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Ahmed F, Jo DH, Lee SH. Can Natural Killer Cells Be a Principal Player in Anti-SARS-CoV-2 Immunity? Front Immunol 2020; 11:586765. [PMID: 33365027 PMCID: PMC7750385 DOI: 10.3389/fimmu.2020.586765] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Faria Ahmed
- Department of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Dong-Hyeon Jo
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Seung-Hwan Lee
- Department of Biochemistry, Microbiology, and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,The University of Ottawa Centre for Infection, Immunity, and Inflammation, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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152
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Dalia T, Lahan S, Ranka S, Acharya P, Gautam A, Goyal A, Mastoris I, Sauer A, Shah Z. Impact of congestive heart failure and role of cardiac biomarkers in COVID-19 patients: A systematic review and meta-analysis. Indian Heart J 2020; 73:91-98. [PMID: 33714416 PMCID: PMC7719198 DOI: 10.1016/j.ihj.2020.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been reported to cause worse outcomes in patients with underlying cardiovascular disease, especially in patients with acute cardiac injury, which is determined by elevated levels of high-sensitivity troponin. There is a paucity of data on the impact of congestive heart failure (CHF) on outcomes in COVID-19 patients. METHODS We conducted a literature search of PubMed/Medline, EMBASE, and Google Scholar databases from 11/1/2019 till 06/07/2020, and identified all relevant studies reporting cardiovascular comorbidities, cardiac biomarkers, disease severity, and survival. Pooled data from the selected studies was used for metanalysis to identify the impact of risk factors and cardiac biomarker elevation on disease severity and/or mortality. RESULTS We collected pooled data on 5967 COVID-19 patients from 20 individual studies. We found that both non-survivors and those with severe disease had an increased risk of acute cardiac injury and cardiac arrhythmias, our pooled relative risk (RR) was - 8.52 (95% CI 3.63-19.98) (p < 0.001); and 3.61 (95% CI 2.03-6.43) (p = 0.001), respectively. Mean difference in the levels of Troponin-I, CK-MB, and NT-proBNP was higher in deceased and severely infected patients. The RR of in-hospital mortality was 2.35 (95% CI 1.18-4.70) (p = 0.022) and 1.52 (95% CI 1.12-2.05) (p = 0.008) among patients who had pre-existing CHF and hypertension, respectively. CONCLUSION Cardiac involvement in COVID-19 infection appears to significantly adversely impact patient prognosis and survival. Pre-existence of CHF, and high cardiac biomarkers like NT-pro BNP and CK-MB levels in COVID-19 patients correlates with worse outcomes.
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Affiliation(s)
- Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Sagar Ranka
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Archana Gautam
- Department of Nephrology, The University of Kansas Health System, KS, USA
| | - Amandeep Goyal
- Research and Clinical Fellow, Advanced heart failure and transplant division, University of Kansas Medical Center, Kansas City, Kansas, USA.
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Andrew Sauer
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, KS, USA.
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153
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Chu Y, Yang J, Shi J, Zhang P, Wang X. Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis. Eur J Med Res 2020; 25:64. [PMID: 33267871 PMCID: PMC7708895 DOI: 10.1186/s40001-020-00464-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obesity has been widely reported to be associated with the disease progression of coronavirus disease 2019 (COVID-19); however, some studies have reported different findings. We conducted a systematic review and meta-analysis to investigate the association between obesity and poor outcomes in patients with COVID-19 pneumonia. METHODS A systematic review and meta-analysis of studies from the PubMed, Embase, and Web of Science databases from 1 November 2019 to 24 May 2020 was performed. Study quality was assessed, and data extraction was conducted. The meta-analysis was carried out using fixed-effects and random-effects models to calculate odds ratios (ORs) of several poor outcomes in obese and non-obese COVID-19 patients. RESULTS Twenty-two studies (n = 12,591 patients) were included. Pooled analysis demonstrated that body mass index (BMI) was higher in severe/critical COVID-19 patients than in mild COVID-19 patients (MD 2.48 kg/m2, 95% CI [2.00 to 2.96 kg/m2]). Additionally, obesity in COVID-19 patients was associated with poor outcomes (OR = 1.683, 95% CI [1.408-2.011]), which comprised severe COVID-19, ICU care, invasive mechanical ventilation use, and disease progression (OR = 4.17, 95% CI [2.32-7.48]; OR = 1.57, 95% CI [1.18-2.09]; OR = 2.13, 95% CI [1.10-4.14]; OR = 1.41, 95% CI [1.26-1.58], respectively). Obesity as a risk factor was greater in younger patients (OR 3.30 vs. 1.72). However, obesity did not increase the risk of hospital mortality (OR = 0.89, 95% CI [0.32-2.51]). CONCLUSIONS As a result of a potentially critical role of obesity in determining the severity of COVID-19, it is important to collect anthropometric information for COVID-19 patients, especially the younger group. However, obesity may not be associated with hospital mortality, and efforts to understand the impact of obesity on the mortality of COVID-19 patients should be a research priority in the future.
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Affiliation(s)
- Yanan Chu
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310006, Zhejiang, China
| | - Jinxiu Yang
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310006, Zhejiang, China
| | - Jiaran Shi
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310006, Zhejiang, China
| | - Pingping Zhang
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310006, Zhejiang, China.,Department of Cardiology, Jinyun People's Hospital, No. 299 North Ziwei Road, Jinyun, 321400, Zhejiang, China
| | - Xingxiang Wang
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310006, Zhejiang, China.
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154
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Luo L, Fu M, Li Y, Hu S, Luo J, Chen Z, Yu J, Li W, Dong R, Yang Y, Tu L, Xu X. The potential association between common comorbidities and severity and mortality of coronavirus disease 2019: A pooled analysis. Clin Cardiol 2020; 43:1478-1493. [PMID: 33026120 PMCID: PMC7675427 DOI: 10.1002/clc.23465] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUD The association between underlying comorbidities and cardiac injury and the prognosis in coronavirus disease 2019 (COVID-19) patients was assessed in this study. HYPOTHESIS The underlying comorbidities and cardiac injury may be associated with the prognosis in COVID-19 patients. METHODS A systematic search was conducted in PubMed, EMBASE, Web of science, and The Cochrane library from December 2019 to July 2020. The odds ratio (OR) and 95% confidence intervals (95% CI) were used to estimate the probability of comorbidities and cardiac injury in COVID-19 patients with or without severe type, or in survivors vs nonsurvivors of COVID-19 patients. RESULTS A total of 124 studies were included in this analysis. A higher risk for severity was observed in COVID-19 patients with comorbidities. The pooled result in patients with hypertension (OR 2.57, 95% CI: 2.12-3.11), diabetes (OR 2.54, 95% CI: 1.89-3.41), cardiovascular diseases (OR 3.86, 95% CI: 2.70-5.52), chronic obstractive pulmonary disease (OR 2.71, 95% CI: 1.98-3.70), chronic kidney disease (OR 2.20, 95% CI: 1.27-3.80), and cancer (OR 2.42, 95% CI: 1.81-3.22) respectively. All the comorbidities presented a higher risk of mortality. Moreover, the prevalence of acute cardiac injury is higher in severe group than in nonsevere group, and acute cardiac injury is associated with an increased risk for in-hospital mortality. CONCLUSION Comorbidities and acute cardiac injury are closely associated with poor prognosis in COVID-19 patients. It is necessary to continuously monitor related clinical indicators of organs injury and concern comorbidities in COVID-19 patients.
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Affiliation(s)
- Liman Luo
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Division of Cardiology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Menglu Fu
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Yuanyuan Li
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Shuiqing Hu
- Division of Cardiology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jinlan Luo
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Zhihui Chen
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Jing Yu
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Wenhua Li
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Ruolan Dong
- Institute of Integrated Traditional Chinese and Western Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Yan Yang
- Division of Endocrinology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Ling Tu
- Department of Geriatric Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Xizhen Xu
- Division of Cardiology and Department of Internal Medicine, Tongji HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
- Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji Medical College, Huazhong University of Science and TechnologyWuhanHubeiChina
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155
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Kumar R, Bhattacharya B, Meena VP, Aggarwal A, Tripathi M, Soneja M, Mittal A, Singh K, Gupta N, Garg RK, Ratre BK, Kumar B, Bhopale SA, Tiwari P, Verma A, Bhatnagar S, Mohan A, Wig N, Guleria R. Characteristics and outcomes of 231 COVID-19 cases admitted at a tertiary facility in India: An observational cohort study. J Family Med Prim Care 2020; 9:6267-6272. [PMID: 33681075 PMCID: PMC7928080 DOI: 10.4103/jfmpc.jfmpc_1198_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ongoing pandemic because of COVID-19 has spread across countries, with varied clinical features and severity. Awareness of clinical course among asymptomatic and symptomatology in symptomatic cases is essential for patients' management as well as optimal utilization of health services (in resource limited settings) based on clinical status and risk factors. This study aimed to describe the clinical characteristics and outcomes of patients admitted with COVID-19 illness in the initial phase of the pandemic in India. METHODS It was an observational study. Patients aged 18 years or more, with confirmed SARS-CoV-2 infection, asymptomatic or mildly ill, were included. Patients with moderate-severe disease at admission or incomplete clinical symptomatology records were excluded. Data regarding demography, comorbidities, clinical features and course, treatment, results of SARS-CoV-2 RT-PCR, chest radiographs, and laboratory parameters were obtained retrospectively from hospital records. The outcome was noted in terms of course, patients discharged, still admitted (at the time of the study), or death. RESULTS Out of 231 cases, most were males (78.3%) with a mean age of 39.8 years. Comorbidities were present in 21.2% of patients, diabetes mellitus and hypertension being the most common. The most common symptoms were dry cough (81, 35%), fever (64, 27.7%), sore throat (36, 15.6%); asymptomatic infection noted in 108 (46.8%) patients. The presence of comorbidities was an independent predictor of symptomatic disease (OR-2.66; 95%CI 1.08-6.53, P = 0·03). None of the patients progressed to moderate-severe COVID-19, and there were no deaths. CONCLUSIONS A large proportion of patients remained asymptomatic whereas those with comorbidities were more likely to be symptomatic. Most with mild disease had a stable disease course, barring few complication in those with comorbidities. The pandemic continues to grow as large number of asymptomatic cases may go undiagnosed.
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Affiliation(s)
- Rohit Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bisakh Bhattacharya
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anivita Aggarwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manasi Tripathi
- Department of Ophthalmology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Mittal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Komal Singh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar Garg
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Brajesh Kumar Ratre
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balbir Kumar
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Arun Bhopale
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pavan Tiwari
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Verma
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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156
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Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. GeroScience 2020; 42:1547-1578. [PMID: 33001410 PMCID: PMC7528158 DOI: 10.1007/s11357-020-00272-3] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic is an extraordinary global emergency that has led to the implementation of unprecedented measures in order to stem the spread of the infection. Internationally, governments are enforcing measures such as travel bans, quarantine, isolation, and social distancing leading to an extended period of time at home. This has resulted in reductions in physical activity and changes in dietary intakes that have the potential to accelerate sarcopenia, a deterioration of muscle mass and function (more likely in older populations), as well as increases in body fat. These changes in body composition are associated with a number of chronic, lifestyle diseases including cardiovascular disease (CVD), diabetes, osteoporosis, frailty, cognitive decline, and depression. Furthermore, CVD, diabetes, and elevated body fat are associated with greater risk of COVID-19 infection and more severe symptomology, underscoring the importance of avoiding the development of such morbidities. Here we review mechanisms of sarcopenia and their relation to the current data on the effects of COVID-19 confinement on physical activity, dietary habits, sleep, and stress as well as extended bed rest due to COVID-19 hospitalization. The potential of these factors to lead to an increased likelihood of muscle loss and chronic disease will be discussed. By offering a number of home-based strategies including resistance exercise, higher protein intakes and supplementation, we can potentially guide public health authorities to avoid a lifestyle disease and rehabilitation crisis post-COVID-19. Such strategies may also serve as useful preventative measures for reducing the likelihood of sarcopenia in general and in the event of future periods of isolation.
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Affiliation(s)
- Richard Kirwan
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK.
| | - Deaglan McCullough
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Tom Butler
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK.
| | - Fatima Perez de Heredia
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Claire Stewart
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
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157
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Jin M, Chen C, Huang J, Zhang F, Dong T, Zhang M, Yue H, Liu K, Li G, Hu K, Zhang H. Clinical characteristics of COVID-19 patients with asthma in Wuhan, China: a retrospective cohort study. J Asthma 2020; 59:230-238. [PMID: 33183117 PMCID: PMC7754932 DOI: 10.1080/02770903.2020.1850768] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Although it is reported that patients with coronavirus disease 2019 (COVID-19) disease who have comorbidities are at higher risk to suffer adverse clinical outcomes, there are inadequate evidence to clarify the association between COVID-19 and asthma. On this ground, this study aims to systematically analyze the clinical characteristics of COVID-19 patients with asthma. METHODS In this single-center, retrospective and observational cohort study, 21 COVID-19 patients with asthma and 100 non-asthma COVID-19 patients were statistically matched by propensity score based on age, sex and comorbidities. Meanwhile, a collection and comparison concerning demographic indicators, clinical and laboratory examinations, treatments and outcomes were conducted between two groups to specify their differences. RESULTS Statistically, the COVID-19 patients with asthma had a higher proportion of ICU admission (14.3% [3/21] vs. 2.1% [2/96] p = 0.040) than those who do not have. On top this, a higher level of inflammatory responses, such as interleukin 6, interleukin 8, procalcitonin, leukocytes, neutrophils and CD4+ T cells was presented in asthma patients. Moreover, the increase of organ damage indices like D-dimer, lactate dehydrogenase and high-sensitivity cardiac troponin I, were more pronounced in COVID-19 patients with asthma. CONCLUSIONS Exacerbated inflammatory responses and multiple organ damages were triggered in COVID-19 patients with asthma, which highlights more intensive surveillance and supportive treatment.
