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Sanhueza ME, San Martín P, Brantes L, Caro S, Carrasco G, Machuca E. Efficacy of vaccination against the SARS-CoV-2 virus in patients with chronic kidney disease on hemodialysis. Hum Vaccin Immunother 2023; 19:2173904. [PMID: 36785953 PMCID: PMC10012891 DOI: 10.1080/21645515.2023.2173904] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
SARS-CoV-2 has had a great impact on world health, patients on hemodialysis have a higher rate of infection and death due to COVID-19. Vaccination is important to control infection and improve the prognosis of infected patients. To describe the efficacy of vaccination against SARS-CoV-2 in Chilean patients on hemodialysis during the year 2021. Retrospective observational study. A total of 9,712 clinical records were reviewed. Data were presented as summary measures. Fisher's exact test, Mann-Whitney U test, and multivariate logistic regression were used for the analysis. Risk and survival analysis were calculated, considering a statistical significance of less than 0.05. The average age of the patients attended was 61.5 ± 14.6 years. Average time on dialysis 67.6 months and 35.0% diabetic. 93.2% of patients were vaccinated against SARS-CoV-2, 70.7% of them received booster doses. The risk of infection was higher for those who received one or no dose, compared to those who received booster doses against SARS-CoV-2: OR = 252.46 [165.13; 401.57]. Of the infected patients, 15.7% died from COVID-19. The risk of death was higher in unvaccinated or single-dose patients compared to those vaccinated with two doses: OR = 2.64 [2.23; 3.12]. Patients with two doses and a booster had a longer survival compared to those who received one or no dose of vaccination against SARS-CoV-2 (p < .05). The vaccination in Chile, which started in February 2021, has demonstrated that booster doses against SARS-CoV-2 significantly reduced the risk of infection, hospitalization, and death due to COVID-19 in patients on hemodialysis.
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Affiliation(s)
- María E Sanhueza
- National Medical Directorate, NephroCare-Chile,Santiago, Chile.,Nephrology DepartmentClinical Hospital, University of Chile, Santiago, Chile
| | | | - Loreto Brantes
- National Medical Directorate, NephroCare-Chile,Santiago, Chile
| | - Sylvia Caro
- National Medical Directorate, NephroCare-Chile,Santiago, Chile
| | | | - Eduardo Machuca
- National Medical Directorate, NephroCare-Chile,Santiago, Chile
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202
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Feng Y, Yang L, Cheng Z, Li J. Derivation and external validation of a nomogram predicting the occurrence of severe illness among hospitalized coronavirus disease 2019 patients: a 2020 Chinese multicenter retrospective study. J Thorac Dis 2023; 15:6589-6603. [PMID: 38249879 PMCID: PMC10797405 DOI: 10.21037/jtd-23-653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/03/2023] [Indexed: 01/23/2024]
Abstract
Background The worldwide pandemic of coronavirus disease 2019 (COVID-19) has still been an overwhelming public health challenge, and it is vital to identify determinants early to forecast the risk of severity using indicators easily available at admission. The current multicenter retrospective study aimed to derive and validate a user-friendly and effective nomogram to address this issue. Methods A training cohort consisting of 437 confirmed COVID-19 cases from three hospitals in Hubei province (Tongji Hospital affiliated with Huazhong University of Science and Technology, Wuhan Third Hospital of Wuhan University and Wuhan Jinyintan Hospital in Hubei province) was retrospectively analyzed to construct a predicting model, and another cohort of 161 hospitalized patients from Public Health Clinical Center of Shanghai was selected as an external validation cohort from January 1, 2020 to March 8, 2020. Determinants of developing into severe COVID-19 were probed using univariate regression together with a multivariate stepwise regression model. The risk of progression to severe COVID-19 was forecasted using the derived nomogram. The performances of the nomogram regarding the discrimination and calibration were assessed in the cohort of training as well as the cohort of external validation, respectively. Results A total of 144 (32.95%) and 54 (33.54%) patients, respectively, in cohorts of training and validation progressed to severe COVID-19 during hospitalization. Multivariable analyses showed determinants of severity consisted of hypertension, shortness of breath, platelet count, alanine aminotransferase (ALT), potassium, cardiac troponin I (cTnI), myohemoglobin, procalcitonin (PCT) and intervals from onset to diagnosis. The nomogram had good discrimination with concordance indices being 0.887 (95% CI: 0.854-0.919) and 0.850 (95% CI: 0.815-0.885) in internal and external validation, respectively. Calibration curves exhibited excellent concordance between the predictions by nomogram and actual observations in two cohorts. Conclusions We have established and validated an early predicting nomogram model, which can contribute to determine COVID-19 cases at risk of progression to severe illness.
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Affiliation(s)
- Yun Feng
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luyu Yang
- Department of ICU/Emergency, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, China
| | - Zenghui Cheng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Li
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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203
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Liu J, Yuan X, Yang Q, Bi X, Li X, Bian H, Sun K, Zhang X, Yang Y. Therapeutic effects of multidisciplinary individualized treatment for COVID-19 patients: the experience of a supporting medical team in Wuhan. J Thorac Dis 2023; 15:6813-6820. [PMID: 38249885 PMCID: PMC10797397 DOI: 10.21037/jtd-23-1428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
Background The sudden outbreak of coronavirus disease 2019 (COVID-19) has brought people around the world into an abyss of suffering. At that time, there were no clear and effective means for the treatment of the virus. We prepared a medical team consisted of specialists in critical care, respiratory diseases, infections, gastroenterology, endocrinology, cardiology, cerebrovascular diseases, nephrology, rehabilitation, psychology, and nutrition. This study shared our multidisciplinary treatment experience in treating patients with COVID-19. Methods Patients with positive SARS-CoV-2 swab test were divided into three groups: ordinary cases, severe cases and critical cases. Every patient received the multi-disciplinary comprehensive and individualized tailored treatment based on the specific situation of each patient. Patients' medical records, epidemiological, clinical, laboratory, radiological characteristics, Borg dyspnea score, Barthel index, self-rating anxiety scale (SAS) as well as treatment and outcome data were analyzed. Results The mean age of the 90 patients was 61.88±15.25 years. Some patients without underlying disease had developed comorbidities such as hyperglycemia (24, 26.67%) and hypertension (9, 10%). With multidisciplinary individualized treatment, the patients' albumin level and Barthel index score increased significantly, while glucose level, blood pressure, and Nutrition Risk Screening 2002 (NRS-2002), Borg scale, and SAS values significantly decreased at discharge. The in-hospital mortality rate was 4.44%. However, there was still a gap in Nutrition Risk Screening, Borg dyspnea score and Barthel index between the critical cases and the ordinary and severe cases at discharge. We observed that the patients with more severe disease had significantly higher age, rates of hypertension, and mortality. The median hospitalization time of discharged patients was 19 days [interquartile range (IQR), 9.0-20.0 days]. Conclusions Multidisciplinary collaboration and individualized treatment could effectively improve the general status of patients with different severity of COVID-19.
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Affiliation(s)
- Jianrong Liu
- Surgical and Transplant Intensive Care Unit, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Yuan
- Department of General ICU, the Third Affiliated Hospital of Sun Yat-sen University Lingnan Hospital, Guangzhou, China
| | - Qing Yang
- Department of Hepatic Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Research Center of Guangdong Province, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaogang Bi
- Department of General ICU, the Third Affiliated Hospital of Sun Yat-sen University Lingnan Hospital, Guangzhou, China
| | - Xinhua Li
- Department of Liver Disease & Infection Diseases, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huawei Bian
- Department of Clinical Nutriology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ke Sun
- Department of Obstetrics, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xianling Zhang
- Nursing Department, Lingnan Hospital of the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Organ Transplantation Research Center of Guangdong Province, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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204
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DOGAN C, BILICI D, ARPINAR YIGITBAS B, ZENGIN O, ZOR O, AKMAN O, KOCABAG I, YALCIN GS, ERTAN YAZAR E. The Impact of Effective Vaccination on Clinical and Radiological Involvement in COVID-19 Patients. Medeni Med J 2023; 38:260-267. [PMID: 38148723 PMCID: PMC10759941 DOI: 10.4274/mmj.galenos.2023.88655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
Objective We aimed to analyze clinical, radiological, and laboratory differences between vaccinated and unvaccinated patients admitted to hospital due to coronavirus disease-2019 (COVID-19) pneumonia. Methods Patients hospitalized in the COVID-19 clinic between February 2022 and August 2022 were included in the study. Demographic, clinical features, and treatment results. Furthermore, the COVID-19 vaccination status of the cases was recorded. The cases were divided into two groups as those with and without COVID vaccination and compared. Results A total of 215 patients were included in our study, and the patients were divided into 2 groups according to their vaccination status: those who were unvaccinated against COVID-19 (n=100) and those who vaccinated COVID-19 (n=115). The presence of comorbid chronic diseases and cancer was lower in the unvaccinated group. The duration of hospitalization was longer in the unvaccinated group than in the vaccinated group (9.6 and 7.1 days, respectively) (p<0.001). While there was no difference between the two groups in terms of the radiological involvement pattern, the number of involved segments was significantly higher in the unvaccinated group (p<0.05). The number of patients who received high-dose glucocorticoid therapy in the unvaccinated group was higher (28 cases vs. 11 cases; p<0.001). There was no statistically significant difference between the two groups in terms of transfer of patients to the intensive care unit (p>0.05). 11.3% (13/115) of the patients in the vaccinated group died, whereas 14% (14/100) died in the unvaccinated group. Conclusions The vaccinated cases who were infected with COVID-19 had a shorter duration of hospitalization and lower severity of radiological involvement. The requirement for pulse steroids was also less compared with unvaccinated individuals. Despite having chronic diseases and cancer, which is considered to have a significant effect on mortality in COVID-19 patients. In addition, although the vaccinated group was older, they had mortality rates similar to those of unvaccinated subjects.
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Affiliation(s)
- Coskun DOGAN
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Deniz BILICI
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Burcu ARPINAR YIGITBAS
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Omer ZENGIN
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Orhan ZOR
- Istanbul Medeniyet University Faculty of Medicine, Department of Family Medicine, Istanbul, Turkey
| | - Oguzhan AKMAN
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Ilyas KOCABAG
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Gonul Seven YALCIN
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
| | - Esra ERTAN YAZAR
- Istanbul Medeniyet University Faculty of Medicine, Department of Chest Diseases, Istanbul, Turkey
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205
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Alshukairi AN, Al-Qahtani AA, Obeid DA, Dada A, Almaghrabi RS, Al-Abdulkareem MA, Alahideb BM, Alsanea MS, Alsuwairi FA, Alhamlan FS. Molecular Epidemiology of SARS-CoV-2 and Clinical Manifestations among Organ Transplant Recipients with COVID-19. Viruses 2023; 16:25. [PMID: 38257726 PMCID: PMC10819349 DOI: 10.3390/v16010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 01/24/2024] Open
Abstract
RNA viruses, including SARS-CoV-2, rely on genetic mutation as a major evolutionary mechanism, leading to the emergence of variants. Organ transplant recipients (OTRs) may be particularly vulnerable to such mutations, making it crucial to monitor the spread and evolution of SARS-CoV-2 in this population. This cohort study investigated the molecular epidemiology of SARS-CoV-2 by comparing the SARS-CoV-2 whole genome, demographic characteristics, clinical conditions, and outcomes of COVID-19 illness among OTRs (n = 19) and non-OTRs with (n = 38) or without (n = 30) comorbid conditions. Most patients without comorbidities were female, whereas most OTRs were male. Age varied significantly among the three groups: patients with comorbidities were the oldest, and patients without comorbidities were the youngest. Whole-genome sequencing revealed that OTRs with mild disease had higher numbers of unusual mutations than patients in the other two groups. Additionally, OTRs who died had similar spike monoclonal antibody resistance mutations and 3CLpro mutations, which may confer resistance to nirmatrelvir, ensitrelvir, and GC37 therapy. The presence of those unusual mutations may impact the severity of COVID-19 illness in OTRs by affecting the virus's ability to evade the immune system or respond to treatment. The higher mutation rate in OTRs may also increase the risk of the emergence of new virus variants. These findings highlight the importance of monitoring the genetic makeup of SARS-CoV-2 in all immunocompromised populations and patients with comorbidity.
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Affiliation(s)
- Abeer N. Alshukairi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah 21362, Saudi Arabia; (A.N.A.); (A.D.)
- College of Medicine, Alfaisal University, Riyadh 11211, Saudi Arabia;
| | - Ahmed A. Al-Qahtani
- College of Medicine, Alfaisal University, Riyadh 11211, Saudi Arabia;
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Dalia A. Obeid
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (D.A.O.); (R.S.A.)
| | - Ashraf Dada
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah 21362, Saudi Arabia; (A.N.A.); (A.D.)
| | - Reem S. Almaghrabi
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (D.A.O.); (R.S.A.)
| | - Maha A. Al-Abdulkareem
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Basma M. Alahideb
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Madain S. Alsanea
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Feda A. Alsuwairi
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Fatimah S. Alhamlan
- College of Medicine, Alfaisal University, Riyadh 11211, Saudi Arabia;
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
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206
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Osmanoglu Ö, Gupta SK, Almasi A, Yagci S, Srivastava M, Araujo GHM, Nagy Z, Balkenhol J, Dandekar T. Signaling network analysis reveals fostamatinib as a potential drug to control platelet hyperactivation during SARS-CoV-2 infection. Front Immunol 2023; 14:1285345. [PMID: 38187394 PMCID: PMC10768010 DOI: 10.3389/fimmu.2023.1285345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Pro-thrombotic events are one of the prevalent causes of intensive care unit (ICU) admissions among COVID-19 patients, although the signaling events in the stimulated platelets are still unclear. Methods We conducted a comparative analysis of platelet transcriptome data from healthy donors, ICU, and non-ICU COVID-19 patients to elucidate these mechanisms. To surpass previous analyses, we constructed models of involved networks and control cascades by integrating a global human signaling network with transcriptome data. We investigated the control of platelet hyperactivation and the specific proteins involved. Results Our study revealed that control of the platelet network in ICU patients is significantly higher than in non-ICU patients. Non-ICU patients require control over fewer proteins for managing platelet hyperactivity compared to ICU patients. Identification of indispensable proteins highlighted key subnetworks, that are targetable for system control in COVID-19-related platelet hyperactivity. We scrutinized FDA-approved drugs targeting indispensable proteins and identified fostamatinib as a potent candidate for preventing thrombosis in COVID-19 patients. Discussion Our findings shed light on how SARS-CoV-2 efficiently affects host platelets by targeting indispensable and critical proteins involved in the control of platelet activity. We evaluated several drugs for specific control of platelet hyperactivity in ICU patients suffering from platelet hyperactivation. The focus of our approach is repurposing existing drugs for optimal control over the signaling network responsible for platelet hyperactivity in COVID-19 patients. Our study offers specific pharmacological recommendations, with drug prioritization tailored to the distinct network states observed in each patient condition. Interactive networks and detailed results can be accessed at https://fostamatinib.bioinfo-wuerz.eu/.
