1
|
Sharafkhah M, Moayedi F, Alimi N, Fini ZH, Ebrahimi-Monfared M, Massoudifar A. Do prior neurological comorbidities predict COVID-19 severity and death? A 25-month cross-sectional multicenter study on 7370 patients. Acta Neurol Belg 2023; 123:1933-1944. [PMID: 36522609 PMCID: PMC9754988 DOI: 10.1007/s13760-022-02152-3] [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: 06/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The prognosis of COVID-19 cases that suffer from particular comorbidities is worse. The impact of chronic neurological disorders (CNDs) on the outcome of COVID-19 patients is not clear yet. This study aimed to assess whether CNDs can predict in-hospital mortality or severity in COVID-19 patients. METHODS Following a cross-sectional design, all consecutive hospitalized patients with PCR-confirmed COVID-19 who were hospitalized at three centers from February 20th, 2020 to March 20th, 2022, were studied. CND was defined as neurological conditions resulting in permanent disability. Data on demographic and clinical characteristics, COVID-19 severity, treatment, and laboratory findings were evaluated. A multivariate Cox-regression log-rank test was used to assess the primary outcome, which was in-hospital all-cause mortality. The relationship among CND, COVID-19 severity and abnormal laboratory findings was analyzed as a secondary endpoint. RESULTS We studied 7370 cases, 43.6% female, with a mean age of 58.7 years. 1654 (22.4%) patients had one or more CNDs. Patients with CNDs had higher age, were more disabled at baseline, and had more vascular risk factors and comorbidities. The ICU admission rate in CND patients with 59.7% was more frequent than the figure among non-CND patients with 20.3% (p = 0.044). Mortality of those with CND was 43.4%, in comparison with 12.8% in other participants (p = 0.005). Based on the Cox regression analysis, CND could independently predict death (HR 1.198, 95% CI 1.023-3.298, p = 0.003). CONCLUSION CNDs could independently predict the death and severity of COVID-19. Therefore, early diagnosis of COVID-19 should be considered in CND patients.
Collapse
Affiliation(s)
- Mojtaba Sharafkhah
- Department of Neurology and Psychiatry, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Farah Moayedi
- Department of Psychiatry, Faculty of Medicine, Hormozgan University of Medical Sciences, 3817876137, Bandar Abbas, Iran
| | - Nozhan Alimi
- Department of Psychiatry, Faculty of Medicine, Hormozgan University of Medical Sciences, 3817876137, Bandar Abbas, Iran
| | - Zeinab Haghighi Fini
- Department of Psychiatry, Faculty of Medicine, Hormozgan University of Medical Sciences, 3817876137, Bandar Abbas, Iran
| | | | - Ali Massoudifar
- Department of Psychiatry, Faculty of Medicine, Hormozgan University of Medical Sciences, 3817876137, Bandar Abbas, Iran.
| |
Collapse
|
2
|
Cheung ECL, Leung MTY, Chen K, Fai Wan EY, Li X, Lai FTT, Wong CKH, Qin XS, Chan EW, Lau KK, Luo H, Lin CC, Wong ICK, Chui CSL. Risk of Adverse Events and Delirium After COVID-19 Vaccination in Patients Living With Dementia. J Am Med Dir Assoc 2023:S1525-8610(23)00380-8. [PMID: 37156470 PMCID: PMC10121138 DOI: 10.1016/j.jamda.2023.04.003] [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: 10/13/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The aim of this study was to compare incidences of adverse events of special interest (AESI) and delirium in 3 cohorts: after COVID-19 vaccination, prepandemic, and SARS-CoV-2 polymerase chain reaction (PCR) test positive. DESIGN This is a population-based cohort study using electronic medical records linked with vaccination records in Hong Kong. SETTING AND PARTICIPANTS A total of 17,449 older people with dementia received at least 1 dose of CoronaVac (n = 14,719) or BNT162b2 (n = 2730) between February 23, 2021, and March 31, 2022. Moreover, 43,396 prepandemic and 3592 SARS-CoV-2 test positive patients were also included in this study. METHODS The incidences of AESI and delirium up to 28 days after vaccination in the vaccinated dementia cohort were compared with the prepandemic and SARS-CoV-2 test positive dementia cohorts by calculating incidence rate ratios (IRRs). Patients who received multiple doses were followed up separately for each dose, up to the third dose. RESULTS We did not detect an increased risk of delirium and most AESI following vaccination compared to the prepandemic period and those tested positive for SARS-CoV-2. No AESI group nor delirium incidence exceeded 10 per 1000 person-days in vaccinated individuals. CONCLUSIONS AND IMPLICATIONS The findings provide evidence for the safe use of COVID-19 vaccines in older patients with dementia. In the short run, benefit appears to outweigh the harm due to vaccine; however, longer follow-up should be continued to identify remote adverse events.