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Affiliation(s)
- Meng Jin
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Can Chen
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, Hubei, PR China
| | - Jinyu Huang
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, Hubei, PR China
| | - Fengqin Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Tianyi Dong
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, Hubei, PR China
| | - Ming Zhang
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan, Hubei, PR China
| | - Huihui Yue
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Kui Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Guangcai Li
- Department of Pulmonary and Critical Care Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, PR China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, PR China
| | - Huilan Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
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158
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Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Sci Rep 2020; 10:20731. [PMID: 33244144 PMCID: PMC7692524 DOI: 10.1038/s41598-020-77698-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023] Open
Abstract
Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk.
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159
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Li J, Yue J, Zhang S, Wu J, Lian R, Zhang R, Cheng P. Relationship between digestive diseases and COVID-19 severity and mortality: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23353. [PMID: 33235103 PMCID: PMC7710250 DOI: 10.1097/md.0000000000023353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Digestive diseases have been often reported in COVID-19 patients, but whether COVID-19 patients with existing digestive comorbidities are at an increased risk of serious disease and death remains unclear. This study aims to evaluate the association between digestive diseases and COVID-19 severity and mortality. METHODS PubMed, Embase.com, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed will be searched to identify relevant studies up to October 1, 2020. We will use the Newcastle-Ottawa quality assessment scale to assess the quality of included studies. We will use Stata to perform pairwise meta-analyses using the random-effects model with the inverse variance method to estimate the association between digestive diseases and the mortality and severity of COVID-19. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity. We will create a "Summary of findings' table presenting our primary and secondary outcomes using the GRADEpro Guideline Development Tool software. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSIONS This study will comprehensively evaluate the association between digestive diseases and the severity and mortality of patients with COVID-19. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.
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Affiliation(s)
- Jinjuan Li
- School of Public Health, Gansu University of Chinese Medicine
| | - Jia Yue
- School of Public Health, Gansu University of Chinese Medicine
| | - Shunan Zhang
- School of Public Health, Gansu University of Chinese Medicine
| | - Jianjun Wu
- School of Public Health, Gansu University of Chinese Medicine
| | - Rongna Lian
- The First Clinical Medical College of Lanzhou University
| | - Ruinian Zhang
- The First Clinical Medical College of Lanzhou University
| | - Peng Cheng
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, China
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160
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Elmore R, Schmidt L, Lam J, Howard BE, Tandon A, Norman C, Phillips J, Shah M, Patel S, Albert T, Taxman DJ, Shah RR. Risk and Protective Factors in the COVID-19 Pandemic: A Rapid Evidence Map. Front Public Health 2020; 8:582205. [PMID: 33330323 PMCID: PMC7732416 DOI: 10.3389/fpubh.2020.582205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Given the worldwide spread of the 2019 Novel Coronavirus (COVID-19), there is an urgent need to identify risk and protective factors and expose areas of insufficient understanding. Emerging tools, such as the Rapid Evidence Map (rEM), are being developed to systematically characterize large collections of scientific literature. We sought to generate an rEM of risk and protective factors to comprehensively inform areas that impact COVID-19 outcomes for different sub-populations in order to better protect the public. Methods: We developed a protocol that includes a study goal, study questions, a PECO statement, and a process for screening literature by combining semi-automated machine learning with the expertise of our review team. We applied this protocol to reports within the COVID-19 Open Research Dataset (CORD-19) that were published in early 2020. SWIFT-Active Screener was used to prioritize records according to pre-defined inclusion criteria. Relevant studies were categorized by risk and protective status; susceptibility category (Behavioral, Physiological, Demographic, and Environmental); and affected sub-populations. Using tagged studies, we created an rEM for COVID-19 susceptibility that reveals: (1) current lines of evidence; (2) knowledge gaps; and (3) areas that may benefit from systematic review. Results: We imported 4,330 titles and abstracts from CORD-19. After screening 3,521 of these to achieve 99% estimated recall, 217 relevant studies were identified. Most included studies concerned the impact of underlying comorbidities (Physiological); age and gender (Demographic); and social factors (Environmental) on COVID-19 outcomes. Among the relevant studies, older males with comorbidities were commonly reported to have the poorest outcomes. We noted a paucity of COVID-19 studies among children and susceptible sub-groups, including pregnant women, racial minorities, refugees/migrants, and healthcare workers, with few studies examining protective factors. Conclusion: Using rEM analysis, we synthesized the recent body of evidence related to COVID-19 risk and protective factors. The results provide a comprehensive tool for rapidly elucidating COVID-19 susceptibility patterns and identifying resource-rich/resource-poor areas of research that may benefit from future investigation as the pandemic evolves.
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161
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Zhao BC, Liu WF, Lei SH, Zhou BW, Yang X, Huang TY, Deng QW, Xu M, Li C, Liu KX. Prevalence and prognostic value of elevated troponins in patients hospitalised for coronavirus disease 2019: a systematic review and meta-analysis. J Intensive Care 2020; 8:88. [PMID: 33292649 PMCID: PMC7682759 DOI: 10.1186/s40560-020-00508-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical significance of cardiac troponin measurement in patients hospitalised for coronavirus disease 2019 (covid-19) is uncertain. We investigated the prevalence of elevated troponins in these patients and its prognostic value for predicting mortality. METHODS Studies were identified by searching electronic databases and preprint servers. We included studies of hospitalised covid-19 patients that reported the frequency of troponin elevations above the upper reference limit and/or the association between troponins and mortality. Meta-analyses were performed using random-effects models. RESULTS Fifty-one studies were included. Elevated troponins were found in 20.8% (95% confidence interval [CI] 16.8-25.0 %) of patients who received troponin test on hospital admission. Elevated troponins on admission were associated with a higher risk of subsequent death (risk ratio 2.68, 95% CI 2.08-3.46) after adjusting for confounders in multivariable analysis. The pooled sensitivity of elevated admission troponins for predicting death was 0.60 (95% CI 0.54-0.65), and the specificity was 0.83 (0.77-0.88). The post-test probability of death was about 42% for patients with elevated admission troponins and was about 9% for those with non-elevated troponins on admission. There was significant heterogeneity in the analyses, and many included studies were at risk of bias due to the lack of systematic troponin measurement and inadequate follow-up. CONCLUSION Elevated troponins were relatively common in patients hospitalised for covid-19. Troponin measurement on admission might help in risk stratification, especially in identifying patients at high risk of death when troponin levels are elevated. High-quality prospective studies are needed to validate these findings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020176747.
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Affiliation(s)
- Bing-Cheng Zhao
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Wei-Feng Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Shao-Hui Lei
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Bo-Wei Zhou
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Xiao Yang
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Tong-Yi Huang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Qi-Wen Deng
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Miao Xu
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Cai Li
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China
| | - Ke-Xuan Liu
- Department of Anaesthesiology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave N, Guangzhou, 510515, China.
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162
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Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, Ceirano A, Espinosa F, Saavedra E, Sanguine V, Tassara A, Cid C, Catalano HN, Agarwal A, Foroutan F, Rada G. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One 2020; 15:e0241955. [PMID: 33201896 PMCID: PMC7671522 DOI: 10.1371/journal.pone.0241955] [Citation(s) in RCA: 366] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE The objective of our systematic review is to identify prognostic factors that may be used in decision-making related to the care of patients infected with COVID-19. DATA SOURCES We conducted highly sensitive searches in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The searches covered the period from the inception date of each database until April 28, 2020. No study design, publication status or language restriction were applied. STUDY SELECTION AND DATA EXTRACTION We included studies that assessed patients with confirmed or suspected SARS-CoV-2 infectious disease and examined one or more prognostic factors for mortality or disease severity. Reviewers working in pairs independently screened studies for eligibility, extracted data and assessed the risk of bias. We performed meta-analyses and used GRADE to assess the certainty of the evidence for each prognostic factor and outcome. RESULTS We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infectious disease: Demographic factors (age, male sex, smoking), patient history factors (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score (sequential organ failure assessment score). CONCLUSION Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infectious disease while researchers can utilise our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes. SYSTEMATIC REVIEW REGISTRATION Prospero registration number: CRD42020178802. Protocol available at: https://www.medrxiv.org/content/10.1101/2020.04.08.20056598v1.
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Affiliation(s)
- Ariel Izcovich
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | | | - Fernando Tortosa
- Departamento Médico, Hospital “Ramón Carrillo”, San Carlos de Bariloche, Argentina
| | | | - Camila Agnoletti
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Agustín Bengolea
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Agustina Ceirano
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Federico Espinosa
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Ezequiel Saavedra
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Verónica Sanguine
- Dirección Nacional de Calidad en Servicios de Salud y Regulación Sanitaria, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Alfredo Tassara
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Candelaria Cid
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | | | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Canada
| | - Gabriel Rada
- Fundación Epistemonikos, Santiago, Chile
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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163
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Abstract
As the COVID-19 pandemic continues to escalate and place pressure on hospital system resources, a proper screening and risk stratification score is essential. We aimed to develop a risk score to identify patients with increased risk of COVID-19, allowing proper identification and allocation of limited resources. A retrospective study was conducted of 338 patients who were admitted to the hospital from the emergency room to regular floors and tested for COVID-19 at an acute care hospital in the Metropolitan Washington D.C. area. The dataset was split into development and validation sets with a ratio of 6:4. Demographics, presenting symptoms, sick contact, triage vital signs, initial laboratory and chest X-ray results were analysed to develop a prediction model for COVID-19 diagnosis. Multivariable logistic regression was performed in a stepwise fashion to develop a prediction model, and a scoring system was created based on the coefficients of the final model. Among 338 patients admitted to the hospital from the emergency room, 136 (40.2%) patients tested positive for COVID-19 and 202 (59.8%) patients tested negative. Sick contact with suspected or confirmed COVID-19 case (3 points), nursing facility residence (3 points), constitutional symptom (1 point), respiratory symptom (1 point), gastrointestinal symptom (1 point), obesity (1 point), hypoxia at triage (1 point) and leucocytosis (−1 point) were included in the prediction score. A risk score for COVID-19 diagnosis achieved area under the receiver operating characteristic curve of 0.87 (95% confidence interval (CI) 0.82–0.92) in the development dataset and 0.85 (95% CI 0.78–0.92) in the validation dataset. A risk prediction score for COVID-19 can be used as a supplemental tool to assist clinical decision to triage, test and quarantine patients admitted to the hospital from the emergency room.
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Metkus TS, Sokoll LJ, Barth AS, Czarny MJ, Hays AG, Lowenstein CJ, Michos ED, Nolley EP, Post WS, Resar JR, Thiemann DR, Trost JC, Hasan RK. Myocardial Injury in Severe COVID-19 Compared With Non-COVID-19 Acute Respiratory Distress Syndrome. Circulation 2020; 143:553-565. [PMID: 33186055 PMCID: PMC7864609 DOI: 10.1161/circulationaha.120.050543] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Knowledge gaps remain in the epidemiology and clinical implications of myocardial injury in coronavirus disease 2019 (COVID-19). We aimed to determine the prevalence and outcomes of myocardial injury in severe COVID-19 compared with acute respiratory distress syndrome (ARDS) unrelated to COVID-19. Methods: We included intubated patients with COVID-19 from 5 hospitals between March 15 and June 11, 2020, with troponin levels assessed. We compared them with patients from a cohort study of myocardial injury in ARDS and performed survival analysis with primary outcome of in-hospital death associated with myocardial injury. In addition, we performed linear regression to identify clinical factors associated with myocardial injury in COVID-19. Results: Of 243 intubated patients with COVID-19, 51% had troponin levels above the upper limit of normal. Chronic kidney disease, lactate, ferritin, and fibrinogen were associated with myocardial injury. Mortality was 22.7% among patients with COVID-19 with troponin under the upper limit of normal and 61.5% for those with troponin levels >10 times the upper limit of normal (P<0.001). The association of myocardial injury with mortality was not statistically significant after adjusting for age, sex, and multisystem organ dysfunction. Compared with patients with ARDS without COVID-19, patients with COVID-19 were older and had higher creatinine levels and less favorable vital signs. After adjustment, COVID-19–related ARDS was associated with lower odds of myocardial injury compared with non–COVID-19–related ARDS (odds ratio, 0.55 [95% CI, 0.36–0.84]; P=0.005). Conclusions: Myocardial injury in severe COVID-19 is a function of baseline comorbidities, advanced age, and multisystem organ dysfunction, similar to traditional ARDS. The adverse prognosis of myocardial injury in COVID-19 relates largely to multisystem organ involvement and critical illness.
