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Chang Z, Wang S, Liu K, Lin R, Liu C, Zhang J, Wei D, Nie Y, Chen Y, He J, Li H, Cheng ZJ, Sun B. Peripheral blood indicators and COVID-19: an observational and bidirectional Mendelian randomization study. BMC Med Genomics 2024; 17:81. [PMID: 38549094 PMCID: PMC10979573 DOI: 10.1186/s12920-024-01844-4] [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: 05/05/2023] [Accepted: 03/01/2024] [Indexed: 04/01/2024] Open
Abstract
Blood is critical for health, supporting key functions like immunity and oxygen transport. While studies have found links between common blood clinical indicators and COVID-19, they cannot provide causal inference due to residual confounding and reverse causality. To identify indicators affecting COVID-19, we analyzed clinical data (n = 2,293, aged 18-65 years) from Guangzhou Medical University's first affiliated hospital (2022-present), identifying 34 significant indicators differentiating COVID-19 patients from healthy controls. Utilizing bidirectional Mendelian randomization analyses, integrating data from over 2.46 million participants from various large-scale studies, we established causal links for six blood indicators with COVID-19 risk, five of which is consistent with our observational findings. Specifically, elevated Troponin I and Platelet Distribution Width levels are linked with increased COVID-19 susceptibility, whereas higher Hematocrit, Hemoglobin, and Neutrophil counts confer a protective effect. Reverse MR analysis confirmed four blood biomarkers influenced by COVID-19, aligning with our observational data for three of them. Notably, COVID-19 exhibited a positive causal relationship with Troponin I (Tnl) and Serum Amyloid Protein A, while a negative association was observed with Plateletcrit. These findings may help identify high-risk individuals and provide further direction on the management of COVID-19.
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Affiliation(s)
- Zhenglin Chang
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
- Guangzhou Laboratory, Guangzhou International Bio Island, XingDaoHuanBei Road, Guangdong Province, Guangzhou, 510005, China
| | - Suilin Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kemin Liu
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Runpei Lin
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Changlian Liu
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Jiale Zhang
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Daqiang Wei
- Guangzhou Medical University, Guangzhou, 510230, Guangdong, China
| | - Yuxi Nie
- Guangzhou Medical University, Guangzhou, 510230, Guangdong, China
| | - Yuerong Chen
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Jiawei He
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Haiyang Li
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
| | - Zhangkai J Cheng
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
- Guangzhou Laboratory, Guangzhou International Bio Island, XingDaoHuanBei Road, Guangdong Province, Guangzhou, 510005, China.
| | - Baoqing Sun
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
- Guangzhou Laboratory, Guangzhou International Bio Island, XingDaoHuanBei Road, Guangdong Province, Guangzhou, 510005, China.
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Wang S, Zhu R, Zhang C, Guo Y, Lv M, Zhang C, Bian C, Jiang R, Zhou W, Guo L. Effects of the pre-existing coronary heart disease on the prognosis of COVID-19 patients: A systematic review and meta-analysis. PLoS One 2023; 18:e0292021. [PMID: 37815980 PMCID: PMC10564240 DOI: 10.1371/journal.pone.0292021] [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: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 10/12/2023] Open
Abstract
Although studies have shown severe Coronavirus disease 2019 (COVID-19) outcomes in patients with pre-existing coronary heart disease (CHD), the prognosis of COVID-19 patients with pre-existing CHD remains uncertain primarily due to the limited number of patients in existing studies. This study aimed to investigate the impacts of pre-existing CHD on the prognosis of COVID-19 patients. Five electronic databases were searched for eligible studies. This article focused on cohort and case-control studies involving the prognosis of COVID-19 patients with pre-existing CHD. The meta-analysis was performed using a random effects model. The odds ratios (ORs) and 95% confidence intervals (CIs) were used as valid indicators. The study was registered in PROSPERO with the identifier: CRD42022352853. A total of 81 studies, involving 157,439 COVID-19 patients, were included. The results showed that COVID-19 patients with pre-existing CHD exhibited an elevated risk of mortality (OR = 2.45; 95%CI: [2.04, 2.94], P < 0.001), severe/critical COVID-19 (OR = 2.57; 95%CI: [1.98, 3.33], P < 0.001), Intensive Care Unit or Coronary Care Unit (ICU/CCU) admission: (OR = 2.75, 95%CI: [1.61, 4.72], P = 0.002), and reduced odds of discharge/recovery (OR = 0.43, 95%CI: [0.28, 0.66], P < 0.001) compared to COVID-19 patients without pre-existing CHD. Subgroup analyses indicated that the prognosis of COVID-19 patients with pre-existing CHD was influenced by publication year, follow-up duration, gender, and hypertension. In conclusion, pre-existing CHD significantly increases the risk of poor prognosis in patients with COVID-19, particularly in those male or hypertensive patients.