Collapse
Affiliation(s)
- Edmund C L Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Miriam T Y Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Kailin Chen
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco T T Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xiwen Simon Qin
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China
| | - Kui Kai Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; Research Department of Practice and Policy, School of Pharmacy, University College London, United Kingdom; Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong SAR, China.
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
3
|
Kostev K, Gessler N, Wohlmuth P, Arnold D, Bein B, Bohlken J, Herrlinger K, Jacob L, Koyanagi A, Nowak L, Smith L, Wesseler C, Sheikhzadeh S, Wollmer MA. Is Dementia Associated with COVID-19 Mortality? A Multicenter Retrospective Cohort Study Conducted in 50 Hospitals in Germany. J Alzheimers Dis 2023; 91:719-726. [PMID: 36463455 DOI: 10.3233/jad-220918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dementia has been identified as a major predictor of mortality associated with COVID-19. OBJECTIVE The objective of this study was to investigate the association between dementia and mortality in COVID-19 inpatients in Germany across a longer interval during the pandemic. METHODS This retrospective study was based on anonymized data from 50 hospitals in Germany and included patients with a confirmed COVID-19 diagnosis hospitalized between March 11, 2020 and July, 20, 2022. The main outcome of the study was the association of mortality during inpatient stays with dementia diagnosis, which was studied using multivariable logistic regression adjusted for age, sex, and comorbidities as well as univariate logistic regression for matched pairs. RESULTS Of 28,311 patients diagnosed with COVID-19, 11.3% had a diagnosis of dementia. Prior to matching, 26.5% of dementia patients and 11.5% of non-dementia patients died; the difference decreased to 26.5% of dementia versus 21.7% of non-dementia patients within the matched pairs (n = 3,317). This corresponded to an increase in the risk of death associated with dementia (OR = 1.33; 95% CI: 1.16-1.46) in the univariate regression conducted for matched pairs. CONCLUSION Although dementia was associated with COVID-19 mortality, the association was weaker than in previously published studies. Further studies are needed to better understand whether and how pre-existing neuropsychiatric conditions such as dementia may impact the course and outcome of COVID-19.
Collapse
Affiliation(s)
| | - Nele Gessler
- Department of Cardiology and Internal Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Asklepios Proresearch, Research Institute, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Wohlmuth
- Asklepios Proresearch, Research Institute, Hamburg, Germany
| | - Dirk Arnold
- Department of Hematology, Oncology, Palliative Care Medicine and Rheumatology, Asklepios Hospital Altona, Hamburg, Germany
| | - Berthold Bein
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain therapy, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of Leipzig, Germany
| | - Klaus Herrlinger
- Department of Internal Medicine - Gastroenterology, Asklepios Hospital Nord-Heidberg, Hamburg, Germany
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Lorenz Nowak
- Department of Intensive Care and Respiratory Medicine, Asklepios Hospital Munich-Gauting, Gauting, Germany
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Claas Wesseler
- Department of Pneumology, Asklepios Hospital Harburg, Hamburg, Germany
| | | | - Marc Axel Wollmer
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Asklepios Klinik Nord Ochsenzoll, Asklepios Campus Hamburg, Hamburg, Germany
| |
Collapse
|
4
|
Zhao Y, Jaber VR, Lukiw WJ. SARS-CoV-2, long COVID, prion disease and neurodegeneration. Front Neurosci 2022; 16:1002770. [PMID: 36238082 PMCID: PMC9551214 DOI: 10.3389/fnins.2022.1002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yuhai Zhao
- Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- LSU Neuroscience Center, LSU Health Sciences Center, New Orleans, LA, United States
| | - Vivian R. Jaber
- LSU Neuroscience Center, LSU Health Sciences Center, New Orleans, LA, United States
| | - Walter J. Lukiw
- LSU Neuroscience Center, LSU Health Sciences Center, New Orleans, LA, United States
- Department of Ophthalmology, LSU Health Sciences Center, New Orleans, LA, United States
- Department of Neurology, LSU Health Sciences Center, New Orleans, LA, United States
| |
Collapse
|
5
|