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Affiliation(s)
- Thomas S Metkus
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lori J Sokoll
- Department of Medicine, and Department of Pathology (L.J.S.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andreas S Barth
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Matthew J Czarny
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison G Hays
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Charles J Lowenstein
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Erin D Michos
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric P Nolley
- Pulmonary and Critical Care Medicine (E.P.N.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy S Post
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jon R Resar
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - David R Thiemann
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jeffrey C Trost
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rani K Hasan
- Divisions of Cardiology (T.S.M., A.S.B., M.J.C., A.G.H., C.J.L., E.D.M., W.S.P., J.R.R., D.R.T., J.C.T., R.K.H.), Johns Hopkins University School of Medicine, Baltimore, MD
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165
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Choupoo NS, Das SK, Haldar R, Sarkar H, Tewari R, Ray S. Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials. Indian J Crit Care Med 2020; 24:1106-1113. [PMID: 33384519 PMCID: PMC7751050 DOI: 10.5005/jp-journals-10071-23664] [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: 12/15/2022] Open
Abstract
PURPOSE The present study systematically searched important medical databases, assessed the quality of available pieces of evidence, and performed a meta-analysis to test the efficacy of different therapeutic options currently available for treating COVID-19. MATERIALS AND METHODS PubMed, CNKI, LILACS, Koreamed, WHO clinical trial registry, and medRxiv were searched since December 2019. Any observational or controlled study that tested the efficacy of any pharmacological intervention in COVID-19 patients either prospectively or retrospectively was included in the qualitative analysis. We assessed outcomes as dichotomous variables, i.e., a patient having a positive clinical outcome. Relative risks/risk ratios (RR) having a 95% confidence interval (CI) were derived. Studies conforming to inclusion criteria were pooled using the random-effect model. RESULTS Nine trials on hydroxychloroquine (HCQ), six studies on antiviral, four studies on monoclonal antibodies, two on corticosteroids, two on convalescent plasma (CP), and one on interferon-α2b were included in the systematic review. Meta-analysis containing six scientific trials and analyzing 522 patients revealed that the relative risk of positive clinical outcomes with HCQ treatment was 1.042 (95% CI, 0.884 to 1.874) with a number needed to treat (NNT) of 12.6. A meta-analysis of two studies analyzing 285 patients showed that the relative risk of clinical resolution with lopinavir and ritonavir combination was 1.152 (95% CI 0.709 to 1.87). Out of various antiviral used, the only remdesivir showed a positive result in a case series. Monoclonal antibodies showed decreased C-reactive protein, decreased oxygen, and ventilator requirements. A corticosteroid may increase mortality with increased dose. Two small case series on CP showed some promising results. CONCLUSION The study showed slightly favorable results with HCQ, monoclonal antibodies, remdesivir, and CP in treating COVID-19 patients. Further research is warranted in establishing the efficacy of studied interventions. PROSPERO IDENTIFIER CRD42020180979. HOW TO CITE THIS ARTICLE Choupoo NS, Das SK, Haldar R, Sarkar H, Tewari R, Ray S. Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials. Indian J Crit Care Med 2020;24(11):1106-1113.
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Affiliation(s)
- Nang S Choupoo
- Department of Anesthesia and Critical Care, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India
| | - Saurabh K Das
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India
| | - Rudrashish Haldar
- Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hillol Sarkar
- Department of Medicine, Fakhruddin Ali Ahmed Medical College and Hospital, Joti Gaon, Assam, India
| | - Resma Tewari
- Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India
| | - Sumit Ray
- Department of Critical Care, Medical Services, Artemis Hospital, Gurugram, Haryana, India
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166
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Soeroto AY, Soetedjo NN, Purwiga A, Santoso P, Kulsum ID, Suryadinata H, Ferdian F. Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:1897-1904. [PMID: 33007661 PMCID: PMC7521380 DOI: 10.1016/j.dsx.2020.09.029] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Corona virus diseases 2019 (COVID-19) pandemic spread rapidly. Growing evidences that overweight and obesity which extent nearly a third of the world population were associated with severe COVID-19. This study aimed to explore the association and risk of increased BMI and obesity with composite poor outcome in COVID-19 adult patients. METHODS We conducted a systematic literature search from PubMed and Embase database. We included all original research articles in COVID-19 adult patients and obesity based on classification of Body Mass Index (BMI) and composite poor outcome which consist of ICU admission, ARDS, severe COVID-19, use of mechanical ventilation, hospital admission, and mortality. RESULTS Sixteen studies were included in meta-analysis with 9 studies presented BMI as continuous outcome and 10 studies presented BMI as dichotomous outcome (cut-off ≥30 kg/m2). COVID-19 patients with composite poor outcome had higher BMI with mean difference 1.12 (95% CI, 0.67-1.57, P < 0.001). Meanwhile, obesity was associated with composite poor outcome with odds ratio (OR) = 1.78 (95% CI, 1.25-2.54, P < 0.001) Multivariate meta-regression showed the association between BMI and obesity on composite poor outcome were affected by age, gender, DM type 2, and hypertension. CONCLUSION Obesity is a risk factor of composite poor outcome of COVID-19. On the other hand, COVID-19 patients with composite poor outcome have higher BMI. BMI is an important routine procedure that should always be assessed in the management of COVID-19 patients and special attention should be given to patients with obesity.
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Affiliation(s)
- Arto Yuwono Soeroto
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia.
| | - Nanny Natalia Soetedjo
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Division of Endocrine and Metabolism, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Aga Purwiga
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Prayudi Santoso
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Iceu Dimas Kulsum
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Hendarsyah Suryadinata
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
| | - Ferdy Ferdian
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, 40161, Indonesia
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167
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Zhang Z, Zhang L, Zha D, Hu C, Wu X. Clinical characteristics and risks of Chinàs 2019 novel coronavirus patients with AKI: a systematic review and meta-analysis. Ren Fail 2020; 42:926-931. [PMID: 32875936 PMCID: PMC7946000 DOI: 10.1080/0886022x.2020.1812401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Zhiqin Zhang
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lian Zhang
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dongqing Zha
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chun Hu
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Wu
- Nephrology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
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168
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Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH, Alsukait RF, Alluhidan M, Alazemi N, Shekar M. Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obes Rev 2020; 21:e13128. [PMID: 32845580 PMCID: PMC7461480 DOI: 10.1111/obr.13128] [Citation(s) in RCA: 672] [Impact Index Per Article: 168.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
The linkage of individuals with obesity and COVID-19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID-19, 75 studies were used to conduct a series of meta-analyses on the relationship of individuals with obesity-COVID-19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID-19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID-19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30-1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74-2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46-2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22-1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID-19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID-19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.
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Affiliation(s)
- Barry M. Popkin
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Shufa Du
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - William D. Green
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Melinda A. Beck
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | | | - Reem F. Alsukait
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
- Community Health SciencesKing Saud UniversityRiyadhKingdom of Saudi Arabia
| | | | | | - Meera Shekar
- Health, Nutrition and Population Global PracticeThe World BankWashington, D.C.USA
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169
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Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res 2020; 161:105107. [PMID: 32739424 PMCID: PMC7393179 DOI: 10.1016/j.phrs.2020.105107] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Currently, coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. This study aimed to investigate whether the presence of acute kidney injury (AKI) might increase the risk of severe infection and fatality in COVID-19 patients. We searched the PubMed, Web of Science, ScienceDirect, MedRxiv and COVID-19 academic research communication platforms for studies reporting severe infection rates and case-fatality rates in COVID-19 patients with and without AKI up to June 20, 2020. The main outcomes were the comparisons of the severe infection rates and fatality rates in COVID-19 patients with and without AKI and the estimation of the odds ratio (OR) and its 95 % confidence interval (CI) for severe infection and mortality. Statistical analyses were performed with R statistical software. A total of 40 studies involving 24,527 patients with COVID-19 were included in our meta-analysis. The incidence of AKI was 10 % (95 % CI 8%-13 %) in COVID-19 patients. The patients had higher severe infection and fatality rates (55.6 % vs. 17.7 % and 63.1 % vs. 12.9 %, respectively, all P < 0.01) with COVID-19. AKI was a predictor of fatality (OR = 14.63, 95 % CI: 9.94-21.51, P < 0.00001) and severe infection (OR = 8.11, 95 % CI: 5.01-13.13, P < 0.00001) in patients with COVID-19. Higher levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were associated with a significant increase in fatality [Scr: mean difference (MD): 20.19 μmol/L, 95 % CI: 14.96-25.42, P < 0.001; BUN: MD: 4.07 mmol/L, 95 % CI: 3.33-4.81, P < 0.001] and severe infection (Scr: MD: 7.78 μmol/L, 95 % CI: 4.43-11.14, P < 0.00001, BUN: MD: 2.12 mmol/L, 95 % CI: 1.74-2.50, P < 0.00001) in COVID-19 patients. In conclusion, AKI is associated with severe infection and higher fatality rates in patients with COVID-19. Clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with AKI.
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Affiliation(s)
- Mengjiao Shao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - XiaoMei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junyi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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170
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Chang TH, Chou CC, Chang LY. Effect of obesity and body mass index on coronavirus disease 2019 severity: A systematic review and meta-analysis. Obes Rev 2020; 21:e13089. [PMID: 32929833 DOI: 10.1111/obr.13089] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
We conducted a systematic review of observational studies to examine the effects of body mass index (BMI) and obesity (BMI ≥ 30 kg/m2 ) on coronavirus disease 2019 (COVID-19). Medline, Embase, and the Cochrane Library were searched. Sixteen articles were finally included in the meta-analysis, and a random effects model was used. BMI was found to be higher in patients with severe disease than in those with mild or moderate disease (MD 1.6, 95% CI, 0.8-2.4; p = .0002) in China; however, the heterogeneity was high (I2 = 75%). Elevated BMI was associated with invasive mechanical ventilation (IMV) use (MD 4.1, 95% CI, 2.1-6.1; p < .0001) in Western countries, and this result was consistent across studies (I2 = 0%). Additionally, there were increased odds ratios of IMV use (OR 2.0, 95% CI, 1.4-2.9; p < .0001) and hospitalization (OR 1.4, 95% CI, 1.3-1.60; p < .00001) in patients with obesity. There was no substantial heterogeneity (I2 = 0%). In conclusion, obesity or high BMI increased the risk of hospitalization, severe disease and invasive mechanical ventilation in COVID-19. Physicians must be alert to these early indicators to identify critical patients.
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Affiliation(s)
- Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chia-Ching Chou
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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Malik VS, Ravindra K, Attri SV, Bhadada SK, Singh M. Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:42115-42123. [PMID: 32710359 PMCID: PMC7380664 DOI: 10.1007/s11356-020-10132-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/14/2020] [Indexed: 05/07/2023]
Abstract
Globally, both obesity and underweight are severe health risks for various diseases. The current study systematically examined the emerging evidence to identify an association between body mass index (BMI) and COVID-19 disease outcome. Online literature databases (e.g., Google Scholar, PubMed, MEDLINE, EMBASE, Scopus, Medrixv and BioRixv) were screened following standard search strategy having the appropriate keyword such as "Obesity", "Underweight", "BMI", "Body Mass Index", "2019-nCov", "COVID-19, "novel coronavirus", "coronavirus disease". Studies published till 20th April 2020 were included without language restriction. These studies include case reports, case series, cohort, and any other which reported BMI, overweight/obesity or underweight, and its complication with COVID-19 disease. This study observed COVID-19 infection among BMI < 25 kg/m2 with prevalence of 0.60 (95%CI: 0.34-0.86, I2 = - 76.77) as compared to the 0.34 (95%CI: 0.23-0.44, I2 = 53.45% heterogeneity) having BMI > 25 kg/m2. The results of the current study show that BMI plays a significant role in COVID-19 severity in all age groups, especially the older individuals. A panel of doctors and nursing staff should review COVID-19 patients with higher BMI with other co-morbidities (diabetes and hypertension), and they should be given increased vigilance, priority in testing, and treatment to control the associated co-morbidities. Further, the COVID-19 patients whose illness entered 7-10 days, age > 50 years, and elevated CRP levels should be given additional medical considerations. Our finding showed that the population and patients with high BMI have moderate to high risk of medical complications with COVID-19, and hence, their health status should be monitored more frequently including monitoring of blood pressure and blood glucose.