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Affiliation(s)
- Saikun Wang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ruiting Zhu
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Chengwei Zhang
- Department of Anesthesiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yingze Guo
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Mengjiao Lv
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Changyue Zhang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ce Bian
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Ruixue Jiang
- School of Nursing, Jilin University, Changchun, Jilin, China
| | - Wei Zhou
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lirong Guo
- School of Nursing, Jilin University, Changchun, Jilin, China
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Verykokou G, Apollonatou V, Papaioannou AI, Vogiatzoglou A, Roukas K, Kyriakopoulos C, Chronis C, Aggelopoulou C, Gundogdu D, Schoini P, Chloros D, Kavatha D, Manali ED, Papiris SA, Tsoukalas G, Kostikas K, Fouka E, Boumpas D, Loukides S. Nursing home elderly patients hospitalized for COVID-19: Characteristics and predictors of outcomes. Geriatr Gerontol Int 2023; 23:62-64. [PMID: 36479800 PMCID: PMC9877989 DOI: 10.1111/ggi.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Galateia Verykokou
- COVID‐19 Unit, GNDA “Agia Varvara” HospitalAthensGreece,2 Respiratory Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | - Vasiliki Apollonatou
- COVID‐19 Unit, GNDA “Agia Varvara” HospitalAthensGreece,2 Respiratory Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | - Andriana I Papaioannou
- 2 Respiratory Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | - Anastasios Vogiatzoglou
- Department of Respiratory Medicine, General Hospital G. PapanikolaouPulmonary Department of Aristotle University of ThessalonikiThessalonikiGreece
| | - Konstantinos Roukas
- Department of Respiratory Medicine, General Hospital G. PapanikolaouPulmonary Department of Aristotle University of ThessalonikiThessalonikiGreece
| | - Christos Kyriakopoulos
- Respiratory Medicine DepartmentUniversity of Ioannina, Faculty of MedicineIoanninaGreece
| | - Christos Chronis
- Respiratory Medicine DepartmentUniversity of Ioannina, Faculty of MedicineIoanninaGreece
| | - Christina Aggelopoulou
- Respiratory Medicine DepartmentUniversity of Ioannina, Faculty of MedicineIoanninaGreece
| | | | | | - Diamantis Chloros
- Department of Respiratory Medicine, General Hospital G. PapanikolaouPulmonary Department of Aristotle University of ThessalonikiThessalonikiGreece
| | - Dimitra Kavatha
- COVID‐19 Unit, GNDA “Agia Varvara” HospitalAthensGreece,4 Internal Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | - Effrosyni D Manali
- 2 Respiratory Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | - Spyros A Papiris
- 2 Respiratory Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | | | - Konstantinos Kostikas
- Respiratory Medicine DepartmentUniversity of Ioannina, Faculty of MedicineIoanninaGreece
| | - Evangelia Fouka
- Department of Respiratory Medicine, General Hospital G. PapanikolaouPulmonary Department of Aristotle University of ThessalonikiThessalonikiGreece
| | - Dimitrios Boumpas
- COVID‐19 Unit, GNDA “Agia Varvara” HospitalAthensGreece,4 Internal Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
| | - Stelios Loukides
- COVID‐19 Unit, GNDA “Agia Varvara” HospitalAthensGreece,2 Respiratory Medicine DepartmentGeneral University Hospital “Attikon”, Medical School, National and Kapodistrian University of AthensAthensGreece
