1
|
Wei X, Guo L, Cai H, Gu S, Tang L, Leng Y, Cheng M, He G, Han Y, Ren X, Lin B, Lv L, Shao H, Wang M, Wang H, Dang D, Wang S, Wang N, Shen P, Wang Q, Xu Y, Jiang Y, Zhang N, He X, Deng X, Dai M, Zhong L, Xiong Y, Pan Y, Tang K, Liu F, Yang B, Ren L, Wang J, Jiang C, Huang L. MASS cohort: Multicenter, longitudinal, and prospective study of the role of microbiome in severe pneumonia and host susceptibility. IMETA 2024; 3:e218. [PMID: 39135692 PMCID: PMC11316923 DOI: 10.1002/imt2.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 08/15/2024]
Abstract
The MASS cohort comprises 2000 ICU patients with severe pneumonia, covering community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia, sourced from 19 hospitals across 10 cities in three provinces. A wide array of samples including bronchoalveolar lavage fluid, sputum, feces, and whole blood are longitudinally collected throughout patients' ICU stays. The cohort study seeks to uncover the dynamics of lung and gut microbiomes and their associations with severe pneumonia and host susceptibility, integrating deep metagenomics and transcriptomics with detailed clinical data.
Collapse
Affiliation(s)
- Xin Wei
- Life Sciences Institute and Department of Critical Care Medicine of First Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Li Guo
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen BiologyChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Hongliu Cai
- Department of Critical Care Medicine, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Silan Gu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Lingling Tang
- Department of Infectious DiseasesShulan (Hangzhou) HospitalHangzhouChina
| | - Yuxin Leng
- Department of Intensive Care UnitPeking University Third HospitalBeijingChina
| | - Minghui Cheng
- Life Sciences Institute and Department of Critical Care Medicine of First Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Guojun He
- Department of Critical Care Medicine, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Yijiao Han
- Department of Critical Care Medicine, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xindie Ren
- Department of Critical Care Medicine, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Baoyue Lin
- Department of Critical Care Medicine, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Longxian Lv
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Huanzhang Shao
- Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, Zhengzhou Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital; Zhengzhou University People's HospitalHenan University People's HospitalZhengzhouChina
| | - Mingqiang Wang
- Department of Critical Care Medicine, Henan Key Laboratory for Critical Care Medicine, Zhengzhou Key Laboratory for Critical Care Medicine, Henan Provincial People's Hospital; Zhengzhou University People's HospitalHenan University People's HospitalZhengzhouChina
| | - Hongyu Wang
- Department of Emergency Intensive Care UnitThe Fifth Clinical Medical College of Henan University of Chinese MedicineZhengzhouChina
| | - Dan Dang
- Department of Critical Care MedicineXi'an People's Hospital (Xi'an No.4 Hospital)Xi'anChina
| | - Shengfeng Wang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Nan Wang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Peng Shen
- Department of Critical Care MedicineThe First Hospital of JiaxingJiaxingChina
| | - Qianqian Wang
- Department of Critical Care MedicineThe First Hospital of JiaxingJiaxingChina
| | - Yinghe Xu
- Department of Critical Care MedicineTaizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical UniversityTaizhouChina
| | - Yongpo Jiang
- Department of Critical Care MedicineTaizhou Hospital of Zhejiang Province affiliated with Wenzhou Medical UniversityTaizhouChina
| | - Ning Zhang
- Department of Critical Care MedicineLishui People's HospitalLishuiChina
| | - Xuwei He
- Department of Critical Care MedicineLishui People's HospitalLishuiChina
| | - Xuntao Deng
- Department of Critical Care MedicineLishui People's HospitalLishuiChina
| | - Muhua Dai
- Department of Critical Care MedicineTongde Hospital of Zhejiang ProvinceHangzhouChina
| | - Lin Zhong
- Department of Critical Care MedicineThe First People's Hospital of PinghuPinghuChina
| | - Yonghui Xiong
- Department of Critical Care MedicineLanxi Hospital of Traditional Chinese MedicineLanxiChina
| | - Yujie Pan
- Department of Critical Care MedicineWenzhou Central HospitalWenzhouChina
| | - Kankai Tang
- Department of Critical Care MedicineThe First People's Hospital of HuzhouHuzhouChina
| | - Fengqi Liu
- Department of Critical Care MedicineThe First People's Hospital of HuzhouHuzhouChina
| | - Bin Yang
- Center for Infectious DiseasesVision Medicals Co., Ltd.GuangzhouGuangdongChina
| | - Lili Ren
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen BiologyChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Jianwei Wang
- NHC Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, National Institute of Pathogen BiologyChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Chao Jiang
- Life Sciences Institute and Department of Critical Care Medicine of First Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Lingtong Huang