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Affiliation(s)
- Vivek Singh Malik
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Savita Verma Attri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Meenu Singh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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172
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Bolay H, Özge A, Uludüz D, Baykan B. Are Migraine Patients at Increased Risk for Symptomatic Coronavirus Disease 2019 Due to Shared Comorbidities? Headache 2020; 60:2508-2521. [PMID: 33124044 DOI: 10.1111/head.13998] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has rapidly transformed the whole world and forced us to look through comorbid diseases and risk factors from a different perspective. COVID-19 shows some inherent risk factors like cardiovascular comorbidities independent from age, gender, and geographic location. One of the most peculiar features of the COVID-19 pandemic is that severe acute respiratory syndrome coronavirus 2 respiratory infections disproportionately impact patients with hypertension, diabetes, and other cardiovascular comorbidities rather than those with allergic respiratory diseases and immune-compromised conditions. Migraine is a complex neuro-vasculo-inflammatory disorder that is also packed frequently with certain medical conditions including vascular disorders, hypertension, allergic diseases such as asthma and systemic inflammatory disorders. Accordingly, 2 different questions arise during the pandemic: (1) Do share comorbidities of cardiovascular diseases and hypertension increase the risk of symptomatic COVID-19 for migraine patients? (2) Do comorbid allergic and atopic diseases, including asthma act as opposite influencers alongside with female gender? This paper focuses on the co-existence of comorbidities of COVID-19, in comparison with migraine, based on a wide clinical dataset and available reports. Discussed mechanisms include potential strategic roles of angiotensin-converting enzyme 2, angiotensin-II, and nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 inflammasome, playing remarkable parts in the pathogenesis of COVID-19 and migraine. There are also some clues about the importance of endothelial and pericyte dysfunction and neuroinflammation in COVID-19 infection, related to complications and survival of the patients. The large epidemiological studies as well as basic research, focusing on migraine patients with COVID-19 will clarify these vital questions during the upcoming periods.
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Affiliation(s)
- Hayrunnisa Bolay
- Department of Neurology and Algology, Medical Faculty, Gazi University, Ankara, Turkey
| | - Aynur Özge
- Department of Neurology and Algology, Medical Faculty, Mersin University, Mersin, Turkey
| | - Derya Uludüz
- Department of Neurology and Algology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Betül Baykan
- Department of Neurology, Headache Center, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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173
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Coronavirus and Cardiovascular Disease, Myocardial Injury, and Arrhythmia: JACC Focus Seminar. J Am Coll Cardiol 2020; 76:2011-2023. [PMID: 33092737 PMCID: PMC7572122 DOI: 10.1016/j.jacc.2020.08.059] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
The cardiovascular system is affected broadly by severe acute respiratory syndrome coronavirus 2 infection. Both direct viral infection and indirect injury resulting from inflammation, endothelial activation, and microvascular thrombosis occur in the context of coronavirus disease 2019. What determines the extent of cardiovascular injury is the amount of viral inoculum, the magnitude of the host immune response, and the presence of co-morbidities. Myocardial injury occurs in approximately one-quarter of hospitalized patients and is associated with a greater need for mechanical ventilator support and higher hospital mortality. The central pathophysiology underlying cardiovascular injury is the interplay between virus binding to the angiotensin-converting enzyme 2 receptor and the impact this action has on the renin-angiotensin system, the body’s innate immune response, and the vascular response to cytokine production. The purpose of this review was to describe the mechanisms underlying cardiovascular injury, including that of thromboembolic disease and arrhythmia, and to discuss their clinical sequelae. The cardiovascular system is affected in diverse ways by severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Myocardial injury can be detected in ∼25% of hospitalized patients with COVID-19 and is associated with an increased risk of mortality. Described mechanisms of myocardial injury in patients with COVID-19 include oxygen supply–demand imbalance, direct viral myocardial invasion, inflammation, coronary plaque rupture with acute myocardial infarction, microvascular thrombosis, and adrenergic stress.
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174
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The characteristics and clinical course of patients with COVID-19 who received invasive mechanical ventilation in Osaka, Japan. Int J Infect Dis 2020; 102:282-284. [PMID: 33127502 PMCID: PMC7590632 DOI: 10.1016/j.ijid.2020.10.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To describe the detailed clinical course of patients with coronavirus disease 2019 (COVID-19) who received invasive mechanical ventilation. METHODS We conducted a case series of patients with COVID-19 who received invasive mechanical ventilation in Osaka, Japan, between January 29 and May 28, 2020. We describe the patient characteristics and clinical course from onset. Additionally, we fitted logistic regression models to investigate the associations between patient characteristics and the 30-day mortality rate. RESULTS A total of 125 patients who received invasive mechanical ventilation (median age [interquartile range], 68 [57-73] years; male, 77.6%) were enrolled. Overall, the 30-day mortality was 24.0%, and the median (interquartile range) length of ICU stay and length of invasive mechanical ventilation use were 16 (12-29) days and 13 (9-26) days, respectively. From clinical onset, 121 patients (96.8%) were intubated within 14 days. In multivariable logistic regression analysis, age of 65 years or older (odds ratio, 3.56; 95% confidence interval, 1.21-10.49; P = 0.02) and male sex (odds ratio, 3.75; 95% confidence interval, 1.00-11.24, P = 0.04) were significantly associated with a higher 30-day mortality rate. CONCLUSIONS In this case series of patients with COVID-19 who received invasive mechanical ventilation in Japan, the 30-day mortality rate was 24.0%, and age 65 years or older and male sex were associated with higher 30-day mortality rate.
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Abstract
Objectives Cardiac injury is associated with poor prognosis of 2019 novel coronavirus disease 2019 (COVID-19), but the risk factors for cardiac injury have not been fully studied. In this study, we carried out a systematic analysis of clinical characteristics in COVID-19 patients to determine potential risk factors for cardiac injury complicated COVID-19 virus infection. Methods We systematically searched relevant literature published in Pubmed, Embase, Europe PMC, CNKI and other databases. All statistical analyses were performed using STATA 16.0. Results We analysed 5726 confirmed cases from 17 studies. The results indicated that compared with non-cardiac-injured patients, patients with cardiac injury are older, with a greater proportion of male patients, with higher possibilities of existing comorbidities, with higher risks of clinical complications, need for mechanical ventilation, ICU transfer and mortality. Moreover, C-reactive protein, procalcitonin, D-dimer, NT-proBNP and blood creatinine in patients with cardiac injury are also higher while lymphocyte counts and platelet counts decreased. However, we fortuitously found that patients with cardiac injury did not present higher clinical specificity for chest distress (P = 0.304), chest pain (P = 0.334), palpitations (P = 0.793) and smoking (P = 0.234). Similarly, the risk of concomitant arrhythmia (P = 0.103) did not increase observably either. Conclusion Age, male gender and comorbidities are risk factors for cardiac injury complicated COVID-19 infection. Such patients are susceptible to complications and usually have abnormal results of laboratory tests, leading to poor outcomes. Contrary to common cardiac diseases, cardiac injury complicated COVID-19 infection did not significantly induce chest distress, chest pain, palpitations or arrhythmias. Our study indicates that early prevention should be applied to COVID-19 patients with cardiac injury to reduce adverse outcomes.
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176
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Budhathoki P, Shrestha DB, Rawal E, Khadka S. Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis. SN COMPREHENSIVE CLINICAL MEDICINE 2020; 2:2600-2620. [PMID: 33103063 PMCID: PMC7569091 DOI: 10.1007/s42399-020-00515-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 01/08/2023]
Abstract
Due to a lack of definitive treatment, many drugs were repurposed for Coronavirus disease (COVID-19) treatment; among them, corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative syntheses, 41, and quantitative studies, 40, were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2) test and random/fixed effect analysis was done to determine the odds/risk ratio. We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1.89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with the corticosteroid-receiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Neither increased discharge rate (RR 0.79, 0.63-0.99) nor recovery/improvement rate was shown among the corticosteroid-receiving group (OR 0.24, 0.13-0.43). Approximately, the overall 4-day longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), approximately a 3-day (MD 2.42, 1.31-3.53) delay was observed with corticosteroid treatment cases. Our study concludes that more severe and critically ill patients tend to get corticosteroids, and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.
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Affiliation(s)
| | - Dhan Bahadur Shrestha
- Department of Emergency Medicine, Mangalbare Hospital, Morang, Ulrabari, 56600 Nepal
| | - Era Rawal
- Department of Emergency Medicine, Kathmandu Medical College, Kathmandu, 44600 Nepal
| | - Sitaram Khadka
- Department of Pharmacy, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, 44600 Nepal
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Santus P, Radovanovic D, Saderi L, Marino P, Cogliati C, De Filippis G, Rizzi M, Franceschi E, Pini S, Giuliani F, Del Medico M, Nucera G, Valenti V, Tursi F, Sotgiu G. Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study. BMJ Open 2020; 10:e043651. [PMID: 33040020 PMCID: PMC7549463 DOI: 10.1136/bmjopen-2020-043651] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES COVID-19 causes lung parenchymal and endothelial damage that lead to hypoxic acute respiratory failure (hARF). The influence of hARF severity on patients' outcomes is still poorly understood. DESIGN Observational, prospective, multicentre study. SETTING Three academic hospitals in Milan (Italy) involving three respiratory high dependency units and three general wards. PARTICIPANTS Consecutive adult hospitalised patients with a virologically confirmed diagnosis of COVID-19. Patients aged <18 years or unable to provide informed consent were excluded. INTERVENTIONS Anthropometrical, clinical characteristics and blood biomarkers were assessed within the first 24 hours from admission. hARF was graded as follows: severe (partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) <100 mm Hg); moderate (PaO2/FiO2 101-200 mm Hg); mild (PaO2/FiO2 201-300 mm Hg) and normal (PaO2/FiO2 >300 mm Hg). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the assessment of clinical characteristics and in-hospital mortality based on the severity of respiratory failure. Secondary outcomes were intubation rate and application of continuous positive airway pressure during hospital stay. RESULTS 412 patients were enrolled (280 males, 68%). Median (IQR) age was 66 (55-76) years with a PaO2/FiO2 at admission of 262 (140-343) mm Hg. 50.2% had a cardiovascular disease. Prevalence of mild, moderate and severe hARF was 24.4%, 21.9% and 15.5%, respectively. In-hospital mortality proportionally increased with increasing impairment of gas exchange (p<0.001). The only independent risk factors for mortality were age ≥65 years (HR 3.41; 95% CI 2.00 to 5.78, p<0.0001), PaO2/FiO2 ratio ≤200 mm Hg (HR 3.57; 95% CI 2.20 to 5.77, p<0.0001) and respiratory failure at admission (HR 3.58; 95% CI 1.05 to 12.18, p=0.04). CONCLUSIONS A moderate-to-severe impairment in PaO2/FiO2 was independently associated with a threefold increase in risk of in-hospital mortality. Severity of respiratory failure is useful to identify patients at higher risk of mortality. TRIAL REGISTRATION NUMBER NCT04307459.
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Affiliation(s)
- Pierachille Santus
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Laura Saderi
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali. Via Padre Manzella, 4-07100, Università degli Studi di Sassari, Sassari, Italy
| | - Pietro Marino
- Department of Medicine and Rehabilitation, Division of Emergency Medicine, ASST Fatebenefratelli-Sacco, Piazzale Principessa Clotilde, 3-20121, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Chiara Cogliati
- Division of Internal Medicine -ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Giuseppe De Filippis
- Direzione Sanitaria Aziendale, Via G.B. Grassi 74-20157, ASST Fatebenefratelli Sacco, Milano, Lombardia, Italy
| | - Maurizio Rizzi
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Elisa Franceschi
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Stefano Pini
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
- Division of Respiratory Diseases, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Fabio Giuliani
- Department of Health Bioscience-Respiratory Unit, Policlinico di San Donato, IRCCS-Via Rodolfo Morandi, 30-20097, San Donato Milanese, Università degli Studi di Milano, Milano, Italy
| | - Marta Del Medico
- Division of Internal Medicine -ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74-20157, Ospedale Luigi Sacco-Polo Universitario, Milano, Italy
| | - Gabriella Nucera
- Department of Medicine and Rehabilitation, Division of Emergency Medicine, ASST Fatebenefratelli-Sacco, Piazzale Principessa Clotilde, 3-20121, Ospedale Fatebenefratelli e Oftalmico, Milano, Italy
| | - Vincenzo Valenti
- Department of Health Bioscience-Respiratory Unit, Policlinico di San Donato, IRCCS-Via Rodolfo Morandi, 30-20097, San Donato Milanese, Università degli Studi di Milano, Milano, Italy
| | - Francesco Tursi
- Dipartimento Medico, USC Pneumologia, USS Servizio di Pneumologia, Ospedale di Codogno, Azienda Socio Sanitaria Territoriale di Lodi, Lodi, Italy
| | - Giovanni Sotgiu
- Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali. Via Padre Manzella, 4-07100, Università degli Studi di Sassari, Sassari, Italy
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Turagam MK, Musikantow D, Goldman ME, Bassily-Marcus A, Chu E, Shivamurthy P, Lampert J, Kawamura I, Bokhari M, Whang W, Bier BA, Malick W, Hashemi H, Miller MA, Choudry S, Pumill C, Ruiz-Maya T, Hadley M, Giustino G, Koruth JS, Langan N, Sofi A, Dukkipati SR, Halperin JL, Fuster V, Kohli-Seth R, Reddy VY. Malignant Arrhythmias in Patients With COVID-19: Incidence, Mechanisms, and Outcomes. Circ Arrhythm Electrophysiol 2020; 13:e008920. [PMID: 33026892 PMCID: PMC7668347 DOI: 10.1161/circep.120.008920] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Patients with coronavirus disease 2019 (COVID-19) who develop cardiac injury are reported to experience higher rates of malignant cardiac arrhythmias. However, little is known about these arrhythmias—their frequency, the underlying mechanisms, and their impact on mortality. Methods: We extracted data from a registry (NCT04358029) regarding consecutive inpatients with confirmed COVID-19 who were receiving continuous telemetric ECG monitoring and had a definitive disposition of hospital discharge or death. Between patients who died versus discharged, we compared a primary composite end point of cardiac arrest from ventricular tachycardia/fibrillation or bradyarrhythmias such as atrioventricular block. Results: Among 800 patients with COVID-19 at Mount Sinai Hospital with definitive dispositions, 140 patients had telemetric monitoring, and either died (52) or were discharged (88). The median (interquartile range) age was 61 years (48–74); 73% men; and ethnicity was White in 34%. Comorbidities included hypertension in 61%, coronary artery disease in 25%, ventricular arrhythmia history in 1.4%, and no significant comorbidities in 16%. Compared with discharged patients, those who died had elevated peak troponin I levels (0.27 versus 0.02 ng/mL) and more primary end point events (17% versus 4%, P=0.01)—a difference driven by tachyarrhythmias. Fatal tachyarrhythmias invariably occurred in the presence of severe metabolic imbalance, while atrioventricular block was largely an independent primary event. Conclusions: Hospitalized patients with COVID-19 who die experience malignant cardiac arrhythmias more often than those surviving to discharge. However, these events represent a minority of cardiovascular deaths, and ventricular tachyarrhythmias are mainly associated with severe metabolic derangement. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04358029.
