, Akinfieva SS, Martyushev-Poklad AV, Beloskurskaya OP, Dinov EN, Ostrovsky SL, Komarov AN, Zakharova OY, Kazhin VA, Nikiforov IA, Glover M. Anxiety: phenomenology, epidemiology, and risk factors during the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2021. [DOI: 10.14412/2074-2711-2021-1-107-112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The COVID-19 coronavirus pandemic in 2020 led to significant negative social consequences associated inter alia with adverse effects on mental health. One of the most common mental illness is anxiety disorders, the rise in which is characteristic of social upheaval periods. This paper analyzes the problem of anxiety, reviews information on the epidemiology of anxiety, on the factors and mechanisms of its development. It unveils the association of anxiety with addictive disorders, lifestyle factors, and traumatic childhood experience and highlights the problem of increased anxiety in the context of the novel coronavirus COVID-19 pandemics in Russia.
Collapse
Affiliation(s)
- A. G. Merkin
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Federal Biomedical Agency of Russia; Centre for Precise Psychiatry and Neurosciences
| | - S. S. Akinfieva
- Doverie (Trust) National Center for Social Support and Rehabilitation Technologies
| | | | | | - E. N. Dinov
- Peoples' Friendship University of Russia (RUDN University)
| | | | - A. N. Komarov
- Doverie (Trust) National Center for Social Support and Rehabilitation Technologies
| | - O. Yu. Zakharova
- Russian Presidential Academy of National Economy and Public Administration
| | | | - I. A. Nikiforov
- Federal Research and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Federal Biomedical Agency of Russia
| | - M. Glover
- Centre of Research Excellence: Indigenous Sovereignty & Smoking
| |
Collapse
|
195
|
Haryalchi K, Heidarzadeh A, Abedinzade M, Olangian-Tehrani S, Ghazanfar Tehran S. The Importance of Happy Hypoxemia in COVID-19. Anesth Pain Med 2021; 11:e111872. [PMID: 34221943 PMCID: PMC8239260 DOI: 10.5812/aapm.111872] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background Nowadays, the new coronavirus (SARS-CoV-2) and its complications are one of the main concerns of the world. One of the most severe complications of COVID-19 is hypoxemia. Objectives This study aimed to assess the importance of happy hypoxemia in COVID-19. Methods We systematically searched web of science, PubMed, and Google scholar databases to find articles related to COVID-19 and happy hypoxemia. Results COVID-19 causes a type of hypoxemia named silent (happy) hypoxemia, which has an atypical clinical presentation. This type of hypoxemia has not been noted before in viral pneumonia, and there is no specific treatment for this serious complication. Patients with silent hypoxemia may develop severe hypoxemia without dyspnea and with near-normal lung compliance. These patients are awake, calm, and responsive. Although their lungs are not oxygenated efficiently, they are alert and cooperative. Their condition may be deteriorated rapidly without warning and causes death. Conclusions According to the findings, paying attention to happy hypoxemia is important for improving the health status of COVID-19 patients.
Collapse
Affiliation(s)
- Katayoun Haryalchi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abtin Heidarzadeh
- Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahmood Abedinzade
- Department of Operating Room, Langroud School of Allied Medical Sciences, Guilan University of Medical Sciences, Rasht, Iran
| | - Sepehr Olangian-Tehrani
- Student Research committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Ghazanfar Tehran
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| |
Collapse
|
196
|
Horwitz LI, Jones SA, Cerfolio RJ, Francois F, Greco J, Rudy B, Petrilli CM. Trends in COVID-19 Risk-Adjusted Mortality Rates. J Hosp Med 2021; 16:90-92. [PMID: 33147129 DOI: 10.12788/jhm.3552] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/21/2020] [Indexed: 12/18/2022]
Abstract
Early reports showed high mortality from coronavirus disease 2019 (COVID-19). Mortality rates have recently been lower, raising hope that treatments have improved. However, patients are also now younger, with fewer comorbidities. We explored whether hospital mortality was associated with changing demographics at a 3-hospital academic health system in New York. We examined in-hospital mortality or discharge to hospice from March through August 2020, adjusted for demographic and clinical factors, including comorbidities, admission vital signs, and laboratory results. Among 5,121 hospitalizations, adjusted mortality dropped from 25.6% (95% CI, 23.2-28.1) in March to 7.6% (95% CI, 2.5-17.8) in August. The standardized mortality ratio dropped from 1.26 (95% CI, 1.15-1.39) in March to 0.38 (95% CI, 0.12-0.88) in August, at which time the average probability of death (average marginal effect) was 18.2 percentage points lower than in March. Data from one health system suggest that mortality from COVID-19 is decreasing even after accounting for patient characteristics.