- Life Sciences Institute and Department of Critical Care Medicine of First Affiliated HospitalZhejiang UniversityHangzhouChina
| |
Collapse
|
2
|
Reilly JP, Zhao Z, Shashaty MGS, Koyama T, Jones TK, Anderson BJ, Ittner CA, Dunn T, Miano TA, Oniyide O, Balmes JR, Matthay MA, Calfee CS, Christie JD, Meyer NJ, Ware LB. Exposure to ambient air pollutants and acute respiratory distress syndrome risk in sepsis. Intensive Care Med 2023; 49:957-965. [PMID: 37470831 PMCID: PMC10561716 DOI: 10.1007/s00134-023-07148-y] [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: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Exposures to ambient air pollutants may prime the lung enhancing risk of acute respiratory distress syndrome (ARDS) in sepsis. Our objective was to determine the association of short-, medium-, and long-term pollutant exposures and ARDS risk in critically ill sepsis patients. METHODS We analyzed a prospective cohort of 1858 critically ill patients with sepsis, and estimated short- (3 days), medium- (6 weeks), and long- (5 years) term exposures to ozone, nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), particulate matter < 2.5 μm (PM2.5), and PM < 10 μm (PM10) using weighted averages of daily levels from monitors within 50 km of subjects' residences. Subjects were followed for 6 days for ARDS by the Berlin Criteria. The association between each pollutant and ARDS was determined using multivariable logistic regression adjusting for preselected confounders. In 764 subjects, we measured plasma concentrations of inflammatory proteins at presentation and tested for an association between pollutant exposure and protein concentration via linear regression. RESULTS ARDS developed in 754 (41%) subjects. Short- and long-term exposures to SO2, NO2, and PM2.5 were associated with ARDS risk (SO2: odds ratio (OR) for the comparison of the 75-25th long-term exposure percentile 1.43 (95% confidence interval (CI) 1.16, 1.77); p < 0.01; NO2: 1.36 (1.06, 1.74); p = 0.04, PM2.5: 1.21 (1.04, 1.41); p = 0.03). Long-term exposures to these three pollutants were also associated with plasma interleukin-1 receptor antagonist and soluble tumor necrosis factor receptor-1 concentrations. CONCLUSION Short and long-term exposures to ambient SO2, PM2.5, and NO2 are associated with increased ARDS risk in sepsis, representing potentially modifiable environmental risk factors for sepsis-associated ARDS.
Collapse
Affiliation(s)
- John P Reilly
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA.
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - Michael G S Shashaty
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - Tiffanie K Jones
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Brian J Anderson
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Caroline A Ittner
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Thomas Dunn
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Todd A Miano
- Center for Clinical Epidemiology and Biostatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Oluwatosin Oniyide
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - John R Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, USA
- Department of Medicine, University of California, San Francisco, USA
| | - Michael A Matthay
- Department of Medicine, University of California, San Francisco, USA
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Carolyn S Calfee
- Department of Medicine, University of California, San Francisco, USA
- Department of Anesthesia and Cardiovascular Research Institute, University of California, San Francisco, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
- Center for Clinical Epidemiology and Biostatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Nuala J Meyer
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Perelman School of Medicine, 5005 Gibson Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA
- Center for Translational Lung Biology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Lorraine B Ware
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, USA
| |
Collapse
|
3
|
Vos S, De Waele E, Goeminne P, Bijnens EM, Bongaerts E, Martens DS, Malina R, Ameloot M, Dams K, De Weerdt A, Dewyspelaere G, Jacobs R, Mistiaen G, Jorens P, Nawrot TS. Pre-admission ambient air pollution and blood soot particles predict hospitalisation outcomes in COVID-19 patients. Eur Respir J 2023; 62:2300309. [PMID: 37343978 PMCID: PMC10288811 DOI: 10.1183/13993003.00309-2023] [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: 12/08/2022] [Accepted: 04/19/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Air pollution exposure is one of the major risk factors for aggravation of respiratory diseases. We investigated whether exposure to air pollution and accumulated black carbon (BC) particles in blood were associated with coronavirus disease 2019 (COVID-19) disease severity, including the risk for intensive care unit (ICU) admission and duration of hospitalisation. METHODS From May 2020 until March 2021, 328 hospitalised COVID-19 patients (29% at intensive care) were recruited from two hospitals in Belgium. Daily exposure levels (from 2016 to 2019) for particulate matter with aerodynamic diameter <2.5 µm and <10 µm (PM2.5 and PM10, respectively), nitrogen dioxide (NO2) and BC were modelled using a