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Affiliation(s)
- Mohit K Turagam
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Musikantow
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Martin E Goldman
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adel Bassily-Marcus
- Department of Critical Care Medicine, Institute for Critical Care Medicine (A.B.-M., R.K.-S.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Edward Chu
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Poojita Shivamurthy
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Lampert
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Iwanari Kawamura
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mahmoud Bokhari
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - William Whang
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin Aaron Bier
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Waqas Malick
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Helen Hashemi
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marc A Miller
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Subbarao Choudry
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Christopher Pumill
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tania Ruiz-Maya
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Hadley
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gennaro Giustino
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob S Koruth
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noelle Langan
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aamir Sofi
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Srinivas R Dukkipati
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan L Halperin
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Valentin Fuster
- Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roopa Kohli-Seth
- Department of Critical Care Medicine, Institute for Critical Care Medicine (A.B.-M., R.K.-S.), Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vivek Y Reddy
- Department of Cardiovascular Medicine, Helmsley Electrophysiology Center (M.K.T., D.M., E.C., P.S., I.K., M.B., W.W., M.A.M., S.C., J.S.K., N.L., A.S., S.R.D., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY.,Department of Cardiovascular Medicine, Zena and Michael A. Wiener Cardiovascular Institute (M.K.T., D.M., M.E.G., E.C., P.S., J.L., I.K., M.B., W.W., B.A., W.M., H.H., M.A.M., S.C., C.P., T.R.-M., M.H., G.G., J.S.K., N.L., A.S., S.R.D., J.L.H., V.F., V.Y.R.), Icahn School of Medicine at Mount Sinai, New York, NY
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Shang L, Shao M, Guo Q, Shi J, Zhao Y, Xiaokereti J, Tang B. Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis. Arch Med Res 2020; 51:700-709. [PMID: 32811670 PMCID: PMC7413048 DOI: 10.1016/j.arcmed.2020.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Currently, the number of patients with coronavirus disease 2019 (COVID-19) infection is increasing rapidly worldwide. In this study, we aimed to assess whether diabetes mellitus (DM) would increase the risk of severe infection and death in patients with COVID-19. METHODS We systematically searched the PubMed, Web of Science, MedRxiv and COVID-19 academic research communication platform for studies reporting clinical severity and/or overall mortality data on DM in patients with COVID-19 published up to July 10, 2020. The primary outcome was to compare the severe infection rate and mortality rate in COVID-19 patients with and without DM, and to calculate the odds ratio (OR) and 95% confidence interval (CI). RESULTS A total of 76 studies involving 31,067 patients with COVID-19 were included in our meta-analysis. COVID-19 patients with DM had higher severe infection and case-mortality rates compared with those without DM (21.4 vs. 10.6% and 28.5 vs. 13.3%, respectively, all p <0.01). COVID-19 patients with DM were at significantly elevated risk of severe infection (OR = 2.38, 95% CI: 2.05-2.78, p <0.001) and mortality (OR = 2.21, 95% CI: 1.83-2.66, p <0.001). CONCLUSION DM is associated with increased risk of severe infection and higher mortality in patients with COVID-19. Our study suggests that clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with DM.
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Affiliation(s)
- Luxiang Shang
- Department of Cardiology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mengjiao Shao
- Department of Cardiology, Xinjiang Key Laboratory of Cardiovascular Disease Research, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qilong Guo
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jia Shi
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yang Zhao
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Hospital of Shenzhen General Station of Exit and Entry Frontier Inspection, Shenzhen, China
| | - Jiasuoer Xiaokereti
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Department of Pacing and Electrophysiology, Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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180
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Wang R, He M, Yin W, Liao X, Wang B, Jin X, Ma Y, Yue J, Bai L, Liu D, Zhu T, Huang Z, Kang Y. The Prognostic Nutritional Index is associated with mortality of COVID-19 patients in Wuhan, China. J Clin Lab Anal 2020; 34:e23566. [PMID: 32914892 PMCID: PMC7595894 DOI: 10.1002/jcla.23566] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/02/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Declared as pandemic by WHO, the coronavirus disease 2019 (COVID-19) pneumonia has brought great damage to human health. The uncontrollable spread and poor progression of COVID-19 have attracted much attention from all over the world. We designed this study to develop a prognostic nomogram incorporating Prognostic nutritional index (PNI) in COVID-19 patients. METHODS Patients confirmed with COVID-19 and treated in Renmin Hospital of Wuhan University from January to February 2020 were included in this study. We used logistic regression analysis to find risk factors of mortality in these patients. A prognostic nomogram was constructed and receiver operating characteristics (ROC) curve was drawn to evaluate the predictive value of PNI and this prognostic model. RESULTS Comparison of baseline characteristics showed non-survivors had higher age (P < .001), male ratio (P = .038), neutrophil-to-lymphocyte ratio (NLR) (P < .001), platelet-to-lymphocyte ratio (PLR) (P < .001), and PNI (P < .001) than survivors. In the multivariate logistic regression analysis, independent risk factors of mortality in COVID-19 patients included white blood cell (WBC) (OR 1.285, P = .039), PNI (OR 0.790, P = .029), LDH (OR 1.011, P < .015). These three factors were combined to build the prognostic model. Area under the ROC curve (AUC) of only PNI and the prognostic model was 0.849 (95%Cl 0.811-0.888) and 0.950 (95%Cl 0.922-0.978), respectively. And calibration plot showed good stability of the prognostic model. CONCLUSION This research indicates PNI is independently associated with the mortality of COVID-19 patients. Prognostic model incorporating PNI is beneficial for clinicians to evaluate progression and strengthen monitoring for COVID-19 patients.
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Affiliation(s)
- Ruoran Wang
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Min He
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
- COVID19 Medical Team (Hubei) of West China HospitalSichuan UniversityChengduChina
| | - Wanhong Yin
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Xuelian Liao
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Bo Wang
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Xiaodong Jin
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Yao Ma
- COVID19 Medical Team (Hubei) of West China HospitalSichuan UniversityChengduChina
- Department of Geriatrics and National Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
| | - Jirong Yue
- COVID19 Medical Team (Hubei) of West China HospitalSichuan UniversityChengduChina
- Department of Geriatrics and National Clinical Research Center for GeriatricsWest China HospitalSichuan UniversityChengduChina
| | - Lang Bai
- COVID19 Medical Team (Hubei) of West China HospitalSichuan UniversityChengduChina
- Center of Infectious DiseaseWest China HospitalSichuan UniversityChengduChina
| | - Dan Liu
- COVID19 Medical Team (Hubei) of West China HospitalSichuan UniversityChengduChina
- Department of Respiratory and Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
| | - Ting Zhu
- Department of Otolaryngology‐Head and Neck SurgeryRenmin Hospital of Wuhan UniversityWuhanChina
| | - Zhixin Huang
- Department of Obstetrics and GynecologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Yan Kang
- Department of Critical Care MedicineWest China HospitalSichuan UniversityChengduChina
- COVID19 Medical Team (Hubei) of West China HospitalSichuan UniversityChengduChina
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181
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Moutchia J, Pokharel P, Kerri A, McGaw K, Uchai S, Nji M, Goodman M. Clinical laboratory parameters associated with severe or critical novel coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. PLoS One 2020; 15:e0239802. [PMID: 33002041 PMCID: PMC7529271 DOI: 10.1371/journal.pone.0239802] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To date, several clinical laboratory parameters associated with Coronavirus disease 2019 (COVID-19) severity have been reported. However, these parameters have not been observed consistently across studies. The aim of this review was to assess clinical laboratory parameters which may serve as markers or predictors of severe or critical COVID-19. METHODS AND FINDINGS We conducted a systematic search of MEDLINE, Embase, Web of Science, CINAHL and Google Scholar databases from 2019 through April 18, 2020, and reviewed bibliographies of eligible studies, relevant systematic reviews, and the medRxiv pre-print server. We included hospital-based observational studies reporting clinical laboratory parameters of confirmed cases of COVID-19 and excluded studies having large proportions (>10%) of children and pregnant women. Two authors independently carried out screening of articles, data extraction and quality assessment. Meta-analyses were done using random effects model. Meta-median difference (MMD) and 95% confidence interval (CI) was calculated for each laboratory parameter. Forty-five studies in 6 countries were included. Compared to non-severe COVID-19 cases, severe or critical COVID-19 was characterised by higher neutrophil count (MMD: 1.23 [95% CI: 0.58 to 1.88] ×109 cells/L), and lower lymphocyte, CD4 and CD8 T cell counts with MMD (95% CI) of -0.39 (-0.47, -0.31) ×109 cells/L, -204.9 (-302.6, -107.1) cells/μl and -123.6 (-170.6, -76.6) cells/μl, respectively. Other notable results were observed for C-reactive protein (MMD: 36.97 [95% CI: 27.58, 46.35] mg/L), interleukin-6 (MMD: 17.37 [95% CI: 4.74, 30.00] pg/ml), Troponin I (MMD: 0.01 [0.00, 0.02] ng/ml), and D-dimer (MMD: 0.65 [0.45, 0.85] mg/ml). CONCLUSIONS Relative to non-severe COVID-19, severe or critical COVID-19 is characterised by increased markers of innate immune response, decreased markers of adaptive immune response, and increased markers of tissue damage and major organ failure. These markers could be used to recognise severe or critical disease and to monitor clinical course of COVID-19.
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Affiliation(s)
- Jude Moutchia
- Bamenda Regional Hospital, Bamenda, Cameroon
- EHESP–French School of Public Health, Paris, France
| | - Pratik Pokharel
- EHESP–French School of Public Health, Paris, France
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Aldiona Kerri
- EHESP–French School of Public Health, Paris, France
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Kaodi McGaw
- EHESP–French School of Public Health, Paris, France
- University of Cambridge, Cambridge, United Kingdom
| | - Shreeshti Uchai
- EHESP–French School of Public Health, Paris, France
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Miriam Nji
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States of America
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, United States of America
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182
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Pongpirul WA, Wiboonchutikul S, Charoenpong L, Panitantum N, Vachiraphan A, Uttayamakul S, Pongpirul K, Manosuthi W, Prasithsirikul W. Clinical course and potential predictive factors for pneumonia of adult patients with Coronavirus Disease 2019 (COVID-19): A retrospective observational analysis of 193 confirmed cases in Thailand. PLoS Negl Trop Dis 2020; 14:e0008806. [PMID: 33064734 PMCID: PMC7592908 DOI: 10.1371/journal.pntd.0008806] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/28/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical spectrum of Coronavirus Disease 2019 (COVID-19) remains unclear, especially with regard to the presence of pneumonia. We aimed to describe the clinical course and final outcomes of adult patients with laboratory-confirmed COVID-19 in the full spectrum of disease severity. We also aimed to identify potential predictive factors for COVID-19 pneumonia. We conducted a retrospective study among adult patients with laboratory-confirmed COVID-19 who were hospitalized at Bamrasnaradura Infectious Diseases Institute, Thailand, between January 8 and April 16, 2020. One-hundred-and-ninety-three patients were included. The median (IQR) age was 37.0 (29.0-53.0) years, and 58.5% were male. The median (IQR) incubation period was 5.5 (3.0-8.0) days. More than half (56%) of the patients were mild disease severity, 22% were moderate, 14% were severe, and 3% were critical. Asymptomatic infection was found in 5%. The final clinical outcomes in 189 (97.9%) were recovered and 4 (2.1%) were deceased. The incidence of pneumonia was 39%. The median (IQR) time from onset of illness to pneumonia detection was 7.0 (5.0-9.0) days. Bilateral pneumonia was more prevalent than unilateral pneumonia. In multivariable logistic regression, increasing age (OR 2.55 per 10-year increase from 30 years old; 95% CI, 1.67-3.90; p<0.001), obesity (OR 8.74; 95%CI, 2.06-37.18; p = 0.003), and higher temperature at presentation (OR 4.59 per 1°C increase from 37.2°C; 95% CI, 2.30-9.17; p<0.001) were potential predictive factors for COVID-19 pneumonia. Across the spectrum of disease severities, most patients with COVID-19 in our cohort had good final clinical outcomes. COVID-19 pneumonia was found in one-third of them. Older age, obesity, and higher fever at presentation were independent predictors of COVID-19 pneumonia.