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Affiliation(s)
- Özge Osmanoglu
- Functional Genomics & Systems Biology Group, Department of Bioinformatics, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | - Shishir K. Gupta
- Evolutionary Genomics Group, Center for Computational and Theoretical Biology, University of Würzburg, Würzburg, Germany
- Institute of Botany, Heinrich Heine University, Düsseldorf, Germany
| | - Anna Almasi
- Functional Genomics & Systems Biology Group, Department of Bioinformatics, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | - Seray Yagci
- Functional Genomics & Systems Biology Group, Department of Bioinformatics, Biocenter, University of Wuerzburg, Wuerzburg, Germany
| | - Mugdha Srivastava
- Core Unit Systems Medicine, University of Wuerzburg, Wuerzburg, Germany
- Algorithmic Bioinformatics, Department of Computer Science, Heinrich Heine University, Düsseldorf, Germany
| | - Gabriel H. M. Araujo
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Zoltan Nagy
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Johannes Balkenhol
- Functional Genomics & Systems Biology Group, Department of Bioinformatics, Biocenter, University of Wuerzburg, Wuerzburg, Germany
- Chair of Molecular Microscopy, Rudolf Virchow Center for Integrative and Translation Bioimaging, University of Würzburg, Würzburg, Germany
| | - Thomas Dandekar
- Functional Genomics & Systems Biology Group, Department of Bioinformatics, Biocenter, University of Wuerzburg, Wuerzburg, Germany
- European Molecular Biology Laboratory (EMBL) Heidelberg, BioComputing Unit, Heidelberg, Germany
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207
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Yan Y, Chen Q, Nuermaimaiti A, Xiao Y, Chang L, Ji H, Sun H, Song Q, Gao Y, Xu J, Wang L. Acceptance of COVID-19 boosters among hypertensive patients in China: A multicenter cross-sectional study. Hum Vaccin Immunother 2023; 19:2283315. [PMID: 37982140 PMCID: PMC10760352 DOI: 10.1080/21645515.2023.2283315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023] Open
Abstract
Hypertension, a prevalent chronic disease, has been associated with increased COVID-19 severity. To promote the COVID-19 booster vaccination of hypertensive patients, this study investigated the willingness to receive boosters and the related influencing factors based on the health belief model (HBM model). Between June and October 2022, 453 valid questionnaires were collected across three Chinese cities. The willingness to receive a booster vaccination was 72.2%. The main factors that influenced the willingness of patients with hypertension to receive a booster shot were male (χ2 = 7.008, p = .008), residence in rural (χ2 = 4.778, p = .029), being in employment (χ2 = 7.232, p = .007), taking no or less antihypertensive medication (χ2 = 9.372, p = .025), with less hypertension-related comorbidities (χ2 = 35.888, p < .0001), and did not have any other chronic diseases (χ2 = 28.476, p < .0001). Amid the evolving COVID-19 landscape, the willingness to receive annual booster vaccination was 59.4%, and employment status (χ2 = 10.058, p = .002), and presence of other chronic diseases (χ2 = 14.256, p < .0001) are associated with the willingness of annual booster vaccination. Respondents with higher perceived severity, perceived benefits, perceived self-efficacy, and lower perceived barriers were more willing to receive booster shots. The mean and median value of willingness to pay (WTP) for a dose of booster were 53.17 CNY and 28.31 CNY. Concerns regarding booster safety and the need for professional advice were prevalent. Our findings highlight the importance of promoting booster safety knowledge and health-related management among hypertensive individuals through professional organizations and medical specialists.
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Affiliation(s)
- Ying Yan
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
| | - Qingyuan Chen
- The First Clinical Medical College, Capital Medical University, Beijing, P.R. China
| | - Abudulimutailipu Nuermaimaiti
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Yingzi Xiao
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Le Chang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
| | - Huimin Ji
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
| | - Huizhen Sun
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
| | - Qinggang Song
- Department of Cardiology, Xi’an No.1 hospital, Xi’an, Shaanxi,P.R. China
| | - Yuanfeng Gao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, P.R. China
| | - Junjie Xu
- Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, Shenzhen, Guangdong, P.R. China
| | - Lunan Wang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing,P.R. China
- Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, Beijing,P.R. China
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
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208
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Kusumoto T, Chubachi S, Namkoong H, Tanaka H, Lee H, Otake S, Nakagawara K, Fukushima T, Morita A, Watase M, Asakura T, Masaki K, Kamata H, Ishii M, Hasegawa N, Harada N, Ueda T, Ueda S, Ishiguro T, Arimura K, Saito F, Yoshiyama T, Nakano Y, Mutoh Y, Suzuki Y, Edahiro R, Murakami K, Sato Y, Okada Y, Koike R, Kitagawa Y, Tokunaga K, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Characteristics of patients with COVID-19 who have deteriorating chest X-ray findings within 48 h: a retrospective cohort study. Sci Rep 2023; 13:22054. [PMID: 38086863 PMCID: PMC10716517 DOI: 10.1038/s41598-023-49340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
The severity of chest X-ray (CXR) findings is a prognostic factor in patients with coronavirus disease 2019 (COVID-19). We investigated the clinical and genetic characteristics and prognosis of patients with worsening CXR findings during early hospitalization. We retrospectively included 1656 consecutive Japanese patients with COVID-19 recruited through the Japan COVID-19 Task Force. Rapid deterioration of CXR findings was defined as increased pulmonary infiltrates in ≥ 50% of the lung fields within 48 h of admission. Rapid deterioration of CXR findings was an independent risk factor for death, most severe illness, tracheal intubation, and intensive care unit admission. The presence of consolidation on CXR, comorbid cardiovascular and chronic obstructive pulmonary diseases, high body temperature, and increased serum aspartate aminotransferase, potassium, and C-reactive protein levels were independent risk factors for rapid deterioration of CXR findings. Risk variant at the ABO locus (rs529565-C) was associated with rapid deterioration of CXR findings in all patients. This study revealed the clinical features, genetic features, and risk factors associated with rapid deterioration of CXR findings, a poor prognostic factor in patients with COVID-19.
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Affiliation(s)
- Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Atsuho Morita
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mayuko Watase
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takanori Asakura
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Ueda
- Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Soichiro Ueda
- Department of Internal Medicine, Japan Community Health Care Organization (JCHO), Saitama Medical Center, Saitama, Japan
| | - Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan
| | - Ken Arimura
- Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Moriguchi, Japan
| | - Takashi Yoshiyama
- Respiratory Disease Center, Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Yasushi Nakano
- Department of Internal Medicine, Kawasaki Municipal Ida Hospital, Kawasaki, Japan
| | - Yoshikazu Mutoh
- Department of Infectious Diseases, Tosei General Hospital, Seto, Japan
| | - Yusuke Suzuki
- Department of Respiratory Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Ryuya Edahiro
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
- The Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
| | - Ryuji Koike
- Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Katsushi Tokunaga
- Genome Medical Science Project (Toyama), National Center for Global Health and Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan
- Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Aktiz Bıçak E, Oğlak SC. Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia. J OBSTET GYNAECOL 2023; 43:2218915. [PMID: 37289641 DOI: 10.1080/01443615.2023.2218915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 05/03/2023] [Indexed: 06/10/2023]
Abstract
This study aims to examine the clinical characteristics and mortality-related factors of obstetric patients, who were taken to the intensive care unit due to Coronavirus Disease 2019 (COVID-19). This study included 31 patients in the peripartum period with COVID-19 pneumonia, followed up in the intensive care unit (ICU) from March 2020 to December 2020. Symptoms, laboratory values, intensive care unit duration of stay, complications, the requirement of non-invasive and invasive mechanical ventilation, and mortality were recorded. The mean age was 30.7 ± 6.2 years and the mean gestational age was 31.1 ± 6.4 weeks. Among the patients, 25.8% had a fever, 87.1% had a cough, 96.8% had dyspnoea and 77.4% had tachypnoea. Seventeen patients (54.8%) had mild, 6 (19.4%) had moderate and 8 (25.8%) had severe pulmonary involvement on computed tomography. Sixteen (51.6%) patients required high-frequency oscillatory ventilation, 6 (19.3%) patients required continuous positive airway pressure, and 5 (16.1%) patients required invasive mechanical ventilation. Sepsis complicated by septic shock and multiorgan failure occurred in 4 patients and all of them died. The ICU duration of stay was 4.9 ± 4.3 days. We have found that older maternal age, obesity, high LDH, AST, ALT, ferritin, leukocyte, CRP, and procalcitonin values, and severe lung involvement were mortality-related factors.Impact statementWhat is already known on this subject? Pregnant women are in the high-risk group for Covid-19 disease and its complications. Although most pregnant women are asymptomatic, severe infection-related hypoxia can cause serious foetal and maternal problems.What do the results of this study add? When we examined the literature, we found that the number of studies on pregnant women with severe Covid-19 infection was limited. For this reason, with our study results, we aim to contribute to the literature by determining the biochemical parameters and patient-related factors associated with severe infection and mortality in pregnant patients with severe Covid-19 infection.What are the implications of these findings for clinical practice and/or further research? With our study results, predisposing factors for the development of severe Covid-19 infection in the pregnant patient population and biochemical parameters that are early indicators of severe infection were determined. In this way, pregnant women in the high-risk group can be followed closely and the necessary treatments can be started quickly so disease-related complications and mortality can be reduced.
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Affiliation(s)
- Esra Aktiz Bıçak
- Department of Anesthesiology and Reanimation, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Süleyman Cemil Oğlak
- Department of Obstetrics and Gynaecology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Bian Y, Han Q, Zheng Y, Yao Y, Fan X, Lv R, Pang J, Xu F, Chen Y. SUPER Score Contributes to Warning and Management in Early-Stage COVID-19. INFECTIOUS MEDICINE 2023; 2:308-314. [PMID: 38205173 PMCID: PMC10774654 DOI: 10.1016/j.imj.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 01/12/2024]
Abstract
Background Some COVID-19 patients deteriorate to severe cases with relatively higher case-fatality rates, which increases the medical burden. This necessitates identification of patients at risk of severe disease. Early assessment plays a crucial role in identifying patients at risk of severe disease. This study is to assess the effectiveness of SUPER score as a predictor of severe COVID-19 cases. Methods We consecutively enrolled COVID-19 patients admitted to a comprehensive medical center in Wuhan, China, and recorded clinical characteristics and laboratory indexes. The SUPER score was calculated using parameters including oxygen saturation, urine volume, pulse, emotional state, and respiratory rate. In addition, the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity of the SUPER score for the diagnosis of severe COVID-19 were calculated and compared with the National Early Warning Score 2 (NEWS2). Results The SUPER score at admission, with a threshold of 4, exhibited good predictive performance for early identification of severe COVID-19 cases, yielding an AUC of 0.985 (95% confidence interval [CI] 0.897-1.000), sensitivity of 1.00 (95% CI 0.715-1.000), and specificity of 0.92 (95% CI 0.775-0.982), similar to NEWS2 (AUC 0.984; 95% CI 0.895-1.000, sensitivity 0.91; 95% CI 0.587-0.998, specificity 0.97; 95% CI 0.858-0.999). Compared with patients with a SUPER score<4, patients in the high-risk group exhibited lower lymphocyte counts, interleukin-2, interleukin-4 and higher fibrinogen, C-reactive protein, aspartate aminotransferase, and lactate dehydrogenase levels. Conclusions In conclusion, the SUPER score demonstrated equivalent accuracy to the NEWS2 score in predicting severe COVID-19. Its application in prognostic assessment therefore offers an effective early warning system for critical management and facilitating efficient allocation of health resources.
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Affiliation(s)
- Yuan Bian
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Qi Han
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yue Zheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yu Yao
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Xinhui Fan
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Ruijuan Lv
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Jiaojiao Pang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
| | - Yuguo Chen
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan 250012, China
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Quenzer FC, Coyne CJ, Ferran K, Williams A, Lafree AT, Kajitani S, Mathen G, Villegas V, Kajitani KM, Tomaszewski C, Brodine S. ICU Admission Risk Factors for Latinx COVID-19 Patients at a U.S.-Mexico Border Hospital. J Racial Ethn Health Disparities 2023; 10:3039-3050. [PMID: 36478268 PMCID: PMC9735002 DOI: 10.1007/s40615-022-01478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Few studies have examined the impact of coronavirus disease 2019 (COVID-19) on the primarily Latinx community along the U.S.-Mexico border. This study explores the socioeconomic impacts which contribute to strong predictors of severe COVID-19 complications such as intensive care unit (ICU) hospitalization in a primarily Latinx/Hispanic U.S.-Mexico border hospital. METHODS A retrospective, observational study of 156 patients (≥ 18 years) Latinx/Hispanic patients who were admitted for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at a U.S.-Mexico border hospital from April 10, 2020, to May 30, 2020. Descriptive statistics of sex, age, body mass index (BMI), and comorbidities (coronary artery disease, hypertension, diabetes, cancer/lymphoma, current use of immunosuppressive drug therapy, chronic kidney disease/dialysis, or chronic respiratory disease). Multivariate regression models were produced from the most significant variables and factors for ICU admission. RESULTS Of the 156 hospitalized Latinx patients, 63.5% were male, 84.6% had respiratory failure, and 45% were admitted to the ICU. The average age was 67.2 (± 12.2). Those with body mass index (BMI) ≥ 25 had a higher frequency of ICU admission. Males had a 4.4 (95% CI 1.58, 12.308) odds of ICU admission (p = 0.0047). Those who developed acute kidney injury (AKI) and BMI 25-29.9 were strong predictors of ICU admission (p < 0.001 and p = 0.0020, respectively). Those with at least one reported comorbidity had 1.98 increased odds (95% CI 1.313, 2.99) of an ICU admission. CONCLUSION Findings show that age, AKI, and male sex were the strongest predictors of COVID-19 ICU admissions in the primarily Latinx population at the U.S.-Mexico border. These predictors are also likely driven by socioeconomic inequalities which are most apparent in border hospitals.
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Affiliation(s)
- Faith C Quenzer
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA.
- Department of Emergency Medicine, Temecula Valley Hospital, Temecula, CA, USA.
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego Health, San Diego, CA, USA
| | - Karen Ferran
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Ashley Williams
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Andrew T Lafree
- Department of Emergency Medicine, University of California San Diego Health, San Diego, CA, USA
- Department of Emergency Medicine, El Centro Regional Medical Center, El Centro, CA, USA
| | - Sten Kajitani
- Department of Emergency Medicine, University of California San Diego Health, San Diego, CA, USA
- Department of Emergency Medicine, El Centro Regional Medical Center, El Centro, CA, USA
| | - George Mathen
- Department of Emergency Medicine, University of California San Diego Health, San Diego, CA, USA
- Department of Emergency Medicine, El Centro Regional Medical Center, El Centro, CA, USA
| | - Vanessa Villegas
- Department of Emergency Medicine, El Centro Regional Medical Center, El Centro, CA, USA
| | - Kari M Kajitani
- Department of Emergency Medicine, University of California San Diego Health, San Diego, CA, USA
- Department of Emergency Medicine, El Centro Regional Medical Center, El Centro, CA, USA
| | - Christian Tomaszewski
- Department of Emergency Medicine, University of California San Diego Health, San Diego, CA, USA
- Department of Emergency Medicine, El Centro Regional Medical Center, El Centro, CA, USA
| | - Stephanie Brodine
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
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Nair PR, Girish K, Mini G, Khan T, Haritha D, Sanyal K, Bhattacharjee S, Baidya DK, Ray BR, Anand RK, Datta SK, Soneja M, Subramaniam R, Maitra S. Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis. J Lab Physicians 2023; 15:558-561. [PMID: 37780871 PMCID: PMC10539064 DOI: 10.1055/s-0043-1768952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/26/2023] [Indexed: 10/03/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronavirus disease (COVID) ARDS. Elevated inflammatory markers such as C-reactive protein, interleukin (IL)-6, etc., are associated with severe infection. This study identified subphenotypes of COVID-19 ARDS patients by latent profile analysis in a cohort of Indian patients. Methods Data of n = 233 adult Indian patients with laboratory-confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital were analyzed in this retrospective study. Only patients with acute respiratory failure (defined by partial pressure of oxygen/fraction of inspired oxygen ratio < 200 mm Hg) and chest X-ray showing bilateral infiltrates were included. Results The patients' mean (standard deviation) age was 53.3 (14.9) years, and 62% were male. A two subphenotypic model was formulated based on the lowest Bayesian information criterion. Neutrophil-to-lymphocyte ratio and serum IL-6 were latent variables in that model (entropy 0.91). The second phenotype (hyperinflammatory) had lower platelet count ( p = 0.02), higher serum creatinine ( p = 0.004), higher C-reactive protein ( p = 0.001), higher ferritin ( p < 0.001), and serum lactate dehydrogenase ( p = 0.009). Age-adjusted hospital mortality ( p = 0.007), duration of hospital stay ( p < 0.001), and duration of intensive care unit stay ( p < 0.001) were significantly higher in the second subphenotype. Conclusion Two distinct but overlapping subphenotypes were identified in SARS-CoV-2-associated respiratory failure. Hyperinflammatory subphenotype was associated with significantly poor short-term outcomes.