Collapse
Affiliation(s)
- Leora I Horwitz
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Simon A Jones
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Robert J Cerfolio
- Department of Surgery, NYU Grossman School of Medicine, New York, New York
| | - Fritz Francois
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | | | - Bret Rudy
- Department of Pediatrics, NYU Grossman School of Medicine, New York, New York
| | | |
Collapse
|
197
|
Rabbani G, Shariful Islam SM, Rahman MA, Amin N, Marzan B, Robin RC, Alif SM. Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis. Expert Rev Respir Med 2021; 15:705-716. [DOI: 10.1080/17476348.2021.1866547] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Golam Rabbani
- Bangladesh Betar (Radio), Ministry of Information, Dhaka, Bangladesh
| | | | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Australia
- Australian Institute of Primary Care and Ageing, La Trobe University, Melbourne, Australia
| | - Nuhu Amin
- Infectious Diseases Division, International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Bushra Marzan
- School of Public Health, Guangxi Medical University, Nanning, China
| | | | - Sheikh M. Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
198
|
Gómez Antúnez M, Muiño Míguez A, Bendala Estrada AD, Maestro de la Calle G, Monge Monge D, Boixeda R, Ena J, Mella Pérez C, Anton Santos JM, Lumbreras Bermejo C. Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2. Int J Chron Obstruct Pulmon Dis 2021; 15:3433-3445. [PMID: 33447021 PMCID: PMC7801905 DOI: 10.2147/copd.s276692] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To describe the characteristics and prognosis of patients with COPD admitted to the hospital due to SARS-CoV-2 infection. Methods The SEMI-COVID registry is an ongoing retrospective cohort comprising consecutive COVID-19 patients hospitalized in Spain since the beginning of the pandemic in March 2020. Data on demographics, clinical characteristics, comorbidities, laboratory tests, radiology, treatment, and progress are collected. Patients with COPD were selected and compared to patients without COPD. Factors associated with a poor prognosis were analyzed. Results Of the 10,420 patients included in the SEMI-COVID registry as of May 21, 2020, 746 (7.16%) had a diagnosis of COPD. Patients with COPD are older than those without COPD (77 years vs 68 years) and more frequently male. They have more comorbidities (hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, kidney failure) and a higher Charlson Comorbidity Index (2 vs 1, p<0.001). The mortality rate in COPD patients was 38.3% compared to 19.2% in patients without COPD (p<0.001). Male sex, a history of hypertension, heart failure, moderate-severe chronic kidney disease, presence of cerebrovascular disease with sequelae, degenerative neurological disease, dementia, functional dependence, and a higher Charlson Comorbidity Index have been associated with increased mortality due to COVID-19 in COPD patients. Survival was higher among patients with COPD who were treated with hydroxychloroquine (87.1% vs 74.9%, p<0.001) and with macrolides (57.9% vs 50%, p<0.037). Neither prone positioning nor non-invasive mechanical ventilation, high-flow nasal cannula, or invasive mechanical ventilation were associated with a better prognosis. Conclusion COPD patients admitted to the hospital with SARS-CoV-2 infection have more severe disease and a worse prognosis than non-COPD patients.
Collapse
Affiliation(s)
- María Gómez Antúnez
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Muiño Míguez
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | | | - Ramón Boixeda
- Internal Medicine Department, Mataró Hospital, Mataró, Barcelona, Spain
| | - Javier Ena
- Internal Medicine Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
| | - Carmen Mella Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, Ferrol, A Coruña, Spain
| | | | | | - On behalf of the SEMI-COVID-19 Network
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
- Internal Medicine Department, Segovia Hospital Complex, Segovia, Spain
- Internal Medicine Department, Mataró Hospital, Mataró, Barcelona, Spain
- Internal Medicine Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
- Internal Medicine Department, Ferrol University Hospital Complex, Ferrol, A Coruña, Spain
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
| |
Collapse
|
199
|
Dementia is a predictor for mortality outcome from coronavirus disease 2019 (COVID-19) infection. Eur Arch Psychiatry Clin Neurosci 2021; 271:393-395. [PMID: 33104903 PMCID: PMC7586198 DOI: 10.1007/s00406-020-01205-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
|
200
|
Individual and community-level risk for COVID-19 mortality in the United States. Nat Med 2020; 27:264-269. [PMID: 33311702 DOI: 10.1038/s41591-020-01191-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
Reducing COVID-19 burden for populations will require equitable and effective risk-based allocations of scarce preventive resources, including vaccinations1. To aid in this effort, we developed a general population risk calculator for COVID-19 mortality based on various sociodemographic factors and pre-existing conditions for the US population, combining information from the UK-based OpenSAFELY study with mortality rates by age and ethnicity across US states. We tailored the tool to produce absolute risk estimates in future time frames by incorporating information on pandemic dynamics at the community level. We applied the model to data on risk factor distribution from a variety of sources to project risk for the general adult population across 477 US cities and for the Medicare population aged 65 years and older across 3,113 US counties, respectively. Validation analyses using 54,444 deaths from 7 June to 1 October 2020 show that the model is well calibrated for the US population. Projections show that the model can identify relatively small fractions of the population (for example 4.3%) that might experience a disproportionately large number of deaths (for example 48.7%), but there is wide variation in risk across communities. We provide a web-based risk calculator and interactive maps for viewing community-level risks.
Collapse
|