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Affiliation(s)
- Wannarat A. Pongpirul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Surasak Wiboonchutikul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Lantharita Charoenpong
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Nayot Panitantum
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Apichart Vachiraphan
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Sumonmal Uttayamakul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Wisit Prasithsirikul
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
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183
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Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, Thursz M, Manousou P, Corbett R, Goldin R, Al-Sarraj S, Abdolrasouli A, Swann OC, Baillon L, Penn R, Barclay WS, Viola P, Osborn M. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. THE LANCET. MICROBE 2020. [PMID: 32844161 DOI: 10.1016/s2666-5247(2030115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Severe COVID-19 has a high mortality rate. Comprehensive pathological descriptions of COVID-19 are scarce and limited in scope. We aimed to describe the histopathological findings and viral tropism in patients who died of severe COVID-19. METHODS In this case series, patients were considered eligible if they were older than 18 years, with premortem diagnosis of severe acute respiratory syndrome coronavirus 2 infection and COVID-19 listed clinically as the direct cause of death. Between March 1 and April 30, 2020, full post-mortem examinations were done on nine patients with confirmed COVID-19, including sampling of all major organs. A limited autopsy was done on one additional patient. Histochemical and immunohistochemical analyses were done, and histopathological findings were reported by subspecialist pathologists. Viral quantitative RT-PCR analysis was done on tissue samples from a subset of patients. FINDINGS The median age at death of our cohort of ten patients was 73 years (IQR 52-79). Thrombotic features were observed in at least one major organ in all full autopsies, predominantly in the lung (eight [89%] of nine patients), heart (five [56%]), and kidney (four [44%]). Diffuse alveolar damage was the most consistent lung finding (all ten patients); however, organisation was noted in patients with a longer clinical course. We documented lymphocyte depletion (particularly CD8-positive T cells) in haematological organs and haemophagocytosis. Evidence of acute tubular injury was noted in all nine patients examined. Major unexpected findings were acute pancreatitis (two [22%] of nine patients), adrenal micro-infarction (three [33%]), pericarditis (two [22%]), disseminated mucormycosis (one [10%] of ten patients), aortic dissection (one [11%] of nine patients), and marantic endocarditis (one [11%]). Viral genomes were detected outside of the respiratory tract in four of five patients. The presence of subgenomic viral RNA transcripts provided evidence of active viral replication outside the respiratory tract in three of five patients. INTERPRETATION Our series supports clinical data showing that the four dominant interrelated pathological processes in severe COVID-19 are diffuse alveolar damage, thrombosis, haemophagocytosis, and immune cell depletion. Additionally, we report here several novel autopsy findings including pancreatitis, pericarditis, adrenal micro-infarction, secondary disseminated mucormycosis, and brain microglial activation, which require additional investigation to understand their role in COVID-19. FUNDING Imperial Biomedical Research Centre, Wellcome Trust, Biotechnology and Biological Sciences Research Council.
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Affiliation(s)
- Brian Hanley
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
- Centre for Haematology, Faculty of Medicine, Imperial College London, London, UK
| | - Kikkeri N Naresh
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
- Centre for Haematology, Faculty of Medicine, Imperial College London, London, UK
| | - Candice Roufosse
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
- Centre for Inflammatory Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College London, London, UK
| | - Justin Weir
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - Graham S Cooke
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Mark Thursz
- Department of Metabolism, Faculty of Medicine, Imperial College London, London, UK
| | - Pinelopi Manousou
- Department of Hepatology, Imperial College London NHS Trust, London, UK
| | - Richard Corbett
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS, London, UK
| | - Robert Goldin
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - Safa Al-Sarraj
- Department of Neuropathology, Kings College Hospital, London, UK
| | - Alireza Abdolrasouli
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Olivia C Swann
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Laury Baillon
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Rebecca Penn
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Wendy S Barclay
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Patrizia Viola
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - Michael Osborn
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
- Death Investigation Committee, Royal College of Pathologists, London, UK
- Nightingale NHS Hospital, London, UK
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184
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Földi M, Farkas N, Kiss S, Zádori N, Váncsa S, Szakó L, Dembrovszky F, Solymár M, Bartalis E, Szakács Z, Hartmann P, Pár G, Erőss B, Molnár Z, Hegyi P, Szentesi A. Obesity is a risk factor for developing critical condition in COVID-19 patients: A systematic review and meta-analysis. Obes Rev 2020; 21:e13095. [PMID: 32686331 PMCID: PMC7404429 DOI: 10.1111/obr.13095] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/14/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
Abstract
The disease course of COVID-19 varies from asymptomatic infection to critical condition leading to mortality. Identification of prognostic factors is important for prevention and early treatment. We aimed to examine whether obesity is a risk factor for the critical condition in COVID-19 patients by performing a meta-analysis. The review protocol was registered onto PROSPERO (CRD42020185980). A systematic search was performed in five scientific databases between 1 January and 11 May 2020. After selection, 24 retrospective cohort studies were included in the qualitative and quantitative analyses. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) in meta-analysis. Obesity was a significant risk factor for intensive care unit (ICU) admission in a homogenous dataset (OR = 1.21, CI: 1.002-1.46; I2 = 0.0%) as well as for invasive mechanical ventilation (IMV) (OR = 2.05, CI: 1.16-3.64; I2 = 34.86%) in COVID-19. Comparing body mass index (BMI) classes with each other, we found that a higher BMI always carries a higher risk. Obesity may serve as a clinical predictor for adverse outcomes; therefore, the inclusion of BMI in prognostic scores and improvement of guidelines for the intensive care of patients with elevated BMI are highly recommended.
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Affiliation(s)
- Mária Földi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Szilárd Váncsa
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Margit Solymár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Eszter Bartalis
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Faculty of Medicine, University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Szeged, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,Department of Anesthesiology and Intensive Therapy, Poznan University for Medical Sciences, Poznan, Poland
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary.,First Department of Medicine, University of Szeged, Szeged, Hungary
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185
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SARS-COV2 infection in 30 HIV-infected patients followed-up in a French University Hospital. Int J Infect Dis 2020; 101:49-51. [PMID: 32987182 PMCID: PMC7518976 DOI: 10.1016/j.ijid.2020.09.1436] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION An acute respiratory disease caused by a novel coronavirus (SARSCOV2) is spreading from China since January 2020. Surprisingly, few cases of Covid-19 have been reported in people living with HIV (PLWHIV). METHODS Here we present a series of 30 PLWHIV diagnosed for SARS-COV2 infection. The principal outcome was to describe clinical characteristics of this population. RESULTS Eighteen (60%) patients were men, 10/30 (33,3%) women and 2/30 (6,7%) transgender women. Median age was 53,7 years (range 30-80 years) and 23/30 patients (76,7%) were born in a foreign country (out of France). The most common comorbidities were cardiovascular disease (11/30, 36,7%), hypertension (11/30, 36,7%), diabetes (9/30,30%) obesity (7/30, 23%) and chronic renal disease (5/30, 16,7%). Twenty (66,7%) patients presented overweight. Five patients (16,7%) had a Charlson comorbidity (Quan et al., 2011) score ≥3. Twenty-seven (90%) patients were virologically suppressed.CD4 count was >500cell/mm 3 in 23/30 (76,6%) patients. An antiviral treatment for SARS-COV2 was administered, in addition to HIV treatment, in 5/30 patients (16,3%). Twenty-four patients (80%) recovered from covid-19, 3/30 (10%) required invasive mechanical ventilation, 2/30 (6,7%) patients died and 4/30 (13,3%) patients were still hospitalized. CONCLUSIONS Most of the patients were virologically suppressed with CD4>500 mm3. Risk factors were the same as those described in other SARS-COV2 series, suggesting that HIV infection is probably not an independent risk factor for covid-19.
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186
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Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: A systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 32995828 DOI: 10.1101/2020.09.22.20199802] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Smoking impairs lung immune functions and damages upper airways, increasing risks of contracting and severity of infectious diseases. METHODS We searched PubMed and Embase for studies published from January 1-May 25, 2020. We included studies reporting smoking behavior of COVID-19 patients and progression of disease, including death. We used a random effects meta-analysis and used meta-regression and lowess regressions to examine relationships in the data. RESULTS We identified 47 peer-reviewed papers with a total of 31,871 COVID-19 patients, 5,759 (18.1%) experienced disease progression and 5,734 (18.0%) with a history of smoking. Among smokers, 29.2% experienced disease progression, compared with 21.1% of non-smokers. The meta-analysis confirmed an association between smoking and COVID-19 progression (OR 1.56, 95% CI 1.32-1.83, p=0.001). Smoking was associated with increased risk of death from COVID-19 (OR 1.19, 95% CI 1.05-1.34, p=0.007). We found no significant difference (p=0.432) between the effects of smoking on COVID-19 disease progression between adjusted and unadjusted analyses, suggesting that smoking is an independent risk factor for COVID-19 disease progression. We also found the risk of having COVID-19 progression among younger adults (p=0.023), with the effect most pronounced among people under about 45 years old. CONCLUSIONS Smoking is an independent risk for having severe progression of COVID-19, including mortality. The effects seem to be higher among young people. Smoking prevention and cessation should remain a priority for the public, physicians, and public health professionals during the COVID-19 pandemic.
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187
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NasrAllah MM, Osman NA, Elalfy M, Malvezzi P, Rostaing L. Transplantation in the era of the Covid-19 pandemic: How should transplant patients and programs be handled? Rev Med Virol 2020; 31:1-9. [PMID: 32954602 PMCID: PMC7537021 DOI: 10.1002/rmv.2149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 01/08/2023]
Abstract
Due to the Covid‐19 pandemic caused by SARS‐CoV‐2, transplant programs worldwide have been severely impacted with dwindling numbers of transplantations performed and a complete halt in several areas. In this review we examine whether SARS‐CoV‐2 infection presents differently in transplant recipients, whom and how we should test, how susceptible the transplant population is to overt infection and describe the range of outcomes. From retrieved published reports on SARS‐CoV‐2infections in 389solid organ transplant recipients reported in the literature, the overall mortality rate was 16.7% (n = 65); however for those with mild or moderate Covid‐19 disease this was 2.9% and 2.3% respectively; conversely, for those with severe infection the mortality rate was 52.2%.We then address questions regarding halting transplantation programs during this pandemic, whether all human tissues being considered for transplantation are capable of transmitting the infection, and if we should alter immunosuppressive medications during the pandemic.
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Affiliation(s)
- Mohamed M NasrAllah
- Department of Nephrology, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Misr International Hospital, Cairo, Egypt
| | - Noha A Osman
- Department of Nephrology, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.,Misr International Hospital, Cairo, Egypt
| | - Mahmoud Elalfy
- Misr International Hospital, Cairo, Egypt.,Cairo University Student's Hospital, Cairo, Egypt
| | - Paolo Malvezzi
- Service de Néphrologie, Hémodialyse, Aphérèseset Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France
| | - Lionel Rostaing
- Service de Néphrologie, Hémodialyse, Aphérèseset Transplantation Rénale, CHU Grenoble-Alpes, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
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188
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Jin C, Tian C, Wang Y, Wu CC, Zhao H, Liang T, Liu Z, Jian Z, Li R, Wang Z, Li F, Zhou J, Cai S, Liu Y, Li H, Li Z, Liang Y, Zhou H, Wang X, Ren Z, Yang J. A Pattern Categorization of CT Findings to Predict Outcome of COVID-19 Pneumonia. Front Public Health 2020; 8:567672. [PMID: 33072703 PMCID: PMC7531052 DOI: 10.3389/fpubh.2020.567672] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background: As global healthcare system is overwhelmed by novel coronavirus disease (COVID-19), early identification of risks of adverse outcomes becomes the key to optimize management and improve survival. This study aimed to provide a CT-based pattern categorization to predict outcome of COVID-19 pneumonia. Methods: One hundred and sixty-five patients with COVID-19 (91 men, 4–89 years) underwent chest CT were retrospectively enrolled. CT findings were categorized as Pattern 0 (negative), Pattern 1 (bronchopneumonia pattern), Pattern 2 (organizing pneumonia pattern), Pattern 3 (progressive organizing pneumonia pattern), and Pattern 4 (diffuse alveolar damage pattern). Clinical findings were compared across different categories. Time-dependent progression of CT patterns and correlations with clinical outcomes, i.e.„ discharge or adverse outcome (admission to ICU, requiring mechanical ventilation, or death), with pulmonary sequelae (complete absorption or residuals) on CT after discharge were analyzed. Results: Of 94 patients with outcome, 81 (86.2%) were discharged, 3 (3.2%) were admitted to ICU, 4 (4.3%) required mechanical ventilation, 6 (6.4%) died. 31 (38.3%) had complete absorption at median day 37 after symptom onset. Significant differences between pattern-categories were found in age, disease severity, comorbidity and laboratory results (all P < 0.05). Remarkable evolution was observed in Pattern 0–2 and Pattern 3–4 within 3 and 2 weeks after symptom-onset, respectively; most of patterns remained thereafter. After controlling for age, CT pattern significantly correlated with adverse outcomes [Pattern 4 vs. Pattern 0–3 [reference]; hazard-ratio [95% CI], 18.90 [1.91–186.60], P = 0.012]. CT pattern [Pattern 3–4 vs. Pattern 0–2 [reference]; 0.26 [0.08–0.88], P = 0.030] and C-reactive protein [>10 vs. ≤ 10 mg/L [reference]; 0.31 [0.13–0.72], P = 0.006] were risk factors associated with pulmonary residuals. Conclusion: CT pattern categorization allied with clinical characteristics within 2 weeks after symptom onset would facilitate early prognostic stratification in COVID-19 pneumonia.