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Affiliation(s)
- Parvathy R. Nair
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kavitha Girish
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Gouri Mini
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Tazeen Khan
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Damarla Haritha
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Koninica Sanyal
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Dalim K. Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash R. Ray
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul K. Anand
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sudip K. Datta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeshwari Subramaniam
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Wei T, Peng S, Li X, Li J, Gu M, Li X. Critical evaluation of established risk prediction models for acute respiratory distress syndrome in adult patients: A systematic review and meta-analysis. J Evid Based Med 2023; 16:465-476. [PMID: 38058055 DOI: 10.1111/jebm.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
AIM To assess the performance of validated prediction models for acute respiratory distress syndrome (ARDS) by systematic review and meta-analysis. METHODS Eight databases (Medline, CINAHL, Embase, The Cochrane Library, CNKI, WanFang Data, Sinomed, and VIP) were searched up to March 26, 2023. Studies developed and validated a prediction model for ARDS in adult patients were included. Items on study design, incidence, derivation methods, predictors, discrimination, and calibration were collected. The risk of bias was assessed by the Prediction model Risk of Bias Assessment Tool. Models with a reported area under the curve of the receiver operating characteristic (AUC) metric were analyzed. RESULTS A total of 25 studies were retrieved, including 48 unique prediction models. Discrimination was reported in all studies, with AUC ranging from 0.701 to 0.95. Emerged AUC value of the logistic regression model was 0.837 (95% CI: 0.814 to 0.859). Besides, the value in the ICU group was 0.856 (95% CI: 0.812 to 0.899), the acute pancreatitis group was 0.863 (95% CI: 0.844 to 0.882), and the postoperation group was 0.835 (95% CI: 0.808 to 0.861). In total, 24 of the included studies had a high risk of bias, which was mostly due to the improper methods in predictor screening (13/24), model calibration assessment (9/24), and dichotomization of continuous predictors (6/24). CONCLUSIONS This study shows that most prediction models for ARDS are at high risk of bias, and the discrimination ability of the model is excellent. Adherence to standardized guidelines for model development is necessary to derive a prediction model of value to clinicians.
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Affiliation(s)
- Tao Wei
- Anesthesiology Department, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Siyi Peng
- The Early Clinical Trial Center in The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Xuying Li
- Department of Nursing, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Jinhua Li
- Department of Nursing, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Mengdan Gu
- Anesthesiology Department, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
| | - Xiaoling Li
- Anesthesiology Department, Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, China
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Madera‐Sandoval RL, Cérbulo‐Vázquez A, Arriaga‐Pizano LA, Cabrera‐Rivera GL, Basilio‐Gálvez E, Miranda‐Cruz PE, García de la Rosa MT, Prieto‐Chávez JL, Rivero‐Arredondo SV, Cruz‐Cruz A, Rodríguez‐Hernández D, Salazar‐Ríos ME, Salazar‐Ríos E, Serrano‐Molina ED, De Lira‐Barraza RC, Villanueva‐Compean AH, Esquivel‐Pineda A, Ramírez‐Montes de Oca R, Unzueta‐Marta O, Flores‐Padilla G, Anda‐Garay JC, Sánchez‐Hurtado LA, Calleja‐Alarcón S, Romero‐Gutiérrez L, Torres‐Rosas R, Bonifaz LC, Pelayo R, Márquez‐Márquez E, López‐Macías CIIIR, Ferat‐Osorio E. Potential biomarkers for fatal outcome prognosis in a cohort of hospitalized COVID-19 patients with pre-existing comorbidities. Clin Transl Sci 2023; 16:2687-2699. [PMID: 37873554 PMCID: PMC10719476 DOI: 10.1111/cts.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
The difficulty in predicting fatal outcomes in patients with coronavirus disease 2019 (COVID-19) impacts the general morbidity and mortality due to severe acute respiratory syndrome-coronavirus 2 infection, as it wears out the hospital services that care for these patients. Unfortunately, in several of the candidates for prognostic biomarkers proposed, the predictive power is compromised when patients have pre-existing comorbidities. A cohort of 147 patients hospitalized for severe COVID-19 was included in a descriptive, observational, single-center, and prospective study. Patients were recruited during the first COVID-19 pandemic wave (April-November 2020). Data were collected from the clinical history whereas immunophenotyping by multiparameter flow cytometry analysis allowed us to assess the expression of surface markers on peripheral leucocyte. Patients were grouped according to the outcome in survivors or non-survivors. The prognostic value of leucocyte, cytokines or HLA-DR, CD39, and CD73 was calculated. Hypertension and chronic renal failure but not obesity and diabetes were conditions more frequent among the deceased patient group. Mixed hypercytokinemia, including inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines, was more evident in deceased patients. In the deceased patient group, lymphopenia with a higher neutrophil-lymphocyte ratio (NLR) value was present. HLA-DR expression and the percentage of CD39+ cells were higher than non-COVID-19 patients but remained similar despite the outcome. Receiver operating characteristic analysis and cutoff value of NLR (69.6%, 9.4), percentage NLR (pNLR; 71.1%, 13.6), and IL-6 (79.7%, 135.2 pg/mL). The expression of HLA-DR, CD39, and CD73, as many serum cytokines (other than IL-6) and chemokines levels do not show prognostic potential, were compared to NLR and pNLR values.
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Affiliation(s)
- Ruth Lizzeth Madera‐Sandoval
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | - Lourdes Andrea Arriaga‐Pizano
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Graciela Libier Cabrera‐Rivera
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Edna Basilio‐Gálvez
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado de Ciencias Químicobiológicas, Escuela Nacional de Ciencias BiológicasInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Patricia Esther Miranda‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Teresa García de la Rosa
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Jessica Lashkmin Prieto‐Chávez
- Centro de Instrumentos, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Silvia Vanessa Rivero‐Arredondo
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Alonso Cruz‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Daniela Rodríguez‐Hernández
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Eugenia Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Enrique Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Esli David Serrano‐Molina
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | | | - Alejandra Esquivel‐Pineda
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rubén Ramírez‐Montes de Oca
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Omar Unzueta‐Marta
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Guillermo Flores‐Padilla
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Juan Carlos Anda‐Garay
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Luis Alejandro Sánchez‐Hurtado
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Salvador Calleja‐Alarcón
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Laura Romero‐Gutiérrez
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rafael Torres‐Rosas
- Laboratorio de Inmunología, Centro de Estudios en Ciencias de la Salud y la Enfermedad, Facultad de OdontologíaUniversidad Autónoma “Benito Juárez” de Oaxaca (UABJO)Oaxaca de JuárezMexico
| | - Laura C. Bonifaz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
| | - Rosana Pelayo
- Centro de Investigación Biomédica de OrienteIMSSPueblaMexico
- Unidad de Educación e Investigación, IMSSCiudad de MéxicoMexico
| | | | | | - Eduardo Ferat‐Osorio
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
- División de Investigación en Salud, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
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Wang T, Zhao Z, Li W, Wu J, Ye Q, Xie H. Machine Learning Predictive Modeling for the Identification of Moderate Coronavirus Disease 2019 During the Pandemic: A Retrospective Study. Cureus 2023; 15:e50619. [PMID: 38226092 PMCID: PMC10789081 DOI: 10.7759/cureus.50619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Timely differentiation of moderate COVID-19 cases from mild cases is beneficial for early treatment and saves medical resources during the pandemic. We attempted to construct a model to predict the occurrence of moderate COVID-19 through a retrospective study. METHODS In this retrospective study, clinical data from patients with COVID-19 admitted to Hainan Western Central Hospital in Danzhou, China, between August 1, 2022, and August 31, 2022, was collected, including sex, age, signs on admission, comorbidities, imaging data, post-admission treatment, length of stay, and the results of laboratory tests on admission. The patients were classified into a mild-to-moderate-type group according to WHO guidance. Factors that differed between groups were included in machine learning models such as Bernoulli Naïve Bayes (BNB), linear discriminant analysis, support vector machine (SVM), least absolute shrinkage and selection operator (LASSO), and logistic regression (LR) models. These models were compared to select the optimal model with the best predictive efficacy for moderate COVID-19. The predictive performance of the models was assessed using the area under the curve (AUC), sensitivity, specificity, and calibration plot. RESULTS A total of 231 patients with COVID-19 were included in this retrospective analysis. Among them, 152 (68.83%) were mild types, 72 (31.17%) were moderate types, and there were no patients with severe or critical types. A logistic regression model combined with age, respiratory rate (RR), lactate dehydrogenase (LDH), D-dimer, and albumin was selected to predict the occurrence of moderate COVID-19. The receiver operating characteristic curve (ROC) showed that AUC, sensitivity, and specificity in the model were 0.719, 0.681, and 0.635, respectively, in predicting moderate COVID-19. Calibration curve analysis revealed that the predicted probability of the model was in good agreement with the true probability. Stratified analysis showed better predictive efficacy after modeling for people aged ≤66 years (AUC = 0.7656) and a better calibration curve. CONCLUSION The LR model, combined with age, RR, D-dimer, LDH, and albumin, can predict the occurrence of moderate COVID-19 well, especially for patients aged ≤66 years.
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Affiliation(s)
- Tao Wang
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai, CHN
| | - Zhanqing Zhao
- Department of Critical Care Medicine, Hainan Western Central Hospital, Danzhou, CHN
| | - Wenzhe Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CHN
| | - Jing Wu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CHN
| | - Qianru Ye
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CHN
| | - Hui Xie
- Department of Critical Care Medicine, Shanghai General Hospital, Shanghai, CHN
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216
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Yang S, Zhang Y, He Y, Liu S. Comparison of Prognostic Scores for Patients with COVID-19 Presenting with Dyspnea in the Emergency Department. J Emerg Med 2023; 65:e487-e494. [PMID: 37838495 DOI: 10.1016/j.jemermed.2023.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/27/2023] [Accepted: 07/15/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Easy-to-use bedside risk assessment is crucial for patients with COVID-19 in the overcrowded emergency department (ED). OBJECTIVE The aim of this study was to explore the prognostic ability of ratio of percutaneous oxygen saturation (SpO2) to fraction of inspired oxygen (FiO2) (S/F); ratio of SpO2/FiO2 to respiratory rate (ROX); National Early Warning Score (NEWS); quick Sequential Organ Failure Assessment (qSOFA); and confusion, respiratory rate, blood pressure, and age ≥ 65 years (CRB-65) in patients with COVID-19 presenting with dyspnea to the ED. METHODS In this retrospective observational study, clinical and demographic details of patients with COVID-19 were obtained at ED admission. S/F, ROX, NEWS, CRB-65, and qSOFA scores were calculated at the time of ED arrival. Accuracy of these five indices to predict the need for invasive mechanical ventilation (IMV) within 48 h, intensive care unit (ICU) admission, and early (7-day) mortality were determined using receiver operating characteristic curves. RESULTS A total of 375 patients were included in this study. Fifty patients (13.3%) required IMV within 48 h and 58 patients (15.5%) were transferred to the ICU. Seven-day mortality was 6.7% and 28-day mortality was 18.1%. Among all five scores determined from patient data on ED admission, ROX, S/F, and NEWS presented greater discriminatory performance than CRB-65 and qSOFA in predicting IMV within 48 h, ICU admission, and early mortality. CONCLUSIONS Emergency physicians can effectively use S/F, ROX, and NEWS scores for rapid risk stratification of patients with COVID-19 infection. Moreover, from the perspective of simplicity and ease of calculation, we recommend the use of the S/F ratio.
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Affiliation(s)
- Shuai Yang
- Department of Emergency Intensive Care Unit, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China
| | - Yuxin Zhang
- Department of Gastroenterology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China
| | - Yan He
- Department of Emergency Intensive Care Unit, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People's Hospital), Zhuhai, China.
| | - Shengming Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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217
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Jiang X, Zhao C, Hu W, Lu D, Chen C, Gong S, Yan J, Mao W. Efficacy and Safety of Glucocorticoid in the Treatment of Acute Respiratory Distress Syndrome caused by Covid-19: A Systematic Review and Meta-Analysis. CLIN INVEST MED 2023; 46:E03-E18. [PMID: 38330183 DOI: 10.3138/cim.v46i4e03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Glucocorticoids are often used to treat acute respiratory distress syndrome (ARDS) and novel coronavirus disease 2019 (COVID-19). However, the efficacy and safety of glucocorticoids in the treatment of ARDS caused by COVID-19 are still controversial; therefore, we conducted this meta-analysis of the literature on this topic. METHODS Four databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were searched from the establishment of the databases to August 16, 2023. Randomized controlled trials (RCTs) and cohort studies that compared glucocorticoid versus standard treatment for ARDS caused by COVID-19 were included. The Newcastle-Ottawa Scale (NOS) checklist and the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the risk of bias. Review Manager 5.4 software and STATA 17.0 were used for meta-analy-sis, and the relative risk (RR), mean difference, and 95% confidence intervals (CIs) were then determined. Results: A total of 17 studies involving 8592 patients were evaluated, including 14 retrospective studies and 3 RCTs. Sixteen studies reported data on all-cause mortality. The results of the meta-analysis showed that glucocorticoids did not reduce all-cause (RR, 0.96; 95% CI 0.82-1.13, P = .62) or 28-day (RR, 1.01; 95% CI 0.78-1.32, P = .93) mortality. Subgroup analysis showed that only methylprednisolone reduced all-cause mortality. No matter whether glucocorticoid use was early or delayed, high-dose or low-dose, long-term or short-term, no regimen reduced all-cause mortality. Furthermore, there were no significant differences in length of intensive care unit (ICU) stay, length of hospital stay, hyperglycemia, and ventilator-associated pneumonia (VAP); how-ever, glucocorticoids increased the number of ventilator-free days. CONCLUSIONS Although methylprednisolone may reduce all-cause mortality from ARDS caused by COVID-19, this effect was not found with other types of glucocorticoids. At the same time, glucocorticoid use was associ-ated with more ventilator-free days, without increasing the incidence of hyperglycemic events or VAP. Con-sidering that almost all of the included studies were retrospective cohort studies, more RCTs are needed to confirm these findings.