high-resolution spatiotemporal model. Blood BC particles (internal exposure to nano-sized particles) were quantified using pulsed laser illumination. Primary clinical parameters and outcomes included duration of hospitalisation and risk of ICU admission. RESULTS Independent of potential confounders, an interquartile range (IQR) increase in exposure in the week before admission was associated with increased duration of hospitalisation (PM2.5 +4.13 (95% CI 0.74-7.53) days, PM10 +4.04 (95% CI 1.24-6.83) days and NO2 +4.54 (95% CI 1.53-7.54) days); similar effects were observed for long-term NO2 and BC exposure on hospitalisation duration. These effect sizes for an IQR increase in air pollution on hospitalisation duration were equivalent to the effect of a 10-year increase in age on hospitalisation duration. Furthermore, for an IQR higher blood BC load, the OR for ICU admission was 1.33 (95% CI 1.07-1.65). CONCLUSIONS In hospitalised COVID-19 patients, higher pre-admission ambient air pollution and blood BC levels predicted adverse outcomes. Our findings imply that air pollution exposure influences COVID-19 severity and therefore the burden on medical care systems during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Stijn Vos
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- S. Vos and E. De Waele contributed equally
| | - Elien De Waele
- Hospital VITAZ Sint-Niklaas, Sint-Niklaas, Belgium
- S. Vos and E. De Waele contributed equally
| | | | - Esmée M Bijnens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Department of Environmental Sciences, Faculty of Science, Open University, Heerlen, The Netherlands
| | - Eva Bongaerts
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Dries S Martens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Robert Malina
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Marcel Ameloot
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - Karolien Dams
- Antwerp University Hospital, University of Antwerp (LEMP), Edegem, Belgium
| | - Annick De Weerdt
- Antwerp University Hospital, University of Antwerp (LEMP), Edegem, Belgium
| | | | - Rita Jacobs
- Antwerp University Hospital, University of Antwerp (LEMP), Edegem, Belgium
| | | | - Philippe Jorens
- Antwerp University Hospital, University of Antwerp (LEMP), Edegem, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, Occupational and Environmental Medicine, KU Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Cui Z, Ma Y, Yu Y, Li N, Wang J, Wang A, Tan Q. Short-term exposure to ambient fine particulate pollution aggravates ventilator-associated pneumonia in pediatric intensive care patients undergoing cardiovascular surgeries. Environ Health 2023; 22:39. [PMID: 37101281 PMCID: PMC10132412 DOI: 10.1186/s12940-023-00991-y] [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: 02/02/2023] [Accepted: 04/19/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Ambient air pollutants can be hazardous to human health, especially for vulnerable children. The impact of ambient air pollutant exposure before and during intensive care unit (ICU) stays on the development of ventilator-associated pneumonia (VAP) in critically ill children has not been established. We aimed to determine the correlations between short-term exposures to ambient fine particulate matter (PM2.5) and VAP in pediatric cardiac surgery patients in the ICU, and explore the effect of delayed exposure. METHODS The medical record of 1755 child patients requiring artificial ventilation in the ICU between December 2013 to December 2020, were analyzed. The daily average concentrations of particulate matters (PM2.5 and PM10), sulfur dioxide (SO2), and ozone (O3) were calculated from public data. Interactions between these pollutants and VAP were simulated with the distributed lag non-linear model. RESULTS Three hundred forty-eight cases (19.829%) of VAP were identified in this study, while the average concentrations of PM2.5, PM10, O3 and SO2 were 58, 118, 98 and 26 μg/m3, respectively. Exposure to increased levels of PM2.5 two days prior (lag 2-day) to VAP diagnosis is significantly correlated with an enhanced risk for VAP development. Even a slight increase of 10 μg/m3 in PM2.5 can translate to a 5.4% increase in VAP incidence (95% CI: 1.4%-9.5%) while the VAP incidence increased to 11.1% (95%CI: 4.5-19.5%) when PM2.5 concentration is well below the National Ambient Air Quality standard (NAAQS) of 50 μg/m3. The association was more pronounced in those aged below 3-months, with low body mass index or suffered from pulmonary arterial hypertension. CONCLUSION Short-term PM2.5 exposure is a significant risk for development of VAP in pediatric patients. This risk is present even with PM2.5 levels below the NAAQS. Ambient PM2.5 may represent a previously unrecognized risk factor for pneumonia and the current environmental pollution standards need to be reevaluated to consider susceptible populations. TRIAL REGISTRATION The trial was registered with the National Clinical Trial Center: The correlation between ambient air pollution and the complications in ICU underwent cardiac surgery. TRIAL REGISTRATION NUMBER ChiCTR2000030507. Date of registration: March 5, 2020. URL of trial registry record: http://www.chictr.org.cn/index.aspx .