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Affiliation(s)
- Chao Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Cong Tian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yan Wang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Carol C Wu
- Department of Thoracic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Huifang Zhao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ting Liang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhe Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhijie Jian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Runqing Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zekun Wang
- Department of Radiology, The Eighth Hospital of Xi'an, Xi'an, China
| | - Fen Li
- Department of Radiology, The Eighth Hospital of Xi'an, Xi'an, China
| | - Jie Zhou
- Department of Radiology, Xi'an Chest Hospital, Xi'an, China
| | - Shubo Cai
- Department of Radiology, Xi'an Chest Hospital, Xi'an, China
| | - Yang Liu
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hao Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhongyi Li
- Department of Critical Care Medicine, Wuhan No.9 Hospital, Wuhan, China
| | - Yukun Liang
- Department of Radiology, Ankang Center Hospital, Ankang, China
| | - Heping Zhou
- Department of Radiology, Ankang Center Hospital, Ankang, China
| | - Xibin Wang
- Department of Radiology, Hanzhong Center Hospital, Hanzhong, China
| | - Zhuanqin Ren
- Department of Radiology, Baoji Center Hospital, Baoji, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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189
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Pranata R, Supriyadi R, Huang I, Permana H, Lim MA, Yonas E, Soetedjo NNM, Lukito AA. The Association Between Chronic Kidney Disease and New Onset Renal Replacement Therapy on the Outcome of COVID-19 Patients: A Meta-analysis. Clin Med Insights Circ Respir Pulm Med 2020; 14:1179548420959165. [PMID: 32994700 PMCID: PMC7502996 DOI: 10.1177/1179548420959165] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of the study was to evaluate the association between chronic kidney disease (CKD) and new onset renal replacement therapy (RRT) with the outcome of Coronavirus Disease 2019 (COVID-19) in patients. METHODOLOGY A systematic literature search from several databases was performed on studies that assessed CKD, use of RRT, and the outcome of COVID-19. The composite of poor outcome consisted of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care, and use of mechanical ventilator. RESULTS Nineteen studies with a total of 7216 patients were included. CKD was associated with increased composite poor outcome (RR 2.63 [1.33, 5.17], P = .03; I 2 = 51%, P = .01) and its subgroup, consisting of mortality (RR 3.47 [1.36, 8.86], P = .009; I 2 = 14%, P = .32) and severe COVID-19 (RR 2.89 [0.98, 8.46], P = .05; I 2 = 57%, P = .04). RRT was associated with increased composite poor outcome (RR 18.04 [4.44, 73.25], P < .001; I 2 = 87%, P < .001), including mortality (RR 26.02 [5.01, 135.13], P < .001; I 2 = 60%, P = .06), severe COVID-19 (RR 12.95 [1.93, 86.82], P = .008; I 2 = 81%, P < .001), intensive care (IC) (RR 14.22 [1.76, 114.62], P < .01; I 2 = 0%, P < .98), and use of mechanical ventilator (RR 34.39 [4.63, 255.51], P < .0005). CONCLUSION CKD and new-onset RRT were associated with poor outcome in patients with COVID-19.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Rudi Supriyadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Hikmat Permana
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of
Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | | | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Nanny Natalia M Soetedjo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of
Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Antonia Anna Lukito
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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190
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Hanif M, Haider MA, Xi Q, Ali MJ, Ahmed MU. A Review of the Risk Factors Associated With Poor Outcomes in Patients With Coronavirus Disease 2019. Cureus 2020; 12:e10350. [PMID: 33062473 PMCID: PMC7549844 DOI: 10.7759/cureus.10350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) and its rapid spread throughout the globe is of much concern. With little known about the peculiar virus and the changing mortality and morbidity, we attempt to review the risk factors associated with significant outcome. We conducted a review of the information available in medical journals published on COVID-19 risk factors associated with poor outcomes using PubMed®, Google Scholar, and material published online. The risk factors associated with poor outcome were kept in particular consideration. A total of 96 articles were thoroughly reviewed and analyzed so as to highlight the risk factors and the subsequent disease presentation that were present in patients with COVID-19. With little data available in this regard, emphasis and consideration of risk factors might help health care workers preclude the worst outcome. From the aforementioned search we can conclude that the most prevalent risk factors were reported to be hypertension followed by diabetes. In terms of mortality, age greater than 65 was the most significant risk factor. Among non-survivors, coagulation profile including d-dimers, prothrombin time, and inflammatory markers like erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum ferritin levels were very deranged. Much emphasis and consideration in relation to risk factors must be deliberated by health care workers so as to prevent severe outcomes and mitigate appropriate treatment modalities.
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Affiliation(s)
- Muhammad Hanif
- Medicine, Khyber Medical College Peshawar, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Qianlan Xi
- Internal Medicine, West China Hospital, Sichuan University, Chengdu, CHN
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191
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Smoking and COVID-19: Adding Fuel to the Flame. Int J Mol Sci 2020; 21:ijms21186581. [PMID: 32916821 PMCID: PMC7555793 DOI: 10.3390/ijms21186581] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 09/07/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, an infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV-2), has led to more than 771,000 deaths worldwide. Tobacco smoking is a major known risk factor for severe illness and even death from many respiratory infections. The effects of smoking on COVID-19 are currently controversial. Here, we provide an overview of the current knowledge on the effects of smoking on the clinical manifestations, disease progression, inflammatory responses, immunopathogenesis, racial ethnic disparities, and incidence of COVID-19. This review also documents future directions of smoking related research in COVID-19. The current epidemiological finding suggests that active smoking is associated with an increased severity of disease and death in hospitalized COVID-19 patients. Smoking can upregulate the angiotensin-converting enzyme-2 (ACE-2) receptor utilized by SARS-CoV-2 to enter the host cell and activate a ‘cytokine storm’ which can lead to worsen outcomes in COVID-19 patients. This receptor can also act as a potential therapeutic target for COVID-19 and other infectious diseases. The COVID-19 pandemic sheds light on a legacy of inequalities regarding gender, racial, and ethnic health disparities associated with active smoking, thus, smoking cessation may help in improving outcomes. In addition, to flatten the COVID-19 curve, staying indoors, avoiding unnecessary social contact, and bolstering the immune defense system by maintaining a healthy diet/living are highly desirable.
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192
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Joseph A, Zafrani L, Mabrouki A, Azoulay E, Darmon M. Acute kidney injury in patients with SARS-CoV-2 infection. Ann Intensive Care 2020; 10:117. [PMID: 32880774 PMCID: PMC7471244 DOI: 10.1186/s13613-020-00734-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Acute Kidney Injury (AKI) is a frequent complication of severe SARS-CoV-2 infection. Multiple mechanisms are involved in COVID-19-associated AKI, from direct viral infection and secondary inflammation to complement activation and microthrombosis. However, data are limited in critically-ill patients. In this study, we sought to describe the prevalence, risk factors and prognostic impact of AKI in this setting. METHODS Retrospective monocenter study including adult patients with laboratory confirmed SARS-CoV-2 infection admitted to the ICU of our university Hospital. AKI was defined according to both urinary output and creatinine KDIGO criteria. RESULTS Overall, 100 COVID-19 patients were admitted. AKI occurred in 81 patients (81%), including 44, 10 and 27 patients with AKI stage 1, 2 and 3 respectively. The severity of AKI was associated with mortality at day 28 (p = 0.013). Before adjustment, the third fraction of complement (C3), interleukin-6 (IL-6) and ferritin levels were higher in AKI patients. After adjustment for confounders, both severity (modified SOFA score per point) and AKI were associated with outcome. When forced in the final model, C3 (OR per log 0.25; 95% CI 0.01-4.66), IL-6 (OR per log 0.83; 95% CI 0.51-1.34), or ferritin (OR per log 1.63; 95% CI 0.84-3.32) were not associated with AKI and did not change the model. CONCLUSION In conclusion, we did not find any association between complement activation or inflammatory markers and AKI. Proportion of patients with AKI during severe SARS-CoV-2 infection is higher than previously reported and associated with outcome.
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Affiliation(s)
- Adrien Joseph
- Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Lara Zafrani
- Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France.
- INSERM U976, Université de Paris, Paris, France.
| | - Asma Mabrouki
- Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
- ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Université de Paris, Paris, France
| | - Michael Darmon
- Service de médecine Intensive et de réanimation médicale, Hôpital Saint-Louis, Assistance-Publique Hôpitaux de Paris, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France
- ECSTRA Team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Université de Paris, Paris, France
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193
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Leeds JS, Raviprakash V, Jacques T, Scanlon N, Cundall J, Leeds CM. Risk factors for detection of SARS-CoV-2 in healthcare workers during April 2020 in a UK hospital testing programme. EClinicalMedicine 2020; 26:100513. [PMID: 32838245 PMCID: PMC7431176 DOI: 10.1016/j.eclinm.2020.100513] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Healthcare workers (HCW) are a crucial part of the workforce but are also at potentially at increased risk of infection from SARS-CoV-2. Emerging evidence has suggested specific groups of HCW are at further increased risk particularly those from Black, Asian and Minority Ethnic (BAME) groups. Previous reports have not examined risk factors associated with contracting the virus and were reported prior to the pandemic peak in the UK. Methods: Staff testing in our facility commenced on the 1st April and all individuals were entered into a database. Repeat testing was used for the first 3 weeks for those initially testing negative. Demographics including age, sex, occupation and ethnicity were recorded. Occupation was divided into acute frontline (e.g. ITU), frontline, clinical support staff and non-clinical staff. Final testing status was analysed using univariate and multivariable analysis to determine independent associations with age, sex, occupation and ethnicity. Findings: 991 individuals (mean age 42.6 years, 145 males) were tested over a 4 week period and overall 440/991 (43.4%) tested positive for SARS-CoV-2. SARS-CoV-2 RNA detection rates were significantly higher in the first week of testing (59.0%) compared to week 2 (odds ratio 0.59), week 3 (odds ratio 0.32) and week 4 (odds ratio 0.23)(all p<0.001). Multivariable analysis showed no increased risk SARS-CoV-2 RNA detection with age (odds ratio 1.01, 95% confidence interval 0.99 - 1.03, p = 0.22), male sex (OR 1.03, 95% CI 0.59 - 1.79, p = 0.92), acute frontline work (OR 0.79, 95% CI 0.53 - 1.17, p = 0.23) or BAME status (OR 1.08, 95% CI 0.56 - 2.07, p = 0.84). Interpretation: A robust healthcare worker testing strategy is a crucial component of managing the workforce during the SARS-CoV-2 pandemic. No specific variables were identified that altered the risk of SARS-CoV-2 RNA detection including age, sex, occupation and ethnicity.
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Affiliation(s)
- John S Leeds
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | - Veena Raviprakash
- Department of Microbiology, County Durham and Darlington NHS Foundation Trust, United Kingdom
| | - Thomas Jacques
- Department of Infection Prevention & Control, County Durham and Darlington NHS Foundation Trust, United Kingdom
| | - Noel Scanlon
- Executive Director of Nursing, County Durham and Darlington NHS Foundation Trust, United Kingdom
| | - Jeremy Cundall
- Medical Director, County Durham and Darlington NHS Foundation Trust, United Kingdom
| | - Clare M Leeds
- Department of Occupational Health and Wellbeing, Bishop Auckland Hospital, County Durham and Darlington NHS Foundation Trust, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, United Kingdom
- Corresponding author.
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194
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Abstract
Coronavirus disease 2019 (COVID-19) is spreading rapidly worldwide. Here, we review recently published studies on COVID-19-associated acute kidney injury (AKI) in China. The pooled incidence of AKI in all reported COVID-19 patients was 6.5%, with a much higher rate in patients from the intensive care unit (32.5%). AKI is associated with the severity of COVID-19 and mortality rates, which is similar to other kidney abnormalities including proteinuria and hematuria. The renal tubule is the main site of injury in COVID-19 patients, and the etiology of renal impairment in COVID-19 patients likely is diverse and multifactorial. Apart from direct viral attack via angiotensin-converting enzyme 2 and transmembrane serine proteases 2, hypoxia and hypercoagulability also may contribute to the occurrence of renal injury. To date, there is only randomized controlled trial evidence to support the use of dexamethasone in patients requiring oxygen therapy and remdesivir for shortening the time to recovery, with no specific treatment for COVID-19-associated AKI. Studies researching kidney pathologies or reporting renal outcome and prognosis are in urgent need. Further studies are urgently warranted to identify risk factors, to predict prognosis and renal outcome, to explore the exact mechanisms of renal injury, and to suggest targeted interventions.