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Affiliation(s)
- Xiangyang Jiang
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
| | - Changyun Zhao
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
| | - Weihang Hu
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
| | - Difan Lu
- Cardiovascular Ultrasound Center of the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Changqin Chen
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
| | - Wenchao Mao
- Department of Critical Care Medicine, Zhejiang Hospital, Lingyin Road 12, Hangzhou, 310013, Zhejiang, China
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218
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Park HR, Yoo MG, Kim JM, Bae SJ, Lee H, Kim J. Effectiveness of Molnupiravir Treatment in Patients with COVID-19 in Korea: A Propensity Score Matched Study. Infect Chemother 2023; 55:490-499. [PMID: 38014730 PMCID: PMC10771951 DOI: 10.3947/ic.2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The MOVe-OUT (efficacy and safety of molnupiravir [MK-4482] in non-hospitalized adult participants with COVID-19 [MK-4482-002]) trial reported that the administration of molnupiravir in unvaccinated patients with coronavirus disease 2019 (COVID-19) before the Omicron epidemic showed a preventive effect of 31% against hospitalization and death. However, studies on the preventive effect of molnupiravir against progression to severe disease and death in patients with COVID-19 during the Omicron epidemic are limited. This study aimed to evaluate the preventive effect of molnupiravir against severe/critical illness or death and death in Korean patients with COVID-19 who were vaccinated mostly during the Omicron epidemic. MATERIALS AND METHODS This study used large-scale retrospective cohort data to select patients with COVID-19 who were either treated or not treated with molnupiravir, between August 2022 and March 2023, at a ratio of 1 : 4 using the propensity score matching method. In total, 762,768 patients comprised the non- administered group, and 190,692 patients comprised the molnupiravir-administered group. The preventive effect of molnupiravir against severe/critical illness or death and death was analyzed using logistic regression analysis. RESULTS The preventive effect of molnupiravir against severe/critical illness or death and death, represented by the odds ratio (OR) and 95% confidence interval (CI), in the molnupiravir-administered and non-administered group was (OR: 0.714; CI: 0.667 - 0.764) and (OR: 0.749; CI: 0.682 - 0.823), respectively. As age increased, the preventive effect against severe/critical illness or death and death increased. The preventive effect against severe/critical illness or death at ≥60 years was (OR: 0.669; CI: 0.624 - 0.717), at ≥70 years was (OR: 0.614; CI: 0.570 - 0.661), and at ≥80 years was (OR: 0.563; CI: 0.515 - 0.615). The preventive effect against death at ≥60 years was (OR: 0.729; CI: 0.663 - 0.802), at ≥70 years was (OR: 0.676; CI: 0.612 - 0.747), and at ≥80 years was (OR: 0.622; CI: 0.554 - 0.698). CONCLUSION Although molnupiravir showed a relatively weak preventive effect against severe/critical illness or death (29%) and death (25%) among patients with COVID-19, it exhibited a stronger protective effect in older patients than in younger patients. In particular, the preventive effect against severe/critical illness or death (44%) and death (38%) in those aged ≥80 years was pronounced. This study strongly suggests that molnupiravir administration can alleviate the burden on the medical system, and treat patients with COVID-19 effectively by reducing its progression to severe disease and death.
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Affiliation(s)
- Hye Rim Park
- Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Min-Gyu Yoo
- Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea
- Division of Public Health Emergency Response Research, Bureau of Public Health Emergency Preparedness, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jong Mu Kim
- Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Soon Jong Bae
- Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Hyungmin Lee
- Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea
- Division of Emerging Infectious Disease, Bureau of Infectious Disease Risk Response, Korea Disease Control and Prevention Agency, Cheongju, Korea
- Division of Vaccine-Prevetable Diseases Control and National Immunization Program, Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Jungyeon Kim
- Patient Management Team, Central Disease Control Headquarters for COVID-19, Korea Disease Control and Prevention Agency, Cheongju, Korea
- Division of Emerging Infectious Disease, Bureau of Infectious Disease Risk Response, Korea Disease Control and Prevention Agency, Cheongju, Korea
- Division of Clinical Research, Center for Emerging Virus Research, National Institute of Infectious Disease, Korea Disease Control and Prevention Agency, Cheongju, Korea.
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219
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Hung T, Lam N. Risk Factors for Death of Burn Patients With Acute Respiratory Distress Syndrome. ANNALS OF BURNS AND FIRE DISASTERS 2023; 36:271-275. [PMID: 38680242 PMCID: PMC11041865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 05/01/2024]
Abstract
The aim of this study was to investigate factors independently affecting outcomes of post-burn ARDS patients at the time of ARDS onset. A prospective study was conducted on 66 patients with ARDS, treated in the ICU at the Le Huu Trac National Burns Hospital in Hanoi, Viet Nam, from 2014 to 2017. Patients were divided into a survivor and non-survivor group. Demographic criteria, burn severity, inhalation injury, clinical and subclinical features at ARDS onset were compared between the two groups. The results showed that overall mortality of ARDS patients was 62.12%. Logistic regression analysis indicated that at the time of ARDS onset, serum lactate level (OR=6.71), blood platelet count (OR=.99), static lung compliance (OR=.73) and driving pressure (OR=1.69) were independent risk factors for death, while patients' demographics, burn severity and ARDS severity did not significantly affect the mortality rate.
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Affiliation(s)
| | - N.N. Lam
- Le Huu Trac National Burn Hospital & Viet Nam Medical Military University, Hanoi, Viet Nam
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220
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Li Y, Menon G, Wu W, Musunuru A, Chen Y, Quint EE, Clark-Cutaia MN, Zeiser LB, Segev DL, McAdams-DeMarco MA. Evolving Trends in Kidney Transplant Outcomes Among Older Adults: A Comparative Analysis Before and During the COVID-19 Pandemic. Transplant Direct 2023; 9:e1520. [PMID: 37928483 PMCID: PMC10624464 DOI: 10.1097/txd.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 11/07/2023] Open
Abstract
Background Advancements in medical technology, healthcare delivery, and organ allocation resulted in improved patient/graft survival for older (age ≥65) kidney transplant (KT) recipients. However, the recent trends in these post-KT outcomes are uncertain in light of the mounting burden of cardiovascular disease, changing kidney allocation policies, heterogeneity in candidates' risk profile, and the coronavirus disease 2019 pandemic. Thus, we examined secular trends in post-KT outcomes among older and younger KT recipients over the last 3 decades. Methods We identified 73 078 older and 378 800 younger adult (aged 18-64) recipients using Scientific Registry of Transplant Recipients (1990-2022). KTs were grouped into 6 prepandemic eras and 1 postpandemic-onset era. Kaplan-Meier and Cox proportional hazards models were used to examine temporal trends in post-KT mortality and death-censored graft failure. Results From 1990 to 2022, a 19-fold increase in the proportion of older KT recipients was observed compared to a 2-fold increase in younger adults despite a slight decline in the absolute number of older recipients in 2020. The mortality risk for older recipients between 2015 and March 14, 2020, was 39% (adjusted hazard ratio [aHR] = 0.61, 95% confidence interval [CI], 0.50-0.75) lower compared to 1990-1994, whereas that for younger adults was 47% lower (aHR = 0.53, 95% CI, 0.48-0.59). However, mortality risk during the pandemic was 25% lower (aHR = 0.75, 95% CI, 0.61-0.93) in older adults and 37% lower in younger adults (aHR = 0.63, 95% CI, 0.56-0.70) relative to 1990-1994. For both populations, the risk of graft failure declined over time and was unaffected during the pandemic relative to the preceding period. Conclusions The steady improvements in 5-y mortality and graft survival were disrupted during the pandemic, particularly among older adults. Specifically, mortality among older adults reflected rates seen 20 y prior.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Wenbo Wu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Amrusha Musunuru
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Yusi Chen
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Evelien E. Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Maya N. Clark-Cutaia
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Laura B. Zeiser
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
| | - Dorry L. Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Mara A. McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, NY
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
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221
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Kafan S, Fattahi MR, Akhbari Shojaei M, Hossein Nezhad A, Imankhan M, Jahansouz D, Montazeri M, Hadadi A, Fattahi S, Iranmehr A, Pazoki M, Rahimzadeh H. Comparing Therapeutic versus Prophylactic Enoxaparin Therapy in Severe COVID-19 Patients: A Randomized Clinical Trial. Med J Islam Repub Iran 2023; 37:129. [PMID: 38318404 PMCID: PMC10843207 DOI: 10.47176/mjiri.37.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 02/07/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has been associated with a hypercoagulopathy state; however, the efficacy of different anticoagulant regimens in preventing thrombotic events is not clear. We aimed to compare therapeutic versus prophylactic enoxaparin therapy in severe COVID-19 patients. Methods In this single-center, open-label, randomized controlled trial, adult patients with severe COVID-19 presentations and an increased D-dimer level of more than 4 times the normal upper limit were randomly assigned to receive either prophylactic or therapeutic dose of enoxaparin. All patients were observed for at least 4 months regarding the overall survival as the primary outcome. Hospitalization duration, the need for intensive care unit (ICU) admission, the need for mechanical ventilation, and major adverse events (MAEs) were also analyzed as the secondary outcomes. Survival analysis was done via Kaplan-Meier curves and the Log-rank test. Cox regression was used, adjusting for baseline variables. Results Overall, 237 patients (152 men and 85 women) were randomized to either arm (121 to prophylactic and 116 to therapeutic groups). The mortality rate was 27 (22.3%) and 52 (44.8%) in prophylactic and therapeutic arms, respectively. Prophylactic enoxaparin was associated with better survival in the log-rank test (P < 0.001; HR, 0.42). Additionally, a significantly lower rate of ICU admission, a lower rate of MAEs, and shorter hospitalization were observed in the prophylactic arm (P < 0.001, P = 0.009, and P = 0.028, respectively). Conclusion The results of the current study were in favor of anticoagulant treatment with prophylactic doses of enoxaparin. Still, due to the limitations of this paper, we suggest that these findings be treated cautiously.
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Affiliation(s)
- Samira Kafan
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Fattahi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Akhbari Shojaei
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Hossein Nezhad
- School of Medicine, Islamic Azad University, Tonekabon Medical Branch, Tonekabon, Iran
| | - Mahshid Imankhan
- School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Davoud Jahansouz
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahnaz Montazeri
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Hadadi
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Fattahi
- Department of Clinical Psychology, Tehran University of Medical Sciences, Tehran, Iran
| | - Arad Iranmehr
- Neurosurgery Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Pazoki
- Department of Internal Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hormat Rahimzadeh
- Department of Nephrology Disease, Tehran University of Medical Sciences, Tehran, Iran
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Roedl K, De Rosa S, Fischer M, Braunsteiner J, Schmidt-Lauber C, Jarczak D, Huber TB, Kluge S, Wichmann D. Early acute kidney injury and transition to renal replacement therapy in critically ill patients with SARS-CoV-2 requiring veno-venous extracorporeal membrane oxygenation. Ann Intensive Care 2023; 13:115. [PMID: 37999776 PMCID: PMC10673790 DOI: 10.1186/s13613-023-01205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requiring veno-venous extracorporeal membrane oxygenation (vv-ECMO) are at risk for acute kidney injury (AKI). Currently, the incidence of AKI and progression to kidney replacement therapy (RRT) in critically ill patients with vv-ECMO for severe COVID-19 and implications on outcome are still unclear. METHODS Retrospective analysis at the University Medical Center Hamburg-Eppendorf (Germany) between March 1st, 2020 and July 31st, 2021. Demographics, clinical parameters, AKI, type of organ support, length of ICU stay, mortality and severity scores were assessed. RESULTS Ninety-one critically ill patients with SARS-CoV-2 requiring ECMO were included. The median age of the study population was 57 (IQR 49-64) years and 67% (n = 61) were male. The median SAPS II and SOFA Score on admission were 40 (34-46) and 12 (10-14) points, respectively. We observed that 45% (n = 41) developed early-AKI, 38% (n = 35) late-AKI and 16% (n = 15) no AKI during the ICU stay. Overall, 70% (n = 64) of patients required RRT during the ICU stay, 93% with early-AKI and 74% with late-AKI. Risk factors for early-AKI were younger age (OR 0.94, 95% CI 0.90-0.99, p = 0.02) and SAPS II (OR 1.12, 95% CI 1.06-1.19, p < 0.001). Patients with and without RRT were comparable regarding baseline characteristics. SAPS II (41 vs. 37 points, p < 0.05) and SOFA score (13 vs. 12 points, p < 0.05) on admission were significantly higher in patients receiving RRT. The median duration of ICU (36 vs. 28 days, p = 0.27) stay was longer in patients with RRT. An ICU mortality rate in patients with RRT in 69% (n = 44) and in patients without RRT of 56% (n = 27) was observed (p = 0.23). CONCLUSION Critically ill patients with severe SARS-CoV-2 related ARDS requiring vv-ECMO are at high risk of early acute kidney injury. Early-AKI is associated with age and severity of illness, and presents with high need for RRT. Mortality in patients with RRT was comparable to patients without RRT.
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Affiliation(s)
- Kevin Roedl
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Silvia De Rosa
- Centre for Medical Sciences, CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Marlene Fischer
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Josephine Braunsteiner
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian Schmidt-Lauber
- III. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Research Center On Rare Kidney Diseases (RECORD), University Hospital Erlangen, Erlangen, Germany
| | - Dominik Jarczak
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Tobias B Huber
- III. Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Dominic Wichmann
- Department of Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Li F, He M, Zhou M, Lai Y, Zhu Y, Liu Z, Wang Y, Wang Y. Association of C-reactive protein with mortality in Covid-19 patients: a secondary analysis of a cohort study. Sci Rep 2023; 13:20361. [PMID: 37990060 PMCID: PMC10663442 DOI: 10.1038/s41598-023-47680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/16/2023] [Indexed: 11/23/2023] Open
Abstract
Our study aimed to explore the association between serum C-reactive protein (CRP) and COVID-19 mortality. This is a retrospective cohort study of all patients admitted to 4 hospitals within the Montefiore Health System between March 1 and April 16, 2020, with SARS-CoV-2 infection. All-cause mortality were collected in 7 May 2020. The mortality risk was estimated using Cox proportional hazards models. Of the 3545 patients with a median age of 63.7 years, 918 (25.9%) died within the time of cohort data collection after admission. When the CRP was < 15.6 mg/L, the mortality rate increased with an adjusted HR of 1.57 (95% CI 1.30-1.91, P < 0.0001) for every 10 mg/L increment in the CRP. When the CRP was ≥ 15.6 mg/L, the mortality rate increased with an adjusted HR of 1.11 (95% CI 0.99-1.24, P = 0.0819) for every 10 mg/L increment in the CRP. For patients with COVID-19, the association between the CRP and the mortality risk was curve and had a saturation effect. When the CRP was small, the mortality rate increased significantly with the increase of CRP. When CRP > 15.6 mg/L, with the increase of CRP, the mortality rate increases relatively flat.
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Affiliation(s)
- Fei Li
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China
| | - Mingjun He
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China
| | - Mingchao Zhou
- Department of Rehabilitation, Futian District, Shenzhen Second People's Hospital/Health Science Centre, The First Affiliated Hospital, School of Medicine, Shenzhen University, No. 3002, Sungang Road, Shenzhen, 518035, Guangdong, China
| | - Yuyao Lai
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China
| | - Yongjie Zhu
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China
| | - Ziji Liu
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China
| | - Yulong Wang
- Department of Rehabilitation, Futian District, Shenzhen Second People's Hospital/Health Science Centre, The First Affiliated Hospital, School of Medicine, Shenzhen University, No. 3002, Sungang Road, Shenzhen, 518035, Guangdong, China.
| | - Yao Wang
- Department of Rehabilitation Medicine, Dapeng New District Nan'ao People's Hospital, No. 6, Renmin Road, Nanao Street, Dapeng New District, Shenzhen, 518121, Guangdong, China.