Collapse
Affiliation(s)
- Zhaomei Cui
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 China
| | - Yingying Ma
- Medical Engineering Department, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yuanyuan Yu
- Data Science Institute, Shandong University, Jinan, Shandong China
| | - Na Li
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong China
| | - Jun Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Anbiao Wang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 China
| | - Qi Tan
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 9677 Jingshi Road, Jinan, 250021 China
| |
Collapse
|
5
|
STOIAN IM, PARVU S, NEAMTU A, CALOTA V, VOINOIU A, PISTOL A, CUCUIU R, MINCA DG. PM10 and NO2 Air Pollution and Evolution of COVID-19 Cases in Romania. MAEDICA 2022; 17:777-784. [PMID: 36818269 PMCID: PMC9923075 DOI: 10.26574/maedica.2022.17.4.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Objectives:Based on the correlation between air pollution and COVID-19 incidence/mortality already existing in the literature, we aimed to develop a study to investigate the link between the average level of PM10 (particulate matter 10 - particulate matter 10 microns in diameter) and NO2 (nitrogen dioxide) concentration over five years and the cumulative incidence of COVID-19 cases per 1000 people in Romania. Methods: To assess PM10 and NO2 exposure, we determined the average value of annual PM10 and NO2 concentration for each city over five years (2015-2019). For this purpose, the average of annual PM10 and NO2 concentrations collected from monitoring stations in selected cities was calculated. Then, the annual values over five years were averaged to finally obtain the average PM10 and NO2 concentration for each city. Data on the cumulative number of confirmed cases of COVID-19 up to the 28th of September 2020 were provided by the National Centre for Surveillance and Control of Communicable Diseases (CNSCBT) of the National Institute of Public Health (INSP). The study used the cumulative incidence/hour per 1000 population on 28.09.2020. Results:According to Law no. 104/2011, the annual permissible limit value of PM10 concentration of 40 μg/m³ was not exceeded in any of the 43 cities in our study. The average for all cities was 24.0±4.8 ìg/m³, with a minimum value of average PM10 concentration of 13.9 μg/m3 measured in Alba Iulia and a maximum value of 39.1 μg/m³ in Iasi. The regression model shows that, in Bucharest, 77.9% of the variation in case incidence is explained by the variation in PM10 concentration. In order to find the number of new cases that would correspond to a cumulative incidence of 0.166, taking as an example one of the districts with a population of 259,084, the above regression model shows that an increase in the average PM10 concentration by one unit is associated with 43 new cases. Conclusion:The study demonstrates that an exposure of the population to particulate matter in atmospheric air, at low values, below the permissible limit values but for a long time (the follow-up period in our study was five years, between 2015 and 2019), can have effects on the health status of the population, which becomes much more vulnerable to external agents, in our case pathogenic microorganisms (viruses).
Collapse
Affiliation(s)
- Irina Mihaela STOIAN
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,National Institute of Public Health, Bucharest, Romania
| | - Simona PARVU
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,National Institute of Public Health, Bucharest, Romania
| | - Andra NEAMTU
- National Institute of Public Health, Bucharest, Romania
| | | | | | - Adriana PISTOL
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,National Institute of Public Health, Bucharest, Romania
| | - Radu CUCUIU
- National Institute of Public Health, Bucharest, Romania
| | - Dana Galieta MINCA
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,National Institute of Public Health, Bucharest, Romania
| |
Collapse
|
6
|
Abstract
The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in the intensive care unit. Improving outcomes depends on not only evidence-based care once ARDS has already developed but also preventing ARDS incidence. Several environmental exposures have now been shown to increase the risk of ARDS and related adverse outcomes. How environmental factors impact the risk of developing ARDS is a growing and important field of research that should inform the care of individual patients as well as public health policy.