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Affiliation(s)
- Xizi Zheng
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Youlu Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
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195
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Hoang T, Anh TTT. Treatment Options for Severe Acute Respiratory Syndrome, Middle East Respiratory Syndrome, and Coronavirus Disease 2019: a Review of Clinical Evidence. Infect Chemother 2020; 52:317-334. [PMID: 32869558 PMCID: PMC7533202 DOI: 10.3947/ic.2020.52.3.317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023] Open
Abstract
Coronaviruses have caused serious Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Coronavirus Disease 2019 (COVID-19) outbreaks, and only remdesivir has been recently indicated for the treatment of COVID-19. In the line of therapeutic options for SARS and MERS, this study aims to summarize the current clinical evidence of treatment options for COVID-19. In general, the combination of antibiotics, ribavirin, and corticosteroids was considered as a standard treatment for patients with SARS. The addition of this conventional treatment with lopinavir/ritonavir, interferon, and convalescent plasma showed potential clinical improvement. For patients with MERS, ribavirin, lopinavir/ritonavir, interferon, and convalescent plasma were continuously recommended. However, a high-dose of corticosteroid was suggested for severe cases only. The use of lopinavir/ritonavir and convalescent plasma was commonly reported. There was limited evidence for the effect of corticosteroids, other antiviral drugs like ribavirin, and favipiravir. Monoclonal antibody of tocilizumab and antimalarial agents of chloroquine and hydroxychloroquine were also introduced. Among antibiotics for infection therapy, azithromycin was suggested. In conclusion, this study showed the up-to-date evidence of treatment options for COVID-19 that is helpful for the therapy selection and the development of further guidelines and recommendations. Updates of on-going clinical trials and observational studies may confirm the current findings.
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Affiliation(s)
- Tung Hoang
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Tho Tran Thi Anh
- Department of Gastroenterology and Hepatology, Nghe An Oncology Hospital, Nghe An, Vietnam.
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196
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ALIMOHAMADI YOUSEF, SEPANDI MOJTABA, TAGHDIR MARYAM, HOSAMIRUDSARI HADISEH. Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E304-E312. [PMID: 33150219 PMCID: PMC7595075 DOI: 10.15167/2421-4248/jpmh2020.61.3.1530] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION COVID-19 is an emerging infectious disease. The study about features of this infection could be very helpful in better knowledge about this infectious disease. The current systematic review and meta-analysis were aimed to estimate the prevalence of clinical symptoms of COVID-19 in a systematic review and meta-analysis. METHODS A systematic review using Medline/PubMed, Scopus, and Google scholar has been conducted. In the current systematic review and meta-analysis, the articles published in the period January 1, 2020, to April 2, 2020, written in English and reporting clinical symptoms of COVID-19 was reviewed. To assess, the presence of heterogeneity, the Cochran's Q statistic, the I2 index, and the tau-squared test were used. Because of significant heterogeneity between the studies the random-effects model with 95% CI was used to calculate the pooled estimation of each symptom prevalence. RESULTS The most common symptoms in COVID-19 patients include: Fever 81.2% (95% CI: 77.9-84.4); Cough: 58.5% (95% CI: 54.2-62.8); Fatigue 38.5% (95% CI: 30.6-45.3); Dyspnea: 26.1% (95% CI: 20.4-31.8); and the Sputum: 25.8% (95% CI: 21.1-30.4). Based on the meta-regression results, the sample size used in different studies did not have a significant effect on the final estimate value (P > 0.05). CONCLUSIONS Considering the main symptoms of COVID-19 such as Fever, Cough, Fatigue, and Dyspnea can have a key role in early detection of this disease and prevent the transmission of the disease to other people.
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Affiliation(s)
- YOUSEF ALIMOHAMADI
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - MOJTABA SEPANDI
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Epidemiology & Biostatistics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - MARYAM TAGHDIR
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Nutrition & Food hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - HADISEH HOSAMIRUDSARI
- Department of Infectious Diseases, Baharloo Hospital, Railway Square, Tehran University of Medical Sciences, Tehran, Iran
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197
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Abstract
In late March 2020, we faced a nosocomial outbreak of novel coronavirus disease 2019 (COVID-19) at Keio University Hospital, Tokyo, Japan. Presently, COVID-19 is an unprecedented worldwide biohazard, and a nosocomial outbreak can occur in any hospital at any time. Therefore, we reviewed the literature regarding hospital preparedness, the initial management of COVID-19, and the surveillance of healthcare workers (HCWs) to find information that would be generally useful for physicians when confronted with COVID-19. In terms of hospital preparedness, each hospital should develop an incident management system and establish a designated multidisciplinary medical team. To initiate case management, COVID-19 should be suspected based on patient symptoms and/or high-risk history and then should be confirmed by viral testing, such as reverse transcription polymerase chain reaction (RT-PCR) analysis. Although some patients will become critically ill, the guidelines for respiratory failure and septic shock for non-COVID-19 cases can be followed for supportive treatment. Antiviral medications should be carefully selected because the available information is confused by the large volume of preprint literature and unreliable data. HCWs who have come into contact with patients with COVID-19 can generate new in-hospital clusters of COVID-19 cases. Quarantine following contact tracking with risk stratification is effective in preventing transmission, and the essentials of medical surveillance include monitoring different types of symptoms, delegation of supervision, and continuation of surveillance regardless of the RT-PCR results. Preparation for COVID-19 is recommended before the first COVID-19 case is encountered.
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198
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Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, Thursz M, Manousou P, Corbett R, Goldin R, Al-Sarraj S, Abdolrasouli A, Swann OC, Baillon L, Penn R, Barclay WS, Viola P, Osborn M. Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study. LANCET MICROBE 2020; 1:e245-e253. [PMID: 32844161 PMCID: PMC7440861 DOI: 10.1016/s2666-5247(20)30115-4] [Citation(s) in RCA: 377] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Severe COVID-19 has a high mortality rate. Comprehensive pathological descriptions of COVID-19 are scarce and limited in scope. We aimed to describe the histopathological findings and viral tropism in patients who died of severe COVID-19. Methods In this case series, patients were considered eligible if they were older than 18 years, with premortem diagnosis of severe acute respiratory syndrome coronavirus 2 infection and COVID-19 listed clinically as the direct cause of death. Between March 1 and April 30, 2020, full post-mortem examinations were done on nine patients with confirmed COVID-19, including sampling of all major organs. A limited autopsy was done on one additional patient. Histochemical and immunohistochemical analyses were done, and histopathological findings were reported by subspecialist pathologists. Viral quantitative RT-PCR analysis was done on tissue samples from a subset of patients. Findings The median age at death of our cohort of ten patients was 73 years (IQR 52–79). Thrombotic features were observed in at least one major organ in all full autopsies, predominantly in the lung (eight [89%] of nine patients), heart (five [56%]), and kidney (four [44%]). Diffuse alveolar damage was the most consistent lung finding (all ten patients); however, organisation was noted in patients with a longer clinical course. We documented lymphocyte depletion (particularly CD8-positive T cells) in haematological organs and haemophagocytosis. Evidence of acute tubular injury was noted in all nine patients examined. Major unexpected findings were acute pancreatitis (two [22%] of nine patients), adrenal micro-infarction (three [33%]), pericarditis (two [22%]), disseminated mucormycosis (one [10%] of ten patients), aortic dissection (one [11%] of nine patients), and marantic endocarditis (one [11%]). Viral genomes were detected outside of the respiratory tract in four of five patients. The presence of subgenomic viral RNA transcripts provided evidence of active viral replication outside the respiratory tract in three of five patients. Interpretation Our series supports clinical data showing that the four dominant interrelated pathological processes in severe COVID-19 are diffuse alveolar damage, thrombosis, haemophagocytosis, and immune cell depletion. Additionally, we report here several novel autopsy findings including pancreatitis, pericarditis, adrenal micro-infarction, secondary disseminated mucormycosis, and brain microglial activation, which require additional investigation to understand their role in COVID-19. Funding Imperial Biomedical Research Centre, Wellcome Trust, Biotechnology and Biological Sciences Research Council.
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Affiliation(s)
- Brian Hanley
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK.,Centre for Haematology, Faculty of Medicine, Imperial College London, London, UK
| | - Kikkeri N Naresh
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK.,Centre for Haematology, Faculty of Medicine, Imperial College London, London, UK
| | - Candice Roufosse
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK.,Centre for Inflammatory Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Institute, Imperial College London, London, UK
| | - Justin Weir
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - Graham S Cooke
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Mark Thursz
- Department of Metabolism, Faculty of Medicine, Imperial College London, London, UK
| | - Pinelopi Manousou
- Department of Hepatology, Imperial College London NHS Trust, London, UK
| | - Richard Corbett
- Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS, London, UK
| | - Robert Goldin
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - Safa Al-Sarraj
- Department of Neuropathology, Kings College Hospital, London, UK
| | - Alireza Abdolrasouli
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Olivia C Swann
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Laury Baillon
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Rebecca Penn
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Wendy S Barclay
- Department of Immunology and Inflammation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Patrizia Viola
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK
| | - Michael Osborn
- Department of Cellular Pathology, Northwest London Pathology, Imperial College London NHS Trust, London, UK.,Death Investigation Committee, Royal College of Pathologists, London, UK.,Nightingale NHS Hospital, London, UK
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199
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Zhang S, Xu Y, Wu K, Wang T, Su X, Han Q, Xi Y, Zhu S, Gao Y, Wang H, Hu Y, Liu C, Zhong N, Ran P, Zhang N. Improved night shift schedule related to the mortality of critically ill patients with Corona Virus Disease 2019. Sleep Med 2020; 75:354-360. [PMID: 32950880 PMCID: PMC7429562 DOI: 10.1016/j.sleep.2020.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022]
Abstract
Purpose To determine the relationship between the improved night shift schedule and the mortality of critically ill patients with Corona Virus Disease 2019 (COVID-19). Methods According to the time of the implementation of the new night shift schedule, we divided all patients into two groups: initial period group and recent period group. The clinical electronic medical records, nursing records, laboratory findings, and radiological examinations for all patients with laboratory confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection were reviewed. Cox proportional hazard ratio (HR) models were used to determine the risk factors associated with in hospital death. Results A total of 75 patients were included in this study. Initial period group includes 45 patients and recent period group includes 30 patients. The difference in mortality between the two groups was significant, 77.8% and 36.7%, respectively. Leukocytosis at admission and admitted to hospital before the new night shift schedule were associated with increased odds of death. Conclusions Shift arrangement of medical staff are associated with the mortality of critically ill patients with COVID-19. The new night shift schedule might improve the continuity of treatment, thereby improving the overall quality of medical work and reducing the mortality of critically ill patients. This is the first study to explore the relationship between night shift schedule and mortality of patients with COVID-19. The improved night shift schedule could significantly affect the adverse outcomes of critically ill patients with COVID-19. A scientific and reasonable night shift schedule will greatly improve the quality of clinical work.
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Affiliation(s)
- Sun Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuanda Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kang Wu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tao Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaofen Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qian Han
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yin Xi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shitao Zhu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong Gao
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hongbo Wang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Hu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chunli Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nuofu Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Pranata R, Huang I, Raharjo SB. Incidence and impact of cardiac arrhythmias in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Indian Pacing Electrophysiol J 2020; 20:193-198. [PMID: 32814094 PMCID: PMC7428753 DOI: 10.1016/j.ipej.2020.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/17/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have shown that cardiac arrhythmias may occur in up to 44% of patients with severe coronavirus disease 2019 (COVID-19) and has been associated with an increased risk of death. This systematic review and meta-analysis aimed to evaluate the incidence of cardiac arrhythmias in patients with COVID-19 and their implications on patient prognosis. METHODS We performed a systematic literature search from PubMed, SCOPUS, Europe PMC, Cochrane Central Databases, and Google Scholar + Preprint Servers. The primary endpoint of the study was poor outcomes including mortality, severe COVID-19, and the need for ICU care. RESULTS A total of 4 studies including 784 patients were analyzed. The incidence of arrhythmia in patients with COVID-19 was 19% (9-28%; I2: 91.45). Arrhythmia occurred in 48% (38-57%; I2: 48.08) of patients with poor outcome and 6% (1-12%; I2: 85.33%) of patients without poor outcome. Patients with COVID-19 experiencing arrhythmia had an increased risk of poor outcome (RR 7.96 [3.77, 16.81], p < 0.001; I2: 71.1%). The funnel-plot analysis showed an asymmetrical funnel plot with most of the studies on the right side of the effect estimate. The regression-based Egger's test showed indication of small-study effects (p = 0.001). CONCLUSION Cardiac arrhythmias were significantly associated with an increased risk of poor outcome in COVID-19. Arrhythmias were observed in 19% of patients with COVID-19 and in 48% of patients with COVID-19 and poor outcomes.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | - Ian Huang
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
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