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Er AG, Ding DY, Er B, Uzun M, Cakmak M, Sadee C, Durhan G, Ozmen MN, Tanriover MD, Topeli A, Son YA, Tibshirani R, Unal S, Gevaert O. Multimodal Biomedical Data Fusion Using Sparse Canonical Correlation Analysis and Cooperative Learning: A Cohort Study on COVID-19. RESEARCH SQUARE 2023:rs.3.rs-3569833. [PMID: 38045288 PMCID: PMC10690316 DOI: 10.21203/rs.3.rs-3569833/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Through technological innovations, patient cohorts can be examined from multiple views with high-dimensional, multiscale biomedical data to classify clinical phenotypes and predict outcomes. Here, we aim to present our approach for analyzing multimodal data using unsupervised and supervised sparse linear methods in a COVID-19 patient cohort. This prospective cohort study of 149 adult patients was conducted in a tertiary care academic center. First, we used sparse canonical correlation analysis (CCA) to identify and quantify relationships across different data modalities, including viral genome sequencing, imaging, clinical data, and laboratory results. Then, we used cooperative learning to predict the clinical outcome of COVID-19 patients. We show that serum biomarkers representing severe disease and acute phase response correlate with original and wavelet radiomics features in the LLL frequency channel (corr(Xu1, Zv1) = 0.596, p-value < 0.001). Among radiomics features, histogram-based first-order features reporting the skewness, kurtosis, and uniformity have the lowest negative, whereas entropy-related features have the highest positive coefficients. Moreover, unsupervised analysis of clinical data and laboratory results gives insights into distinct clinical phenotypes. Leveraging the availability of global viral genome databases, we demonstrate that the Word2Vec natural language processing model can be used for viral genome encoding. It not only separates major SARS-CoV-2 variants but also allows the preservation of phylogenetic relationships among them. Our quadruple model using Word2Vec encoding achieves better prediction results in the supervised task. The model yields area under the curve (AUC) and accuracy values of 0.87 and 0.77, respectively. Our study illustrates that sparse CCA analysis and cooperative learning are powerful techniques for handling high-dimensional, multimodal data to investigate multivariate associations in unsupervised and supervised tasks.
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Affiliation(s)
- Ahmet Gorkem Er
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, Stanford, CA, 94305, USA
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, Ankara, 06800, Türkiye
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Daisy Yi Ding
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA
| | - Berrin Er
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Mertcan Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Mehmet Cakmak
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Christoph Sadee
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Gamze Durhan
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Arzu Topeli
- Department of Internal Medicine, Division of Intensive Care Medicine, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Yesim Aydin Son
- Department of Health Informatics, Graduate School of Informatics, Middle East Technical University, Ankara, 06800, Türkiye
| | - Robert Tibshirani
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA
- Department of Statistics, Stanford University, Stanford, CA, 94305, USA
| | - Serhat Unal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, 06230, Türkiye
| | - Olivier Gevaert
- Stanford Center for Biomedical Informatics Research (BMIR), Department of Medicine, Stanford University, Stanford, CA, 94305, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, 94305, USA
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225
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Xu Q, Li F, Chen X. Factors Affecting Mortality in Elderly Hypertensive Hospitalized Patients with COVID-19: A Retrospective Study. Clin Interv Aging 2023; 18:1905-1921. [PMID: 38020447 PMCID: PMC10674107 DOI: 10.2147/cia.s431271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Corona Virus Disease 2019 (COVID-19) endangers the health and survival of the elderly. We tried to explore factors especially kidney function which affected mortality in elderly hypertensive patients with COVID-19. Methods We conducted a retrospective research of 748 COVID-19 elderly patients (≥65 years old) at Zhejiang Hospital. This study compared demographic data, laboratory values, comorbidities, treatments, and clinical outcomes of hypertension and non-hypertension participants, and subgroup analysis of age and frailty was conducted in the hypertension population. Survival analysis was used to determine risk factors for death in elderly patients with COVID-19. Results Our study revealed that the elderly hypertensive patients with COVID-19 had higher blood urea nitrogen (BUN), serum uric acid (UA), serum creatinine (Scr), lower estimated glomerular filtration rate (eGFR), higher incidence of severity, admission to intensive care unit (ICU) and death, and longer in-hospital stay than non-hypertensive patients, which also occurred in the very elderly hypertensive patients compared with younger hypertensive patients and frail hypertensive patients compared with no-frail hypertensive patients. In addition, the prevalence of acute kidney injury (AKI) was higher in the oldest old hypertensive patients and frail hypertensive patients. Multivariate survival analysis indicated that the independent risk factors for death from COVID-19 were age ≥80 years, heart failure, antiviral therapy, calcium channel blocker (CCB) therapy, mechanical ventilation, AKI, and eGFR<60 mL/min per 1.73 m2. Conclusion The results of the present study suggested that the elderly hypertensive patients with COVID-19 would have more serious kidney injury, more serious disease progression and higher mortality, which also occurred in very elderly and frailty subgroup. Kidney dysfunction was closely related to mortality in elderly patients with COVID-19.
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Affiliation(s)
- Qun Xu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Fangzhou Li
- Department of Geriatrics, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Xujiao Chen
- Department of Geriatrics, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
- Zhejiang Hospital, Hangzhou, Zhejiang Province, People's Republic of China
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Alizad G, Ayatollahi AA, Shariati Samani A, Samadizadeh S, Aghcheli B, Rajabi A, Nakstad B, Tahamtan A. Hematological and Biochemical Laboratory Parameters in COVID-19 Patients: A Retrospective Modeling Study of Severity and Mortality Predictors. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7753631. [PMID: 38027038 PMCID: PMC10676280 DOI: 10.1155/2023/7753631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/08/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Background It is well known that laboratory markers could help in identifying risk factors of severe illness and predicting outcomes of diseases. Here, we performed a retrospective modeling study of severity and mortality predictors of hematological and biochemical laboratory parameters in Iranian COVID-19 patients. Methods Data were obtained retrospectively from medical records of 564 confirmed Iranian COVID-19 cases. According to the disease severity, the patients were categorized into two groups (severe or nonsevere), and based on the outcome of the disease, patients were divided into two groups (recovered or deceased). Demographic and laboratory data were compared between groups, and statistical analyses were performed to define predictors of disease severity and mortality in the patients. Results The study identified a panel of hematological and biochemical markers associated with the severe outcome of COVID-19 and constructed different predictive models for severity and mortality. The disease severity and mortality rate were significantly higher in elderly inpatients, whereas gender was not a determining factor of the clinical outcome. Age-adjusted white blood cells (WBC), platelet cells (PLT), neutrophil-to-lymphocyte ratio (NLR), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), erythrocyte sedimentation rate (ESR), mean corpuscular hemoglobin (MCHC), blood urea nitrogen (BUN), and creatinine (Cr) also showed high accuracy in predicting severe cases at the time of hospitalization, and logistic regression analysis suggested grouped hematological parameters (age, WBC, NLR, PLT, HGB, and international normalized ratio (INR)) and biochemical markers (age, BUN, and lactate dehydrogenase (LDH)) as the best models of combined laboratory predictors for severity and mortality. Conclusion The findings suggest that a panel of several routine laboratory parameters recorded on admission could be helpful for clinicians to predict and evaluate the risk of disease severity and mortality in COVID-19 patients.
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Affiliation(s)
- Ghazaleh Alizad
- Department of Immunology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Asghar Ayatollahi
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | | | - Saeed Samadizadeh
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Bahman Aghcheli
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdolhalim Rajabi
- Environmental Health Research Center, Biostatistics & Epidemiology Department, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Britt Nakstad
- Division of Paediatric and Adolescent Medicine, University of Oslo, Oslo, Norway
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Alireza Tahamtan
- School of International, Golestan University of Medical Sciences, Gorgan, Iran
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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Taks EJ, Moorlag SJ, Föhse K, Simonetti E, van der Gaast-de Jongh CE, van Werkhoven CH, Bonten MJ, Oever JT, de Jonge MI, van de Wijgert JH, Netea MG. The impact of Bacillus Calmette-Guérin vaccination on antibody response after COVID-19 vaccination. iScience 2023; 26:108062. [PMID: 37860692 PMCID: PMC10583058 DOI: 10.1016/j.isci.2023.108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/10/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023] Open
Abstract
Earlier studies showed that BCG vaccination improves antibody responses of subsequent vaccinations. Similarly, in older volunteers we found an increased IgG receptor-binding domain (RBD) concentration after SARS-CoV-2 infection if they were recently vaccinated with BCG. This study aims to assess the effect of BCG on the serum antibody concentrations induced by COVID-19 vaccination in a population of adults older than 60 years. Serum was collected from 1,555 participants of the BCG-CORONA-ELDERLY trial a year after BCG or placebo, and we analyzed the anti-SARS-CoV-2 antibody concentrations using a fluorescent-microsphere-based multiplex immunoassay. Individuals who received the full primary COVID-19 vaccination series before serum collection and did not test positive for SARS-CoV-2 between inclusion and serum collection were included in analyses (n = 945). We found that BCG vaccination before first COVID-19 vaccine (median 347 days [IQR 329-359]) did not significantly impact the IgG RBD concentration after COVID-19 vaccination in an older European population.
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Affiliation(s)
- Esther J.M. Taks
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simone J.C.F.M. Moorlag
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Konstantin Föhse
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elles Simonetti
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Christa E. van der Gaast-de Jongh
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelis H. van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc J.M. Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap ten Oever
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marien I. de Jonge
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Mihai G. Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Department for Immunology and Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, Germany
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Peng B, Li J, Chen M, Yang X, Hao M, Wu F, Yang Z, Liu D. Clinical value of glucocorticoids for severe community-acquired pneumonia: A systematic review and meta-analysis based on randomized controlled trials. Medicine (Baltimore) 2023; 102:e36047. [PMID: 37986401 PMCID: PMC10659673 DOI: 10.1097/md.0000000000036047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (sCAP) is characterized by severe symptoms and a poor prognosis, especially with the recent global impact of novel coronavirus in recent years. The use of glucocorticoids in sCAP is currently a subject of debate. To evaluate the clinical efficacy and safety of glucocorticoids and provide guidance for their rational use in clinical practice, we conducted this study. METHODS We searched PubMed, Web of Science, and China National Knowledge Infrastructure using the following search terms: "pneumonia", "pneumonias", "Pulmonary Inflammation", "Pulmonary Inflammations", "Lung Inflammation", and "Lung Inflammations". The primary outcomes included mortality and the length of hospital stay. The secondary outcomes included the duration of mechanical ventilation, duration of vasoactive drug use, gastrointestinal bleeding, and multiple infections. The Cochrane Collaboration was used to assess the risk of bias of the included studies. Stata/MP14 was used for meta-analysis. RESULTS These studies contained information on 1252 patients who received glucocorticoids and 1280 patients who did not. Meta-analysis showed that there was no difference in terms of mortality [risk ratio (RR) = 0.93, 95% confidence interval (CI): 0.81-1.07, P > .05], gastrointestinal bleeding (RR = 1.38, 95% CI: 0.83-2.30, P < .05), multiple infections (RR = 1.17, 95% CI: 0.90-1.53, P > .05) and length of hospital stay (mean difference [MD] = -0.87, 95% CI: -2.35 to 0.61, P > .05) between the hormonal and nonhormonal groups. However, there was a significant difference in the duration of mechanical ventilation (MD = -1.54; 95% CI, -1.89 to -1.12, P < .05) and the duration of use of vasoactive drugs (MD = -14.09, 95% CI: -15.72 to -12.46, P < .05). CONCLUSION Glucocorticoids reduced the duration of mechanical ventilation duration and vasoactive drug use in sCAP patients without increasing the risk of adverse events including hyperglycemia and multiple infections. However, there was no significant difference in mortality or length of hospital stay in sCAP patients between glucocorticoid and non-glucocorticoid groups. Glucocorticoids could be recommended for patients with sCAP with respiratory failure or hemodynamic instability.
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Affiliation(s)
- Biao Peng
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Jin Li
- Medical College of Jishou University, Jishou, China
| | - Minwei Chen
- Department of Critical Care Medicine, Anhua County People’s Hospital, Anhua, China
| | - Xianghui Yang
- Department of Oncology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Meng Hao
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Feifei Wu
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - ZhiChao Yang
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Da Liu
- Department of Respiratory and Critical Care Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Wałaszek M, Serwacki P, Cholewa Z, Kosiarska A, Świątek-Kwapniewska W, Kołpa M, Rafa E, Słowik R, Nowak K, Różańska A, Wójkowska-Mach J. Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients. BMC Pulm Med 2023; 23:443. [PMID: 37974141 PMCID: PMC10652561 DOI: 10.1186/s12890-023-02743-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Healthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients. METHODS The study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases. RESULTS The study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084-4.806), p < 0.001. CONCLUSIONS Patients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.
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Affiliation(s)
- Marta Wałaszek
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Piotr Serwacki
- St Luke Regional Hospital in Tarnów, ul. Lwowska 178A, Tarnów, 33-100, Poland
| | - Zbigniew Cholewa
- St Luke Regional Hospital in Tarnów, ul. Lwowska 178A, Tarnów, 33-100, Poland
| | - Alicja Kosiarska
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | | | - Małgorza Kołpa
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Elżbieta Rafa
- University of Applied Sciences in Nowy Sącz, ul. Staszica 1, Nowy Sącz, 33-300, Poland
| | - Róża Słowik
- University of Applied Sciences in Tarnów, ul. Mickiewicza 8, Tarnów, 33-100, Poland
| | - Karolina Nowak
- Department of Microbiology, Jagiellonian University Medical College, Czysta str. 18, Krakow, 31-121, Poland
| | - Anna Różańska
- Department of Microbiology, Jagiellonian University Medical College, Czysta str. 18, Krakow, 31-121, Poland.
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Jagiellonian University Medical College, Czysta str. 18, Krakow, 31-121, Poland
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Abdelouahed M, Yateem D, Fredericks S. Fc γRIIa - dependent platelet activation identified in COVID-19 vaccine-induced immune thrombotic thrombocytopenia-, heparin-induced thrombocytopenia, streptokinase- and anisoylated plasminogen-streptokinase activator complex-induced platelet activation. Front Cardiovasc Med 2023; 10:1282637. [PMID: 38034388 PMCID: PMC10684751 DOI: 10.3389/fcvm.2023.1282637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which was caused by the coronavirus - severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was globally responsible for remarkable morbidity and mortality. Several highly effective vaccines for COVID-19 were developed and disseminated worldwide within an unprecedented timescale. Rare but dangerous clotting and thrombocytopenia events, and subsequent coagulation abnormalities, have been reported after massive vaccination against SARS-CoV-2. Soon after their global rollout, reports of a morbid clinical syndrome following vaccination with adenovirus-DNA-based vaccines appeared. In the spring of 2021, reports of a novel, rare and morbid clinical syndrome, with clinically devastating and fatal complication after vaccination with adenovirus-based coronavirus vaccines (Janssen/Johnson & Johnson and Astra-Zeneca vaccines) led to a brief suspension of their use by several countries. Those complications were associated with unusual cerebral and splanchnic venous thrombosis, and circulating autoantibodies directed against anti-platelet factor 4 (PF4), a protein secreted from platelets, leading to the designation: Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT). The reported VITT incidence remains very low and does not affect the overall benefit of immunization, however, if left untreated, VITT can be debilitating or even fatal. VITT resembled specific adverse drugs' reactions that also involved the production of autoantibodies and subsequent abnormal platelet activation through platelet FcγRIIa. These unusual but well-documented drug reactions were heparin-induced thrombocytopenia (HIT), streptokinase- (SK), and anisoylated plasminogen-streptokinase activator complex- (APSAC) associated with platelet-activating antibodies. There was considerable overlapping of clinical features between VITT, COVID-19 and these adverse drugs' reactions. We review the phenomenon of VITT against the backdrop of shared and common mechanisms that underlie HIT-, SK-, and APSAC-platelet FcγRIIa-dependent platelet activation. An understanding of VITT's pathogenesis may be achieved by comparing and contrasting VITT-, HIT-, SK- and APSAC-induced platelet activation mechanisms, their respective physiopathology and similarities. Discussing these conditions in parallel provides insight into complex immunological disorders and diseases associated with abnormal hemostasis and thrombosis in particular.