Collapse
Affiliation(s)
- Katherine D Wick
- Department of Anesthesia, University of California, San Francisco, 513 Parnassus Avenue, HSE 760, San Francisco, CA 94143, USA; Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Matthay
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, M-917, San Francisco, CA 94143, USA; Department of Anesthesia, University of California, San Francisco, 505 Parnassus Avenue, M-917, San Francisco, CA 94143, USA.
| |
Collapse
|
7
|
Katoto PDMC, Brand AS, Bakan B, Obadia PM, Kuhangana C, Kayembe-Kitenge T, Kitenge JP, Nkulu CBL, Vanoirbeek J, Nawrot TS, Hoet P, Nemery B. Acute and chronic exposure to air pollution in relation with incidence, prevalence, severity and mortality of COVID-19: a rapid systematic review. Environ Health 2021; 20:41. [PMID: 33838685 PMCID: PMC8035877 DOI: 10.1186/s12940-021-00714-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/05/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Air pollution is one of the world's leading mortality risk factors contributing to seven million deaths annually. COVID-19 pandemic has claimed about one million deaths in less than a year. However, it is unclear whether exposure to acute and chronic air pollution influences the COVID-19 epidemiologic curve. METHODS We searched for relevant studies listed in six electronic databases between December 2019 and September 2020. We applied no language or publication status limits. Studies presented as original articles, studies that assessed risk, incidence, prevalence, or lethality of COVID-19 in relation with exposure to either short-term or long-term exposure to ambient air pollution were included. All patients regardless of age, sex and location diagnosed as having COVID-19 of any severity were taken into consideration. We synthesised results using harvest plots based on effect direction. RESULTS Included studies were cross-sectional (n = 10), retrospective cohorts (n = 9), ecological (n = 6 of which two were time-series) and hypothesis (n = 1). Of these studies, 52 and 48% assessed the effect of short-term and long-term pollutant exposure, respectively and one evaluated both. Pollutants mostly studied were PM2.5 (64%), NO2 (50%), PM10 (43%) and O3 (29%) for acute effects and PM2.5 (85%), NO2 (39%) and O3 (23%) then PM10 (15%) for chronic effects. Most assessed COVID-19 outcomes were incidence and mortality rate. Acutely, pollutants independently associated with COVID-19 incidence and mortality were first PM2.5 then PM10, NO2 and O3 (only for incident cases). Chronically, similar relationships were found for PM2.5 and NO2. High overall risk of bias judgments (86 and 39% in short-term and long-term exposure studies, respectively) was predominantly due to a failure to adjust aggregated data for important confounders, and to a lesser extent because of a lack of comparative analysis. CONCLUSION The body of evidence indicates that both acute and chronic exposure to air pollution can affect COVID-19 epidemiology. The evidence is unclear for acute exposure due to a higher level of bias in existing studies as compared to moderate evidence with chronic exposure. Public health interventions that help minimize anthropogenic pollutant source and socio-economic injustice/disparities may reduce the planetary threat posed by both COVID-19 and air pollution pandemics.
Collapse
Affiliation(s)
- Patrick D. M. C. Katoto
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505 South Africa
- Department of Internal Medicine, Division of Respiratory Medicine & Centre for Global Health and Tropical Diseases, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Amanda S. Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Buket Bakan
- Department of Molecular Biology and Genetics, Faculty of Science, Ataturk University, 25240 Erzurum, Turkey
| | - Paul Musa Obadia
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Carsi Kuhangana
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
- Department of Public Health, Faculty of Medicine and Public Health, University of Kolwezi, Kolwezi, Democratic Republic of the Congo
| | - Tony Kayembe-Kitenge
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Joseph Pyana Kitenge
- Occupational Medicine and Environmental Health, Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Celestin Banza Lubaba Nkulu
- Unit of Toxicology and Environment, School of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| | - Tim S. Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
- Centre of Environmental Health, University of Hasselt, Hasselt, Belgium
| | - Peter Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Herestraat 49 (O&N 706), B-3000 Leuven, Belgium
| |
Collapse
|
8
|
Sunyer J, Dadvand P, Foraster M, Gilliland F, Nawrot T. Environment and the COVID-19 pandemic. ENVIRONMENTAL RESEARCH 2021; 195:110819. [PMID: 33524330 PMCID: PMC7845501 DOI: 10.1016/j.envres.2021.110819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; IMIM-Parc Salut Mar, Barcelona, Catalonia, Spain.