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Keisam A, Kulabidhu H, Singh TB, Devi LB, Akham N. Morbidity and mortality pattern of COVID-19 patients and its associated risk factors: A cross-sectional study. J Family Med Prim Care 2022; 11:5643-5648. [PMID: 36505546 PMCID: PMC9730952 DOI: 10.4103/jfmpc.jfmpc_997_22] [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: 05/05/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Early identification of patients with poor prognosis may facilitate the provision of proper supportive treatment in advance and reduce mortality due to Coronavirus Disease 2019 (COVID-19). The present study estimates the recovery and mortality rates among in-house COVID-19 patients admitted to a tertiary care center and also determines any association between mortality and variables of interest. Methods and Material This cross-sectional study was conducted in June to December 2021 among the COVID-19 patients admitted to the hospital based on their case sheets. A sample size of 1500 was calculated which was obtained by simple random sampling. Descriptive statistics were generated. Association between mortality and other variables was tested by using bivariate logistic regression and multiple logistic regression analysis. Results The overall recovery rate was 80.1%. Vaccination status was significantly associated with mortality, with the AOR (95% CI) of getting both vaccine doses and a single dose being 0.18 (0.05-0.70) and 0.28 (0.15-0.55), respectively, when compared to the unvaccinated group. Also, patients who sought admission on their own were found to be having more chances of recovery compared to those who were referred from other health facilities. The risk of dying was found to be increased nearly 5-fold among those who used Non-Rebreathing machines. The use of Non-Invasive ventilation and Bain Circuit was significantly associated with a bad prognosis. None on the mechanical ventilation survived. Conclusions The mortality rate of COVID-19 patients admitted to the tertiary care hospital was found to be one-fifth and the ICU-specific mortality rate was 83.6% while other factors like age and gender were not found to be associated with mortality. Among comorbidities, only liver diseases were found to be a significant determinant of mortality. Finally, patients who needed more flow rate of oxygen had a significant association with mortality.
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Affiliation(s)
- Avinash Keisam
- Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Heisnam Kulabidhu
- Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Takhellambam B. Singh
- Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | - Laishram B. Devi
- Department of Orthodontics and Dentofacial Orthopedics, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Ngamba Akham
- Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India,Address for correspondence: Dr. Ngamba Akham, Post-Graduate Trainee, Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal - 795 005, Manipur, India. E-mail:
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5
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Alimohamadi Y, Mansouri Yekta E, Sepandi M, Sharafoddin M, Arshadi M, Hesari E. Hospital length of stay for COVID-19 patients: A systematic review and meta-analysis. Multidiscip Respir Med 2022; 17:856. [PMID: 36117876 PMCID: PMC9472334 DOI: 10.4081/mrm.2022.856] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023] Open
Abstract
The length of stay in the hospital for COVID-19 can aid in understanding the disease's prognosis. Thus, the goal of this study was to collectively estimate the hospital length of stay (LoS) in COVID-19 hospitalized individuals. To locate related studies, international databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched. The I2 index, the Cochran Q test, and T2 were used to analyze study heterogeneity. The mean LoS in COVID- 19 hospitalized patients was estimated using a random-effects model. COVID-19's total pooled estimated hospital LoS was 15.35, 95%CI:13.47-17.23; p<0.001, I2 = 80.0). South America had the highest pooled estimated hospital LoS of COVID-19 among the continents, at 20.85 (95%CI: 14.80-26.91; p<0.001, I2 = 0.01), whereas Africa had the lowest at 8.56 8 (95%CI: 1.00-22.76). The >60 age group had the highest pooled estimated COVID-19 hospital LoS of 16.60 (95%CI: 12.94-20.25; p<0.001, I2 = 82.6), while the 40 age group had the lowest hospital LoS of 10.15 (95% CI: 4.90-15.39, p<0.001, I2 = 22.1). The metanalysis revealed that COVID-19's hospital LoS was more than 10 days. However, it appears that this duration varies depending on a number of factors, including the patient's age and the availability of resources.