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Affiliation(s)
- Mustapha Abdelouahed
- Department of Medical Sciences and Education, Boston University School of Medicine, Boston, MA, United States
| | - Dana Yateem
- School of Medicine, The Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Sayh, Muharraq Governorate, Bahrain
| | - Salim Fredericks
- School of Medicine, The Royal College of Surgeons in Ireland, Medical University of Bahrain, Al Sayh, Muharraq Governorate, Bahrain
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Moreira-de-Oliveira ME, de Menezes GB, Pozza A, Massa L, Albertella L, Prestia D, Olcese M, Fontenelle LF, Marazziti D. A "transatlantic" follow-up study of the impact of the COVID-19 pandemic on patients with obsessive-compulsive disorder. J Affect Disord 2023; 341:313-318. [PMID: 37661060 DOI: 10.1016/j.jad.2023.08.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Obsessive-compulsive symptom fluctuations may be contingent on the number of stressful pandemic-related events and the resilience characterizing different cultures. We investigated the influence of the pandemic on symptom changes in a sample of obsessive-compulsive disorder (OCD) patients from Brazil and Italy, two countries that were highly affected by the outbreak. METHODS Ninety-one OCD outpatients were evaluated at baseline and about one year later. Thirty of them were assessed in Brazil and 61 in Italy. Socio-demographic variables, symptoms' severity and the number of stressful pandemic-related events were collected. Comparisons between countries' samples were performed, and a linear regression examined whether the country of origin, demographic features and the number of stressful events were able to predict the symptoms' severity at the follow-up. RESULTS Brazilian patients experienced more stressful pandemic-related events than Italian patients (p = 0.018). However, along with higher age (p < 0.01) and increased severity of symptoms at baseline (p < 0.01), lower number of events predicted increased symptoms' severity after one year (p < 0.01). Country of origin was not a significant predictor of severity. LIMITATIONS Small number of subjects; lack of information regarding duration of illness; and potential sample differences between countries. CONCLUSIONS During the pandemic, the occurrence of more stressful pandemic-related events was associated with decreased severity of patients' OCD symptoms. Nevertheless, older patients and those with more severe symptoms seemed prone to exhibit increased OCD severity at follow-up.
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Affiliation(s)
- Maria Eduarda Moreira-de-Oliveira
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy
| | - Lucia Massa
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health, Monash University, Australia
| | | | - Martina Olcese
- Department of Education Sciences, University of Genoa, Genoa, Italy
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy; Saint Camillus-Unicamillus International University of Medical Sciences, Rome, Italy
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232
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Adzic-Vukicevic T, Markovic D, Reljic A, Brkovic V. What did we learn about tocilizumab use against COVID-19? A single-center observational study from an intensive care unit in Serbia. Front Med (Lausanne) 2023; 10:1253135. [PMID: 38034537 PMCID: PMC10683091 DOI: 10.3389/fmed.2023.1253135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/24/2023] [Indexed: 12/02/2023] Open
Abstract
Background Selection of effective and safe therapy for management of patients with coronavirus disease is challenging. Tocilizumab (TZB) has emerged as a potential treatment option for COVID-19. Several aspects regarding Tocilizumab treatment remain uncertain, such as the optimal timing for its administration and the safety profile, including the potential risk of infections. The aim of the study is to present the clinical characteristics of patients with COVID-19 following the application of Tocilizumab. Methods This is a retrospective analysis of 121 patients with severe forms of COVID-19 previously treated with Tocilizumab was conducted. All patients were admitted to intensive care units (ICUs). Results Of 121 patients, the majority were men 72 (59.5%) with a median age at presentation of 65 ± 13 years. Only 9 (7.43%) patients were without comorbidities, while the other 112 (92.55%) had two or more comorbidities. Almost all of the 120 patients (99.2%) needed oxygen therapy, such as nasal cannulas in 110 (90.9%) patients, high flow nasal catheter (HFNC) in 4 (3.3%) patients, and continuous positive airway pressure (CPAP) in 5 (4.1%) patients while 1 patient was intubated at the time of hospital admission. The average time from Tocilizumab application to admission to the ICU was 3 days. During clinical deterioration, almost half 57 (47.1%) of the patients were intubated, and 52 (82.5%) of these intubated patients (p < 0.001) had lethal outcomes. The most significant predictors for a lethal outcome according to multivariate analysis were diabetes mellitus (p < 0.001) followed by a subsequent elevation in C-reactive protein levels (CRP; p < 0.002) and ferritin (p < 0.013) after Tocilizumab application. Bloodstream infections were found in 20 (16.5%) patients, most frequently with Gram-negative pathogens like Acinetobacter spp. as in 12 (18.6%) patients, Klebsiella spp. in 6 (8%) patients, and Pseudomonas spp. in 2 (3.2%) patients. Urine culture isolates were found in 9 (7.43%) patients, with Candida spp. being most frequently isolated in 7 (5.8%) patients, followed by Klebsiella spp. and Pseudomonas spp. in 1 patient each (0.8%). Significantly lower survival was seen in patients with proven infection. Conclusion The benefit of tocilizumab was not found in our study. The high mortality rate among intubated patients after Tocilizumab use suggests appropriate patient selection and monitoring and emphasizes the risk of superinfections. Diabetes mellitus, increased levels of CRP, and ferritin were identified as the most significant predictors of poor outcomes in contrast to increased levels of IL-6.
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Affiliation(s)
- Tatjana Adzic-Vukicevic
- Clinic of Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejan Markovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Anesthesiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandar Reljic
- Covid Hospital Batajnica, University Clinical Center of Serbia, Belgrade, Serbia
| | - Voin Brkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
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233
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Azagew AW, Beko ZW, Ferede YM, Mekonnen HS, Abate HK, Mekonnen CK. Global prevalence of COVID-19-induced acute respiratory distress syndrome: systematic review and meta-analysis. Syst Rev 2023; 12:212. [PMID: 37957723 PMCID: PMC10644454 DOI: 10.1186/s13643-023-02377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is potentially a fatal form of respiratory failure among COVID-19 patients. Globally, there are inconsistent findings regarding ARDS among COVID-19 patients. Therefore, this study aimed to estimate the pooled prevalence of COVID-19-induced ARDS among COVID-19 patients worldwide. METHODS To retrieve relevant studies, the authors searched Embase, MEDLINE, PubMed, Web of Science, Cochrane Library, Google, and Google Scholar using a combination of search terms. The search was conducted for articles published from December 2019 to September 2022. Articles were searched and screened by title (ti), abstract (ab), and full-text (ft) by two reviewers independently. The quality of each included article was assessed using the Newcastle-Ottawa Assessment Scale. Data were entered into Microsoft Word and exported to Stata version 14 for analysis. Heterogeneity was detected using the Cochrane Q statistics and I-square (I2). Then the sources of variations were identified by subgroup and meta-regression analysis. A random effect meta-analysis model was used. The publication bias was detected using the graphic asymmetry test of the funnel plot and/or Egger's test (p value < 0.05). To treat the potential publication bias, trim and fill analysis were computed. The protocol has been registered in an international database, the Prospective Register of Systematic Reviews (PROSPERO) with reference number: CRD42023438277. RESULTS A total of 794 studies worldwide were screened for their eligibility. Of these 11 studies with 2845 participants were included in this systematic review and meta-analysis. The overall pooled prevalence of COVID-19-induced ARDS in the world was found to be 32.2% (95%CI = 27.70-41.73%), I2 = 97.3%, and p value < 0.001). CONCLUSION The pooled prevalence of COVID-19-induced ARDS was found to be high. The virus remains a global burden because its genetic causes are constantly changing or it mutated throughout the pandemic to emerge a new strain of infection. Therefore, interventions such as massive vaccination, early case detection, screening, isolation, and treatment of the cases need to be implemented to tackle its severity.
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Affiliation(s)
- Abere Woretaw Azagew
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zerko Wako Beko
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yohannes Mulu Ferede
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Sewunet Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie Abate
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Al Saihati HA, Hussein HAM, Thabet AA, Wardany AA, Mahmoud SY, Farrag ES, Mohamed TIA, Fathy SM, Elnosary ME, Sobhy A, Ahmed AE, El-Adly AM, El-Shenawy FS, Elsadek AA, Rayan A, Zahran ZAM, El-Badawy O, El-Naggar MGM, Afifi MM, Zahran AM. Memory T Cells Discrepancies in COVID-19 Patients. Microorganisms 2023; 11:2737. [PMID: 38004749 PMCID: PMC10673271 DOI: 10.3390/microorganisms11112737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
The immune response implicated in Coronavirus disease 2019 (COVID-19) pathogenesis remains to be fully understood. The present study aimed to clarify the alterations in CD4+ and CD8+ memory T cells' compartments in SARS-CoV-2-infected patients, with an emphasis on various comorbidities affecting COVID-19 patients. Peripheral blood samples were collected from 35 COVID-19 patients, 16 recovered individuals, and 25 healthy controls, and analyzed using flow cytometry. Significant alterations were detected in the percentage of CD8+ T cells and effector memory-expressing CD45RA CD8+ T cells (TEMRA) in COVID-19 patients compared to healthy controls. Interestingly, altered percentages of CD4+ T cells, CD8+ T cells, T effector (TEff), T naïve cells (TNs), T central memory (TCM), T effector memory (TEM), T stem cell memory (TSCM), and TEMRA T cells were significantly associated with the disease severity. Male patients had more CD8+ TSCMs and CD4+ TNs cells, while female patients had a significantly higher percentage of effector CD8+CD45RA+ T cells. Moreover, altered percentages of CD8+ TNs and memory CD8+CD45RO+ T cells were detected in diabetic and non-diabetic COVID-19 patients, respectively. In summary, this study identified alterations in memory T cells among COVID-19 patients, revealing a sex bias in the percentage of memory T cells. Moreover, COVID-19 severity and comorbidities have been linked to specific subsets of T memory cells which could be used as therapeutic, diagnostic, and protective targets for severe COVID-19.
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Affiliation(s)
- Hajir A. Al Saihati
- Department of Clinical Laboratory Sciences, College of Applied Medical Science, University of Hafr Al Batin, P.O. Box 1803, Hafar Al Batin 31991, Saudi Arabia; (H.A.A.S.); (E.S.F.)
| | - Hosni A. M. Hussein
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt; (A.A.W.); (T.I.A.M.); (A.M.E.-A.); (F.S.E.-S.)
| | - Ali A. Thabet
- Department of Zoology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt;
| | - Ahmed A. Wardany
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt; (A.A.W.); (T.I.A.M.); (A.M.E.-A.); (F.S.E.-S.)
| | - Sabry Y. Mahmoud
- Biology Department, College of Sciences, University of Hafr Al-Batin, Hafr Al-Batin 31991, Saudi Arabia;
- Department of Microbiology, Sohag University, Sohag 82524, Egypt
| | - Eman S. Farrag
- Department of Clinical Laboratory Sciences, College of Applied Medical Science, University of Hafr Al Batin, P.O. Box 1803, Hafar Al Batin 31991, Saudi Arabia; (H.A.A.S.); (E.S.F.)
- Department of Microbiology, South Valley University, Qena 83523, Egypt
| | - Taha I. A. Mohamed
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt; (A.A.W.); (T.I.A.M.); (A.M.E.-A.); (F.S.E.-S.)
| | - Samah M. Fathy
- Department of Zoology, Faculty of Science, Fayoum University, Fayoum 63514, Egypt;
| | - Mohamed E. Elnosary
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Nasr City 11884, Egypt; (M.E.E.); (M.M.A.)
| | - Ali Sobhy
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt; (A.S.); (A.E.A.)
| | - Abdelazeem E. Ahmed
- Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut 71524, Egypt; (A.S.); (A.E.A.)
| | - Ahmed M. El-Adly
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt; (A.A.W.); (T.I.A.M.); (A.M.E.-A.); (F.S.E.-S.)
| | - Fareed S. El-Shenawy
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut 71524, Egypt; (A.A.W.); (T.I.A.M.); (A.M.E.-A.); (F.S.E.-S.)
| | | | - Amal Rayan
- Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | | | - Omnia El-Badawy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Mohamed G. M. El-Naggar
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut 71515, Egypt; (M.G.M.E.-N.); (A.M.Z.)
| | - Magdy M. Afifi
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Nasr City 11884, Egypt; (M.E.E.); (M.M.A.)
| | - Asmaa M. Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut 71515, Egypt; (M.G.M.E.-N.); (A.M.Z.)
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Hu Y, Liu Y, Zheng H, Liu L. Risk Factors for Long COVID in Older Adults. Biomedicines 2023; 11:3002. [PMID: 38002002 PMCID: PMC10669899 DOI: 10.3390/biomedicines11113002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
As time has passed following the COVID-19 pandemic, individuals infected with SARS-CoV-2 have gradually exhibited a variety of symptoms associated with long COVID in the postacute phase of infection. Simultaneously, in many countries worldwide, the process of population aging has been accelerating. Within this context, the elderly population has not only become susceptible and high-risk during the acute phase of COVID-19 but also has considerable risks when confronting long COVID. Elderly individuals possess specific immunological backgrounds, and during the process of aging, their immune systems can enter a state known as "immunosenescence". This further exacerbates "inflammaging" and the development of various comorbidities in elderly individuals, rendering them more susceptible to long COVID. Additionally, long COVID can inflict both physical and mental harm upon elderly people, thereby reducing their overall quality of life. Consequently, the impact of long COVID on elderly people should not be underestimated. This review seeks to summarize the infection characteristics and intrinsic factors of older adults during the COVID-19 pandemic, with a focus on the physical and mental impact of long COVID. Additionally, it aims to explore potential strategies to mitigate the risk of long COVID or other emerging infectious diseases among older adults in the future.
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Affiliation(s)
| | | | | | - Longding Liu
- Key Laboratory of Systemic Innovative Research on Virus Vaccines, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming 650118, China; (Y.H.); (Y.L.); (H.Z.)
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Bhargava A, Knapp JD. Immunological Misfiring and Sex Differences/Similarities in Early COVID-19 Studies: Missed Opportunities of Making a Real IMPACT. Cells 2023; 12:2591. [PMID: 37998327 PMCID: PMC10670326 DOI: 10.3390/cells12222591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 11/25/2023] Open
Abstract
COVID-19-associated intensive care unit (ICU) admissions were recognized as critical health issues that contributed to morbidity and mortality in SARS-CoV-2-infected patients. Severe symptoms in COVID-19 patients are often accompanied by cytokine release syndrome. Here, we analyzed publicly available data from the Yale IMPACT cohort to address immunological misfiring and sex differences in early COVID-19 patients. In 2020, SARS-CoV-2 was considered far more pathogenic and lethal than other circulating respiratory viruses, and the inclusion of SARS-CoV-2 negative patients in IMPACT cohorts confounds many findings. We ascertained the impact of several important biological variables such as days from symptom onset (DFSO); pre-existing risk factors, including obesity; and early COVID-19 treatments on significantly changed immunological measures in ICU-admitted COVID-19 patients that survived versus those that did not. Deceased patients had 19 unique measures that were not shared with ICU patients including increased granzyme-B-producing GzB+CD8+ T cells and interferon-γ. Male COVID-19 patients in ICU experienced many more changes in immunological and clinical measures than female ICU patients (25% vs. ~16%, respectively). A total of 13/124 measures including CCL5, CCL17, IL-18, IFNα2, Fractalkine, classical monocytes, T cells, and CD4Temra exhibited significant sex differences in female vs. male COVID-19 patients. A total of nine measures including IL-21, CCL5, and CD4Temra differed significantly between female and male healthy controls. Immunosuppressed patients experienced the most decreases in CD4Temra and CD8Tem cell numbers. None of the early COVID-19 treatments were effective in reducing levels of IL-6, a major component of the cytokine storm. Obesity (BMI >30) was the most impactful risk factor for COVID-19-related deaths and worst clinical outcomes. Our analysis highlights the contribution of biological sex, risk factors, and early treatments with respect to COVID-19-related ICU admission and progression to morbidity and mortality.