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Maria Foraster
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Gebouw D, 3590, Diepenbeek, Belgium; Department of Public Health & Primary Care, University of Leuven, 3000, Leuven, Belgium
| |
Collapse
|
9
|
Hallmarks of environmental insults. Cell 2021; 184:1455-1468. [PMID: 33657411 DOI: 10.1016/j.cell.2021.01.043] [Citation(s) in RCA: 173] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/15/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Environmental insults impair human health around the world. Contaminated air, water, soil, food, and occupational and household settings expose humans of all ages to a plethora of chemicals and environmental stressors. We propose eight hallmarks of environmental insults that jointly underpin the damaging impact of environmental exposures during the lifespan. Specifically, they include oxidative stress and inflammation, genomic alterations and mutations, epigenetic alterations, mitochondrial dysfunction, endocrine disruption, altered intercellular communication, altered microbiome communities, and impaired nervous system function. They provide a framework to understand why complex mixtures of environmental exposures induce severe health effects even at relatively modest concentrations.
Collapse
|
10
|
Groves CP, Butland BK, Atkinson RW, Delaney AP, Pilcher DV. Intensive care admissions and outcomes associated with short-term exposure to ambient air pollution: a time series analysis. Intensive Care Med 2020; 46:1213-1221. [PMID: 32355989 DOI: 10.1007/s00134-020-06052-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/10/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Short-term exposure to outdoor air pollution has been positively associated with numerous measures of acute morbidity and mortality, most consistently as excess cardiorespiratory disease associated with fine particulate matter (PM2.5), particularly in vulnerable populations. It is unknown if the critically ill, a vulnerable population with high levels of cardiorespiratory disease, is affected by air pollution. METHODS We performed a time series analysis of emergency cardiorespiratory, stroke and sepsis intensive care (ICU) admissions for the years 2008-2016, using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS-APD). Case-crossover analysis was conducted to assess the relationship between air pollution and the frequency and severity of ICU admissions having adjusted for temperature, humidity, public holidays and influenza activity. RESULTS 46,965 episodes in 87 separate ICUs were analysed. We found no statistically significant associations with admission counts. However, ICU admissions ending in death within 30 days were significantly positively associated with short-term exposure to PM2.5 [RR 1.18, 95% confidence interval (CI) 1.02-1.37, per 10 µg/m3 increase]. This association was more pronounced in those aged 65 and over (RR 1.33, 95% CI 1.11-1.58, per 10 µg/m3). CONCLUSIONS Increased ICU mortality was associated with higher levels of PM2.5. Larger studies are required to determine if the frequency of ICU admissions is positively associated with short-term exposure to air pollution.
Collapse
Affiliation(s)
- Christopher P Groves
- Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Barbara K Butland
- Population Health Research Institute, St George's, University of London, London, UK
| | - Richard W Atkinson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Anthony P Delaney
- Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David V Pilcher
- Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.,Australia and New Zealand Intensive Care Society (ANZICS), Centre for Outcomes and Resource Evaluation (CORE), Carlton, VIC, Australia
| |
Collapse
|
11
|
Cole MA, Ozgen C, Strobl E. Air Pollution Exposure and Covid-19 in Dutch Municipalities. ENVIRONMENTAL & RESOURCE ECONOMICS 2020; 76:581-610. [PMID: 32836849 PMCID: PMC7399597 DOI: 10.1007/s10640-020-00491-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 05/20/2023]
Abstract
In light of the existing preliminary evidence of a link between Covid-19 and poor air quality, which is largely based upon correlations, we estimate the relationship between long term air pollution exposure and Covid-19 in 355 municipalities in the Netherlands. Using detailed data we find compelling evidence of a positive relationship between air pollution, and particularly P M 2.5 concentrations, and Covid-19 cases, hospital admissions and deaths. This relationship persists even after controlling for a wide range of explanatory variables. Our results indicate that, other things being equal, a municipality with 1 μg/m3 more P M 2.5 concentrations will have 9.4 more Covid-19 cases, 3.0 more hospital admissions, and 2.3 more deaths. This relationship between Covid-19 and air pollution withstands a number of sensitivity and robustness exercises including instrumenting pollution to mitigate potential endogeneity in the measurement of pollution and modelling spatial spillovers using spatial econometric techniques.
Collapse
Affiliation(s)
- Matthew A. Cole
- Department of Economics, University of Birmingham, Birmingham, B15 2TT UK
| | - Ceren Ozgen
- Department of Economics, University of Birmingham, Birmingham, B15 2TT UK
- IZA, Bonn, Germany
| | - Eric Strobl
- Department of Economics, University of Birmingham, Birmingham, B15 2TT UK
- University of Bern, Bern, Switzerland
| |
Collapse
|