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Shesha N, Melebari S, Alghamdi S, Refaat B, Naffadi H, Alquthami K. Associations of Clinical Factors and Blood Groups With the Severity of COVID-19 Infection in Makkah City, Saudi Arabia. Front Cell Infect Microbiol 2022; 12:870096. [PMID: 35800382 PMCID: PMC9255230 DOI: 10.3389/fcimb.2022.870096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Context The possible associations between the different blood groups and clinical factors with COVID-19 infection among patients in Makkah city. Objective To investigate the relationship between ABO blood groups and COVID-19 infection in patients who were tested positive and to elucidate the most common ABO blood groups with a higher infectivity of COVID-19 and disease association. Materials and Methods This was an observational cross-sectional study that included COVID-19 patients diagnosed with PCR and who were hospitalized in Al-Noor Specialist Hospital (Makkah) during the period between March to November 2020. The ABO and Rhesus blood groups alongside the clinical characteristics were determined and retrieved from medical records and HESN of the Ministry of Health of the Kingdom of Saudi Arabia (KSA). Results The overall confirmed COVID-19 cases included in this study were 1,583 patients who underwent positive PCR testing between March and November 2020. The frequencies of blood groups were as follows: group O+ (37%), group A+ (29.2%), group B+ (22.6%), group AB+ (5.1%), group O- (2.8%), group B- (1.8%), group A- (1.1%), and group AB- (0.4%). However, no significant correlations were observed for ABO groups and Rh types with the severity of COVID-19 illness. Conversely, signs and symptoms of respiratory distress syndrome (RDS), pneumonia, and respiratory failure symptoms, alongside a history of diabetes mellitus, hypertension, chronic kidney diseases, and congestive heart failure significantly increased the risk of death from COVID-19 infection. Moreover, the rates of fever, cough, and asthma were markedly lower in the deceased group compared with the recovered group of patients. Conclusion The association between the different blood groups with the prevalence and mortality of COVID-19 among infected patients has yet to be elucidated as we found no significant differences in the observed versus expected distribution of ABO phenotypes among the included cases. The prevalence of RDS, pneumonia, and respiratory failure was found higher among hospitalized COVID-19 patients in the deceased group. However, other factors such as fever, cough, and asthma appeared to be more significantly lower than in the recovered group.
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Affiliation(s)
- Nashwa Shesha
- Serology and Immunology Department, Hera General Hospital, Makkah Healthcare Cluster, Makkah, Saudi Arabia
- *Correspondence: Nashwa Shesha,
| | - Sami Melebari
- Molecular Biology Department, The Regional Laboratory, Ministry of Health, Makkah, Saudi Arabia
| | - Saad Alghamdi
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Bassem Refaat
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hind Naffadi
- Medical Genetics Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Khalid Alquthami
- Molecular Biology Department, Al-Noor Specialist Hospital, Makkah Healthcare Cluster, Makkah, Saudi Arabia
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Almutairi MS, Assiri AM, Almohammed OA. Predictors of Poor Outcome among Critically Ill COVID-19 Patients: A Nationally Representative Sample of the Saudi Arabian Population. J Clin Med 2022; 11:jcm11102818. [PMID: 35628942 PMCID: PMC9147701 DOI: 10.3390/jcm11102818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
The outbreak and continuing impact of COVID-19 have significantly increased the rates of hospitalization and admissions to intensive care units (ICU). This study evaluates clinical outcomes in critically ill patients and investigates variables tied to poor prognosis. A secondary database analysis was conducted to investigate the predictors of poor outcome among critically ill COVID-19 patients in Saudi Arabia. Multivariable logistic regression analysis was used to assess the association between various demographic characteristics, comorbidities, and COVID-19 symptoms and patients’ poor prognosis, as a composite outcome. A total of 2257 critically ill patients were identified (male (71.8%), and elderly (37.3%)). The mortality rate was 50.0%, and the composite poor outcome was 68.4%. The predictors of poor outcome were being elderly (OR = 4.79, 95%CI 3.19−7.18), obesity (OR = 1.43, 95%CI 1.1−1.87), having a severe or critical case at admission (OR = 6.46, 95%CI 2.34−17.8; OR = 22.3, 95%CI 11.0−45, respectively), and some signs and symptoms of COVID-19 such as shortness of breath, feeling fatigued or headache, respiratory rate ≥ 30/min, PaO2/FiO2 ratio < 300, and altered consciousness. In conclusion, identifying high-risk populations that are expected to have a poor prognosis based on their criteria upon admission helps policymakers and practitioners better triage patients when faced with limited healthcare resources.