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Affiliation(s)
- Aditi Bhargava
- Center for Reproductive Sciences and Department of ObGyn, University of California San Francisco, San Francisco, CA 94143, USA
- Aseesa Inc., Hillsborough, CA 94010, USA;
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Mirsaliyev M, Kashikova K, Zholdybayeva A, Myrzakhmetova B, Isbassarova A, Petrova N, Kozhamberdiyeva D. Exploring Prognostically Significant Factors in COVID-19-Associated Pulmonary Fibrosis after Adaptive Lung Ventilation. Med J Islam Repub Iran 2023; 37:118. [PMID: 38145181 PMCID: PMC10744177 DOI: 10.47176/mjiri.37.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Indexed: 12/26/2023] Open
Abstract
Background Research data on hospitalized coronavirus 2019 (COVID-19) survivors indicate the persistence of symptoms, radiological abnormalities, and physiological disorders months after the initial infection. Given the scale of the ongoing pandemic, a substantial number of patients with severe residual pulmonary fibrosis (PF) and oxygen dependence are anticipated. Currently, the search for risk factors associated with the development of fibrotic radiological abnormalities after moderate to severe COVID-19 is underway. Furthermore, the extent to which computed tomography (CT) data correlate with postdischarge symptoms and physical functions remains unclear. This study aimed to characterize patients experiencing persistent pulmonary consequences after hospital discharge. We examined clinical, radiological, and laboratory predictors of pulmonary fibrosis after COVID-19 infection. Methods We retrospectively evaluated fibrosis-like lung changes and their prognostic factors in COVID-19 survivors. Our study included 77 patients with laboratory-confirmed COVID-19 who received inpatient treatment at City Clinical Hospital No. 1 in Almaty between November and December 2020. We assessed patients during the acute phase of the disease and again 6 to 8 months after discharge using high-resolution computed tomography (CT). Patients were classified into 2 cohorts based on semi-quantitative analysis of subsequently added tomograms-those with radiological fibrosis-like abnormalities (main group) and those who had recovered (control group). Results Parenchymal cords, irregular interfaces, reticulation, and traction bronchiectasis were common CT findings among all COVID-19 patients. Our study focused on patients who developed pulmonary fibrosis within 1 month after the onset of the disease. After 6 to 8 months, fibrosis-like lung changes persisted in 49.35% of patients (leading group), while 50.65% showed disease resolution (control group). Age, body mass index, high interleukin-6 (IL-6) levels, low IO levels, and the need for mechanical ventilation were identified as prognostic indicators for the persistence of pulmonary fibrosis. Conclusion Our study revealed that pulmonary function can return to normal in over half of COVID-19 patients 8 months after infection onset. Despite advancements in COVID-19 treatment, there remains a significant knowledge gap in managing long-term effects, especially pulmonary fibrosis. Continued clinical trials and research on post COVID-19 fibrosis are essential to prevent early mortality due to the long-term impacts on these patients.
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Affiliation(s)
| | | | | | | | | | - Natalya Petrova
- Caspian University, International School of Medicine, Kazakhstan
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Wang X, White E, Giacona F, Khurana A, Li Y, Christiani DC, Alladina JW. Serial laboratory biomarkers are associated with ICU outcomes in patients hospitalized with COVID-19. PLoS One 2023; 18:e0293842. [PMID: 37934759 PMCID: PMC10629639 DOI: 10.1371/journal.pone.0293842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/18/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Clinical utility of routinely measured serial biomarkers in predicting escalation of inpatient care intensity and mortality among hospitalized patients with COVID-19 remains unknown. METHODS This retrospective cohort study included patients with COVID-19 who admitted to the Massachusetts General Hospital between March and June 2020 and January to March 2021. White blood cell (WBC) count, platelet count, C-reactive protein (CRP), and D-dimer values were measured on days 1, 3, and 7 of admission. Clinical outcomes include 30- and 60-day morality, ICU transfer, and overall survival (OS) over a follow-up period of 90 days. The association between serial biomarkers and outcomes were assessed using multivariable logistic regression and Cox proportional hazards models. MEASUREMENTS AND MAIN RESULTS Of the 456 patients hospitalized with COVID-19, 199 (43.6%) were ICU, 179 (39.3%) were medical floor, and 78 (17.1%) were initially admitted to the medical floor and then transferred to the ICU. In adjusted analyses, each unit increase in the slope of CRP was associated with a 42% higher odds of ICU transfer after controlling for the initial admission level (OR = 1.42, 95% CI: 1.25-1.65, P < 0.001). Including serial change in CRP levels from initial level on admission achieved the greatest predictive accuracy for ICU transfer (AUC = 0.72, 95% CI: 0.64-0.79). CONCLUSIONS Serial change in CRP levels from admission is associated with escalations of inpatient care intensity and mortality among hospitalized patients with COVID-19.
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Affiliation(s)
- Xinan Wang
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Emma White
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Francesca Giacona
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Amita Khurana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Yi Li
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
| | - David C. Christiani
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jehan W. Alladina
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
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Primo MGS, da Silva LAA, de Carvalho VBL, de Azevedo MAF, Monteiro NVDN, Mendes VR, da Silva JKM, Oliveira ASDSS, Brito AKDS, Sales ALDCC, Mallet JRDS, Parente JML, de Matos Neto EM, Ferreira PMP, Arcanjo DDR, Martins MDCDCE. Relationship among Dietary Intake of Vitamin E, Lipid Peroxidation Markers, and C-Reactive Protein in Flu-Like Patients Diagnosed with COVID-19. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:8889213. [PMID: 39263681 PMCID: PMC11390186 DOI: 10.1155/2023/8889213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/05/2023] [Accepted: 09/30/2023] [Indexed: 09/13/2024]
Abstract
Objective This research aimed to assess the intake of vitamin E and its relationship with lipid peroxidation markers and C-reactive protein levels in patients with flu symptoms and COVID-19 diagnosis. Methods A cross-sectional study with 121 patients of both sexes assisted at two basic health units in the city of Teresina, Piauí, with COVID-19 diagnosis confirmed through real-time reverse transcription polymerase chain reaction, was performed between the 3rd and 7th days of flu symptoms. The global nutritional status and the measurement of waist circumference were assessed according to the World Health Organization recommendations. The dietary energy intake, macronutrients, and vitamin E consumption were assessed through the 24 hr food recall method. The malondialdehyde plasmatic concentration (MDA) was measured through the method of thiobarbituric acid-reactive substances. Myeloperoxidase (MPO) was assessed through the oxidation speed of the o-dianisidine substrate in the presence of hydrogen peroxide. C-reactive protein (CRP) levels were measured by a high-sensitivity immunoturbidimetry method. Results The most common symptoms reported by the participants were sore throat, fever, and cough. Regarding the global nutritional status evaluation, the majority of the sample had overweight. The dietary intake of vitamin E was 100% inadequate and presented a mild correlation (r = 0.197) with MDA, a redox status marker. No correlation was observed among MPO, CRP, and the dietary intake of vitamin E. Conclusion The dietary intake of vitamin E was related to MDA as the marker of redox status.
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Kidane K, Alemu ZA, Biratu TD, Juhar LH. Factors Associated with COVID-19 Severity Among Kidney Transplant and Non-Kidney Transplant Patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Int J Gen Med 2023; 16:5097-5108. [PMID: 37954659 PMCID: PMC10637368 DOI: 10.2147/ijgm.s423805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background The COVID-19 epidemic is a rapidly shifting situation that has resulted in significant regulatory reforms and widespread initiatives to deal with the initial crisis and its effects. The COVID-19 pandemic has had a significant impact on transplantation activities. The COVID-19 pandemic has caused various important challenges in the kidney transplant industry. Objective To identify the factors influencing COVID-19 severity in kidney transplant and non-kidney transplant patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods A comparative cross-sectional study was conducted. This study included 364 patients (182 kidney transplants and 182 non-kidney transplants). A systematic random sampling was used to select the respondents. Professional nurses collected data for this study using a data extraction tools. Data were analyzed by using SPSS version 25 software. A multivariable logistic regression analysis was performed to identify the association between independent variables and COVID-19 severity with adjusted odds ratio (AOR), and 95% CI for AOR and P-value for testing significance. Results This study included 364 patients. Off the total, 34.1% developed severe COVID-19. In Multivariable logistic regression analysis, patients with 60 years and above age groups (AOR = 4.73; 95% CI: 1.86, 12.02), aged 40-59 years (AOR = 2.70; 95% CI: 1.17, 6.22), chest congestion (AOR = 4.49; 95% CI: 2.37, 8.50), history of muscle or body aches (AOR = 0.47; 95% CI: 0.22, 0.99) shortness of breath (AOR = 3.03; 95% CI: 1.36, 6.74), changed or lost sense of taste or smell (AOR = 2.77; 95% CI: 1.34, 5.71), and muscle pain (AOR = 3.05; 95% CI: 1.40, 6.65) were significant variables associated with COVID-19 severity after adjusting for other variables. Conclusion The study revealed that 34.1% of patients had severe COVID-19. The majority of these patients underwent non-kidney transplants. Age groups and symptoms, such as chest congestion, shortness of breath, changed or lost sense of taste or smell, and muscle pain, were significant predictors of COVID-19 disease severity.
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Affiliation(s)
- Kal Kidane
- Kidney Transplantation Center, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Zewdie Aderaw Alemu
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tolesa Diriba Biratu
- School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Leja Hamza Juhar
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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ElNahid MS, Issac MSM, Sadek KM. Outcome of COVID-19 in Egyptian living-donor kidney transplant recipients and relation to maintenance immunosuppressive drugs: a pilot study. Sci Rep 2023; 13:19002. [PMID: 37923735 PMCID: PMC10624883 DOI: 10.1038/s41598-023-45750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) in kidney transplant recipients is a subject of much debate and became of interest to nephrologists amidst the pandemic. The main concerns are the influence of the chronic use of immunosuppressive drugs, the viral-related risk of acute rejection, and the long-term outcome of allograft function. This single-center prospective study included kidney transplant recipients with COVID-19 infection. Patients were maintained on immunosuppressive regimens. The severity of disease was defined as oxygen saturation < 94%, the need for hospitalization and/or hemodialysis, the occurrence of acute kidney injury (AKI), and mortality. Seventeen patients (54.8%) required hospital admission, four patients needed hemodialysis (12.9%), twelve patients (38.7%) had AKI, and three patients died (9.7%). Oxygen saturation < 94% showed a positive correlation with the presence of diabetes (p value 0.031) and a negative correlation with the maintenance steroid dose (p value 0.046). A negative correlation existed between the need for hemodialysis and average Cyclosporin level (p value 0.019) and between the need for hospitalization and average Tacrolimus level (p value 0.046). Severity of disease was associated with the presence of lymphopenia (p value 0.042), the cumulative steroid dose (p value 0.001), increased serum levels of LDH (p value 0.010), Ferritin (p value 0.020), AST (p value 0.047), and ALT (p value 0.006) and D-dimer levels more than 0.5 mg/L (p value 0.038). This study highlighted that the immunocompromised state of renal transplant recipients may not be regarded as a disadvantage in the setting of COVID-19 infection. Studies on a larger scale are needed to validate these results.
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Affiliation(s)
- Maggie Said ElNahid
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | | | - Khaled Marzouk Sadek
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Micheals K, Lee MJ, Al Snih S, Walsh BK, Rojas JD. The Effect of Oxygenation Impairment and Compliance on Mortality Among Subjects With COVID-19 Requiring Mechanical Ventilation. Respir Care 2023; 68:1565-1568. [PMID: 37280073 PMCID: PMC10589116 DOI: 10.4187/respcare.10776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Khamron Micheals
- School of Public and Population Health, University of Texas Medical Branch at Galveston, Galveston, Texas; and School of Health Professions, Department of Respiratory Care, University of Texas Medical Branch at Galveston, Galveston, Texas.
| | - Mi Jung Lee
- School of Health Professions, Department of Nutrition, Metabolism, and Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Soham Al Snih
- School of Population and Public Health, Department of Population Health and Health Disparities, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Brian K Walsh
- School of Health Professions, Department of Respiratory Care, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - José D Rojas
- School of Health Professions, Department of Respiratory Care, University of Texas Medical Branch at Galveston, Galveston, Texas
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Imai D, Ushigome E, Hamaguchi M, Hashimoto S, Fukui M. Factors associated with bleeding complications in patients with coronavirus disease 2019 admitted to intensive care units: A multicenter retrospective cohort study. J Diabetes Investig 2023; 14:1312-1317. [PMID: 37581471 PMCID: PMC10583641 DOI: 10.1111/jdi.14068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/07/2023] [Accepted: 07/23/2023] [Indexed: 08/16/2023] Open
Abstract
AIMS/INTRODUCTION Diabetes is a major risk factor for coronavirus disease 2019 (COVID-19) severity. We aimed to retrospectively investigate the rates of patients with no diabetes, untreated diabetes, treated diabetes, COVID-19-related diabetes and the factors associated with bleeding complications in a cohort of patients with severe COVID-19. MATERIALS AND METHODS This was a multicenter, retrospective, observational study. Participants were COVID-19 patients enrolled in the Cross-sectional ICU Information Search System (CRISIS) from February 2020 to March 2022. Patients were classified into four groups according to diabetes status and treatment status. Hemorrhagic complications were defined as bleeding requiring transfusion of four or more red blood cell units, a drop of hemoglobin of ≥2 g in 24 h and retroperitoneal, airway or intracranial bleeding. Logistic regression analysis was carried out to examine factors associated with bleeding complications. RESULTS A total of 1,076 patients were included in the analysis. The rates of patients in the no diabetes, untreated diabetes, treated diabetes and COVID-19-related diabetes groups were 17.4, 23.0, 23.9 and 35.7%, respectively. Bleeding complications were observed in 7.5% of all patients. Glycated hemoglobin level and renal failure were significantly correlated with bleeding complications (odds ratio 1.16, 95% confidence interval 1.02-1.33 and 2.77, 95% confidence interval 1.16-6.63, respectively). Patients with diabetes, including those with COVID-19-related diabetes, accounted for approximately 83% of all cases. CONCLUSIONS In patients with severe COVID-19 with high glycated hemoglobin and renal failure, we recommend additional attention to the course of COVID-19, given the risk of bleeding complications.
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Affiliation(s)
- Dan Imai
- Department of Endocrinology and Metabolism, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Satoru Hashimoto
- Department of Anesthesiology and Intensive Care MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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McEvoy NL, Friel O, Clarke J, Browne E, Geoghegan P, Budri A, Avsar P, Connolly S, Patton D, Curley GF, Moore Z. Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study. Nurs Crit Care 2023; 28:1115-1123. [PMID: 36221908 PMCID: PMC9875092 DOI: 10.1111/nicc.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). AIM This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. STUDY DESIGN This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. RESULTS In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). CONCLUSION The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. RELEVANCE TO CLINICAL PRACTICE The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.