Lukiw WJ, Jaber VR, Pogue AI, Zhao Y. SARS-CoV-2 Invasion and Pathological Links to Prion Disease. Biomolecules 2022; 12:1253. [PMID: 36139092 PMCID: PMC9496025 DOI: 10.3390/biom12091253] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 12/19/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the COVID-19 disease, is a highly infectious and transmissible viral pathogen that continues to impact human health globally. Nearly ~600 million people have been infected with SARS-CoV-2, and about half exhibit some degree of continuing health complication, generically referred to as long COVID. Lingering and often serious neurological problems for patients in the post-COVID-19 recovery period include brain fog, behavioral changes, confusion, delirium, deficits in intellect, cognition and memory issues, loss of balance and coordination, problems with vision, visual processing and hallucinations, encephalopathy, encephalitis, neurovascular or cerebrovascular insufficiency, and/or impaired consciousness. Depending upon the patient’s age at the onset of COVID-19 and other factors, up to ~35% of all elderly COVID-19 patients develop a mild-to-severe encephalopathy due to complications arising from a SARS-CoV-2-induced cytokine storm and a surge in cytokine-mediated pro-inflammatory and immune signaling. In fact, this cytokine storm syndrome: (i) appears to predispose aged COVID-19 patients to the development of other neurological complications, especially those who have experienced a more serious grade of COVID-19 infection; (ii) lies along highly interactive and pathological pathways involving SARS-CoV-2 infection that promotes the parallel development and/or intensification of progressive and often lethal neurological conditions, and (iii) is strongly associated with the symptomology, onset, and development of human prion disease (PrD) and other insidious and incurable neurological syndromes. This commentary paper will evaluate some recent peer-reviewed studies in this intriguing area of human SARS-CoV-2-associated neuropathology and will assess how chronic, viral-mediated changes to the brain and CNS contribute to cognitive decline in PrD and other progressive, age-related neurodegenerative disorders.
Collapse
Affiliation(s)
- Walter J. Lukiw
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA 70112, USA
- Alchem Biotek Research, Toronto, ON M5S 1A8, Canada
- Department of Ophthalmology, LSU Health Science Center, New Orleans, LA 70112, USA
- Department Neurology, LSU Health Science Center, New Orleans, LA 70112, USA
| | - Vivian R. Jaber
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA 70112, USA
| | | | - Yuhai Zhao
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA 70112, USA
- Department of Cell Biology & Anatomy, LSU Health Science Center, New Orleans, LA 70112, USA
| |
Collapse
|
6
|
Zhao Y, Lukiw WJ. SARS-CoV-2 Neuroinvasion, Inflammatory Neurodegeneration and Alzheimer's Disease. Front Cell Neurosci 2022; 16:937961. [PMID: 35783095 PMCID: PMC9247146 DOI: 10.3389/fncel.2022.937961] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yuhai Zhao
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Cell Biology and Anatomy, LSU Health Science Center, New Orleans, LA, United States
| | - Walter J. Lukiw
- LSU Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Ophthalmology, LSU Health Science Center, New Orleans, LA, United States
- Department of Neurology, Louisiana State University Health Science Center, New Orleans, LA, United States
| |
Collapse
|
7
|
Hill JM, Lukiw WJ. microRNA, the Innate-Immune System and SARS-CoV-2. Front Cell Infect Microbiol 2022; 12:887800. [PMID: 35782132 PMCID: PMC9245018 DOI: 10.3389/fcimb.2022.887800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/02/2022] [Indexed: 12/31/2022] Open
Abstract
The single-stranded viral RNA (ssvRNA) known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19 can be effectively inactivated by a number of natural ribonucleic acid-based host cell defenses. One of the most important of these defenses includes the actions of a class of small non-coding RNAs (sncRNAs) known as microRNAs (miRNAs). Via base-pair complementarity miRNAs are capable of specifically targeting ssvRNA sequences such as SARS-CoV-2 promoting its inactivation and neutralization. RNA-sequencing and bioinformatics analysis indicate that multiple naturally-occurring human miRNAs have extensive complementarity to the SARS-CoV-2 ssvRNA genome. Since miRNA abundance, speciation, and complexity vary significantly amongst human individuals, this may in part explain the variability in the innate-immune and pathophysiological response of different individuals to SARS-CoV-2 and overall susceptibility to ssvRNA-mediated viral infection.
Collapse
Affiliation(s)
- James M. Hill
- Louisiana State University (LSU) Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Ophthalmology, LSU Health Science Center, New Orleans, LA, United States
- Department of Pharmacology, Louisiana State University (LSU) Health Science Center, New Orleans, LA, United States
- Department of Microbiology, Louisiana State University (LSU) Health Science Center, New Orleans, LA, United States
| | - Walter J. Lukiw
- Louisiana State University (LSU) Neuroscience Center, Louisiana State University Health Science Center, New Orleans, LA, United States
- Department of Ophthalmology, LSU Health Science Center, New Orleans, LA, United States
- Department Neurology, Louisiana State University Health Science Center, New Orleans, LA, United States
- *Correspondence: Walter J. Lukiw,
| |
Collapse
|