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Affiliation(s)
- Masaad Saeed Almutairi
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim 51452, Saudi Arabia;
| | - Ahmed M. Assiri
- Health Volunteering Center, Ministry of Health, Riyadh 11176, Saudi Arabia;
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Correspondence: ; Tel.: +966-555-10-4065
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Sancho Ferrando E, Hanslin K, Hultström M, Larsson A, Frithiof R, Lipcsey M. Soluble TNF receptors predict acute kidney injury and mortality in critically ill COVID-19 patients: A prospective observational study. Cytokine 2021; 149:155727. [PMID: 34628127 PMCID: PMC8491926 DOI: 10.1016/j.cyto.2021.155727] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023]
Abstract
Background Although pneumonia is the hallmark of coronavirus disease 2019 (COVID-19), multiple organ failure may develop in severe disease. TNFα receptors in their soluble form (sTNFR) are involved in the immune cascade in other systemic inflammatory processes such as septic shock, and could mediate the inflammatory activation of distant organs. The aim of this study is to analyse plasma levels of sTNFR 1 and 2 in association with organ failure and outcome in critically ill patients with COVID-19. Methods After informed consent, we included 122 adult patients with PCR-confirmed COVID-19 at ICU admission. Demographic data, illness severity scores, organ failure and survival at 30 days were collected. Plasma sTNFR 1 and 2 levels were quantified during the first days after ICU admission. Twenty-five healthy blood donors were used as control group. Results Levels of sTNFR were higher in severe COVID-19 patients compared to controls (p < 0.001). Plasma levels of sTNFR were associated to illness severity scores (SAPS 3 and SOFA), inflammation biomarkers such as IL-6, ferritin and PCT as well as development of AKI during ICU stay. sTNFR 1 higher than 2.29 ng/mL and? sTNFR 2 higher than 11.7 ng/mL were identified as optimal cut-offs to discriminate survivors and non-survivors 30 days after ICU admission and had an area under the curve in receiver operating characteristic curve of 0.75 and 0.67 respectively. Conclusion Plasma levels of sTNFR 1 and 2 were higher in COVID-19 patients compared to controls and were strongly associated with other inflammatory biomarkers, severity of illness and acute kidney injury development during ICU stay. In addition, sTNFR 1 was an independent predictor of 30-day mortality after adjustment for age and respiratory failure.
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Affiliation(s)
- Elena Sancho Ferrando
- Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Intensive Care Medicine. Hospital Universitario y Politécnico La Fe. Valencia, Spain
| | - Katja Hanslin
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden; Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
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Marziliano A, Burns E, Chauhan L, Liu Y, Makhnevich A, Zhang M, Carney MT, Dbeis Y, Lindvall C, Qiu M, Diefenbach MA, Sinvani L. Patient Factors and Hospital Outcomes Associated With Atypical Presentation in Hospitalized Older Adults With COVID-19 During the First Surge of the Pandemic. J Gerontol A Biol Sci Med Sci 2021; 77:e124-e132. [PMID: 34279628 PMCID: PMC8344548 DOI: 10.1093/gerona/glab171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 12/15/2022] Open
Abstract
Background Literature indicates an atypical presentation of COVID-19 among older adults (OAs). Our purpose is to identify the frequency of atypical presentation and compare demographic and clinical factors, and short-term outcomes, between typical versus atypical presentations in OAs hospitalized with COVID-19 during the first surge of the pandemic. Methods Data from the inpatient electronic health record were extracted for patients aged 65 and older, admitted to our health systems’ hospitals with COVID-19 between March 1 and April 20, 2020. Presentation as reported by the OA or his/her representative is documented by the admitting professional and includes both symptoms and signs. Natural language processing was used to code the presence/absence of each symptom or sign. Typical presentation was defined as words indicating fever, cough, or shortness of breath; atypical presentation was defined as words indicating functional decline or altered mental status. Results Of 4 961 unique OAs, atypical presentation characterized by functional decline or altered mental status was present in 24.9% and 11.3%, respectively. Atypical presentation was associated with older age, female gender, Black race, non-Hispanic ethnicity, higher comorbidity index, and the presence of dementia and diabetes mellitus. Those who presented typically were 1.39 times more likely than those who presented atypically to receive intensive care unit–level care. Hospital outcomes of mortality, length of stay, and 30-day readmission were similar between OAs with typical versus atypical presentations. Conclusion Although atypical presentation in OAs is not associated with the same need for acute intervention as respiratory distress, it must not be dismissed.
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Affiliation(s)
- Allison Marziliano
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Edith Burns
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Lakshpaul Chauhan
- Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Yan Liu
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Alex Makhnevich
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Meng Zhang
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Maria T Carney
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Yasser Dbeis
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Michael Qiu
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Michael A Diefenbach
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
| | - Liron Sinvani
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.,Department of Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Manhasset, NY, USA
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