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Affiliation(s)
- Natalie L. McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Oisin Friel
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Emmet Browne
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | | | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
| | - Gerard F. Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Beaumont HospitalDublinIreland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Health Sciences, Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Lida InstituteShanghaiChina
- Cardiff UniversityCardiffWalesUK
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Sobhani N, Mondani G, Roviello G, Catalano M, Sirico M, D'Angelo A, Scaggiante B, Generali D. Cancer management during the COVID-19 world pandemic. Cancer Immunol Immunother 2023; 72:3427-3444. [PMID: 37642709 PMCID: PMC10992624 DOI: 10.1007/s00262-023-03524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
Since 2019, the world has been experiencing an outbreak of a novel beta-coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV)-2. The worldwide spread of this virus has been a severe challenge for public health, and the World Health Organization declared the outbreak a public health emergency of international concern. As of June 8, 2023, the virus' rapid spread had caused over 767 million infections and more than 6.94 million deaths worldwide. Unlike previous SARS-CoV-1 and Middle East respiratory syndrome coronavirus outbreaks, the COVID-19 outbreak has led to a high death rate in infected patients; this has been caused by multiorgan failure, which might be due to the widespread presence of angiotensin-converting enzyme 2 (ACE2) receptors-functional receptors of SARS-CoV-2-in multiple organs. Patients with cancer may be particularly susceptible to COVID-19 because cancer treatments (e.g., chemotherapy, immunotherapy) suppress the immune system. Thus, patients with cancer and COVID-19 may have a poor prognosis. Knowing how to manage the treatment of patients with cancer who may be infected with SARS-CoV-2 is essential. Treatment decisions must be made on a case-by-case basis, and patient stratification is necessary during COVID-19 outbreaks. Here, we review the management of COVID-19 in patients with cancer and focus on the measures that should be adopted for these patients on the basis of the organs or tissues affected by cancer and by the tumor stage.
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Affiliation(s)
- Navid Sobhani
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Giuseppina Mondani
- Royal Infirmary Hospital, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Martina Catalano
- Royal Infirmary Hospital, Foresterhill Health Campus, Foresterhill Rd, Aberdeen, AB25 2ZN, UK
| | - Marianna Sirico
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AX, UK
| | - Bruna Scaggiante
- Department of Life Sciences, University of Trieste, 34127, Trieste, Italy
| | - Daniele Generali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127, Trieste, Italy
- Multidisciplinary Unit of Breast Pathology and Translational Research, Cremona Hospital, 26100, Cremona, Italy
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Ali S, Sattar Y, Erdem S, Hussain B, Duhan S, Atti L, Patel N, Hamza M, Gonuguntla K, Jalil B, Havistin R, Alamzaib SM, Elgendy IY, Daggubati R, Alraiyes AH, Alraies MC. Predictors and Outcomes of Extracorporeal Membrane Oxygenation in COVID-19 Patients With ARDS: A Propensity-Matched Analysis of National Inpatient Sample. Curr Probl Cardiol 2023; 48:101988. [PMID: 37473942 DOI: 10.1016/j.cpcardiol.2023.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a significant treatment modality for COVID-19 patients on ventilators. The current data is limited for understanding the indicators and outcomes of ECMO in COVID-19 patients with acute respiratory distress syndrome (ARDS). The National Inpatient Sample (NIS) database from 2020 was queried in this study. Among 1,666,960 patients admitted with COVID-19, 99,785 (5.98%) patients developed ARDS, and 60,114 (60.2%) were placed on mechanical ventilation. Of these mechanically ventilated COVID-ARDS patients, 2580 (4.3%) were placed on ECMO. Patients with ECMO intervention had higher adjusted odds (aOR) of blood loss anemia (aOR 9.1, 95% CI: 6.16-13.5, propensity score-matched (PSM) 42% vs 5.4%, P < 0.001), major bleeding (aOR 3.79, 95% CI: 2.5-5.6, PSM 19.9% vs 5.9%, P < 0.001) and acute liver injury (aOR 1.7, 95% CI: 1.14-2.6 PSM 14% vs 6%, P = 0.009) compared to patients without ECMO intervention. However, in-hospital mortality, acute kidney injury, transfusions, acute MI, and cardiac arrest were insignificant. On subgroup analysis, patients placed on veno-arterial ECMO had higher odds of cardiogenic shock (aOR 13.4, CI 3.95-46, P < 0.0001), cardiac arrest (aOR 3.5, CI 1.45-8.47, P = 0.0057), acute congestive heart failure (aOR 4.18, CI 1.05-16.5, P = 0.042) and lower odds of major bleeding (aOR 0.26, CI 0.07-0.92). However, there was no significant difference in mortality, intracranial hemorrhage, and acute MI. Further studies are needed before considering COVID-19 ARDS patients for placement on ECMO.
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Affiliation(s)
- Shafaqat Ali
- Department of Medicine, Louisiana State University, Shreveport, LA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Saliha Erdem
- Detroit Medical Center, Wayne State University, Detroit, MI
| | - Bilal Hussain
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY
| | - Sanchit Duhan
- Department of Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Lalitsiri Atti
- Department of Medicine, Sparrow Hospital-Michigan State University, Lansing, MI
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI
| | - Mohammad Hamza
- Department of Medicine, Albany Medical Center, Albany, NY
| | | | - Bilal Jalil
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Ruby Havistin
- Department of Cardiology, West Virginia University, Morgantown, WV
| | | | - Islam Y Elgendy
- Gill Heart & Vascular Institute, University of Kentucky, Lexington, KY
| | - Ramesh Daggubati
- Department of Cardiology, West Virginia University, Morgantown, WV
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Al-Salman J, Sanad Salem Alsabea A, Alkhawaja S, Al Balooshi AM, Alalawi M, Abdulkarim Ebrahim B, Hasan Zainaldeen J, Al Sayyad AS. Evaluation of an adjusted MEWS (Modified Early Warning Score) for COVID-19 patients to identify risk of ICU admission or death in the Kingdom of Bahrain. J Infect Public Health 2023; 16:1773-1777. [PMID: 37738693 DOI: 10.1016/j.jiph.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND While most COVID-19 cases have uncomplicated infection, a small proportion has the potential to develop life-threatening disease, as such development of a prediction tool using patients baseline characteristics at the time of diagnosis should aid in early identification of high-risk groups and devise pertinent management. Hence, we set up this retrospective study to determine preadmission triaging tool to predict the development of severe COVID-19 in the Kingdom of Bahrain MATERIALS AND METHODS: A retrospective study was conducted from 1 September 2020 to 30 November 2020 with enrolment of all SARS-CoV-2 PCR-confirmed persons aged ≥ 14 years who attended Al-Shamil Field Hospital (SFH) in the Kingdom of Bahrain for triaging and assessment with recording of the following parameters: systolic blood pressure, heart rate, respiratory rate, temperature, the alert, verbal, pain, unresponsive neurological score, age, oxygen saturation, comorbidities, Body Mass Index (BMI), duration of symptoms and living with immunocompromised populations to develop our local adjusted MEWS as predictor for ICU admission & for consideration of suitable isolation at home. Follow up data of all patients was obtained from the electronic medical records system including CXR findings, treatments/medications received, need of oxygen supplements /intubation, needs of ICU care, and the outcome (death /discharged alive) IBM SPSS statistic version 21 program was used for data analysis. RESULTS Our study showed that using the locally developed adjusted MEWS score, there was an significant association between high value of this adjusted MEWS score and abnormal radiographic finding (49.7 % Vs. 17 % for patients with high score Vs. those with low score respectively). Out of the 181 patients with high scores on adjusted MEWS; 38.7 % required oxygen via nasal cannula, 14.4 % required face mask and 8.3 % non-rebreather mask; this proportion was significantly higher than their counterpart patients who score low on adjusted MEWS (20.9 %, 7.7 %, 4.8 %respectively) with statistically significance difference between the two groups (p value of 0.00, 0.00,.004 respectively) Requirement of ICU admission was significantly higher among patients with high score in comparison to those with low score (14.4 % vs. 3 %) with significant p value (0.00) But higher score value was not associated significantly with increase mortality rate among COVID patients. CONCLUSION Development of our new Adjusted MEWS score system by adding the additional elements of age, oxygen saturation, comorbidities, Body Mass Index (BMI) and duration of symptoms found to be very useful predictor tool for preadmission triaging of COVID patients based on their risk assessment to help clinician to decide on the appropriate placement to different level of isolation facilities.
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Affiliation(s)
- Jameela Al-Salman
- Senior Infectious Disease consultant King Hamad American medical Mission Salmaniya medical complex Associate professor of medicine, Arabian Gulf University.
| | | | - Safa Alkhawaja
- Senior Infectious Disease consultant Salmaniya medical complex
| | | | - Maryam Alalawi
- Internal Medicine chief resident - specialist, Internal medicine Department, Salmaniya medical complex
| | | | - Jenan Hasan Zainaldeen
- Pediatric resident, Pediatric department, Salmaniya medical complex, Wafa Fawzi Hassan Statistician, Infection Control Department, Salmaniya Medical Complex
| | - Adel Salman Al Sayyad
- ABFM, Msc, DLSHTM Consultant Family Medicine, Epidemiology & Public Health Chief of Disease Control Section, Ministry of health Associate Prof. of Family and community Medicine, AGU
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248
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Liu Y, Liu P, Sun Y, Deng G. Clinical characteristics, outcomes, and risk factors of SARS-CoV-2 breakthrough infections among 572 fully vaccinated (BBIBP-CorV) hospitalized patients. Heliyon 2023; 9:e21387. [PMID: 37954305 PMCID: PMC10637974 DOI: 10.1016/j.heliyon.2023.e21387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breakthrough infections have been widely reported in vaccinated individuals. However, the clinical characteristics, outcomes, and risk factors of SARS-CoV-2 breakthrough infections among fully vaccinated (BBIBP-CorV) hospitalized patients have not yet been fully elucidated. Methods In the single-center cohort study conducted at Xiangya Hospital of Central South University, we enrolled the hospitalized COVID-19 patients who had received full (2 doses) vaccination with the BBIBP-CorV vaccine between December 5, 2022, and January 31, 2023. We collected and analyzed information related to clinical characteristics, laboratory results, treatments, outcomes and prognostic data. Univariate and multivariable Cox regression were performed to assess the impact of clinical characteristics and laboratory results on the composite outcome (including the initiation of endotracheal intubation, non-invasive respiratory support, intensive care unit admission, and all-cause death). Results A total of 572 COVID-19 hospitalized patients with fully vaccinated (BBIBP-CorV) were included. The median age of the patients was 66 years (IQR 53, 74). The most common symptoms included fever (347 [60.7 %]), dry cough (401 [70.1 %]), and expectoration (333 [58.2 %]). Among those with pre-existing chronic comorbidities, 44.2 % had hypertension and 20.5 % had diabetes. Laboratory tests revealed that the majority of patients (425/549 [77.4 %]) had normal white blood cell counts. Composite outcome occurred in 11.9 % of patients, with 96.7 % of patients discharged and 3.3 % of patients died. Multivariate Cox regression analyses suggested that the NLR >4 (adjusted HR, 5.50 [95%CI: 1.56-19.47]; P = 0.008), D-dimer >0.5 mg/ml (adjusted HR, 2.17 [95%CI: 1.03-4.59]; P = 0.042) and procalcitonin >0.1 ng/ml (adjusted HR, 3.22 [95%CI: 1.38-7.52]; P = 0.007) were independently associated with the composite outcome. Conclusion Breakthrough infection after being fully vaccinated (BBIBP-CorV) is more likely to occur in older patients and patients with pre-existing chronic comorbidities. NLR >4, D-dimer >0.5 mg/ml and procalcitonin >0.1 ng/ml were independent risk factors for composite outcome.
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Affiliation(s)
- Yihuang Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, 410008, China
- Furong Laboratory, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Peilin Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan Province, 410008, China
| | - Yuming Sun
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
| | - Guangtong Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, 410008, China
- Furong Laboratory, Changsha, Hunan, 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
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249
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Pingping Z, Yanyu Z, Xuri S, Qiming H, Yi W, Guoliang T. Comparison between original SARS-CoV-2 strain and omicron variant on thin-section chest CT imaging of COVID-19 pneumonia. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:55-63. [PMID: 37280418 PMCID: PMC10243278 DOI: 10.1007/s00117-023-01147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES We investigated different computed tomography (CT) features between Omicron-variant and original-strain SARS-CoV‑2 pneumonia to facilitate the clinical management. MATERIALS AND METHODS Medical records were retrospectively reviewed to select patients with original-strain SARS-CoV‑2 pneumonia from February 22 to April 22, 2020, or Omicron-variant SARS-CoV‑2 pneumonia from March 26 to May 31, 2022. Data on the demographics, comorbidities, symptoms, clinical types, and CT features were compared between the two groups. RESULTS There were 62 and 78 patients with original-strain or Omicron-variant SARS-CoV‑2 pneumonia, respectively. There were no differences between the two groups in terms of age, sex, clinical types, symptoms, and comorbidities. The main CT features differed between the two groups (p = 0.003). There were 37 (59.7%) and 20 (25.6%) patients with ground-glass opacities (GGO) in the original-strain and Omicron-variant pneumonia, respectively. A consolidation pattern was more frequently observed in the Omicron-variant than original-strain pneumonia (62.8% vs. 24.2%). There was no difference in crazy-paving pattern between the original-strain and Omicron-variant pneumonia (16.1% vs. 11.6%). Pleural effusion was observed more often in Omicron-variant pneumonia, while subpleural lesions were more common in the original-strain pneumonia. The CT score in the Omicron-variant group was higher than that in the original-strain group for critical-type (17.00, 16.00-18.00 vs. 16.00, 14.00-17.00, p = 0.031) and for severe-type (13.00, 12.00-14.00 vs 12.00, 10.75-13.00, p = 0.027) pneumonia. CONCLUSION The main CT finding of the Omicron-variant SARS-CoV‑2 pneumonia included consolidations and pleural effusion. By contrast, CT findings of original-strain SARS-CoV‑2 pneumonia showed frequent GGO and subpleural lesions, but without pleural effusion. The CT scores were also higher in the critical and severe types of Omicron-variant than original-strain pneumonia.
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Affiliation(s)
- Zeng Pingping
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Zhou Yanyu
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Sun Xuri
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Huang Qiming
- Department of Medical Imaging of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Wang Yi
- Department of Medical Imaging of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China
| | - Tan Guoliang
- Department ICU of the Second Affiliated Hospital, Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian, China.
- Wuhan Jinyintan Hospital, Wuhan City, China.
- The Fourth People's Hospital of Shanghai, Shanghai City, China.
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Muto M, Sasaki Y, Kano T, Fukao Y, Hosoya R, Nomura T, Sugita M, Io H, Suzuki Y. Successful Management of Critical Acute Respiratory Distress Syndrome following COVID-19 through Extracorporeal Membrane Oxygenation in a Patient with Concurrent Nephrotic Syndrome Relapse. Intern Med 2023; 62:3209-3214. [PMID: 37558472 PMCID: PMC10686741 DOI: 10.2169/internalmedicine.2293-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/02/2023] [Indexed: 08/11/2023] Open
Abstract
A 44-year-old man with coronavirus disease 2019 (COVID-19) and nephrotic syndrome relapse was admitted to our intensive-care unit for respiratory failure. Despite receiving mechanical ventilation and immunomodulators, the patient experienced refractory hypoxemia, necessitating venovenous extracorporeal membrane oxygenation (VV-ECMO) therapy. Due to a worsening renal function, continuous hemodiafiltration was initiated. After 11 days, his respiratory status gradually improved, and VV-ECMO was withdrawn. The kidney function and proteinuria improved, and hemodialysis was subsequently discontinued. The patient was discharged 64 days after admission. This case highlights the potential benefit of early ECMO application in dramatically promoting recovery in severe COVID-19 cases.
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Affiliation(s)
- Masahiro Muto
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yu Sasaki
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Toshiki Kano
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yusuke Fukao
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Reina Hosoya
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Japan
| | - Hiroaki Io
- Department of Nephrology, Juntendo University Nerima Hospital, Japan
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Japan
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