Burden and prevalence of risk factors for severe COVID-19 in the ageing European population - a SHARE-based analysis

The Impact of Pentraxin 3 Serum Levels and Angiotensin-Converting Enzyme Polymorphism on Pulmonary Infiltrates and Mortality in COVID-19 Patients

OBJECTIVES

The aim of this study was to examine the impact of the pentraxin 3 (PTX3) serum level and angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism on the severity of radiographic pulmonary infiltrates and the clinical outcomes of COVID-19.

METHODS

The severity of COVID-19 pulmonary infiltrates was evaluated within a week of admission by analyzing chest X-rays (CXR) using the modified Brixia (MBrixa) scoring system. The insertion (I)/deletion (D) polymorphism of the ACE gene and the serum levels of PTX3 were determined for all patients included in the study.

RESULTS

This study included 80 patients. Using a cut-off serum level of PTX3 ≥ 2.765 ng/mL, the ROC analysis (AUC 0.871, 95% CI 0.787-0.954, p < 0.001) showed a sensitivity of 85.7% and specificity of 78.8% in predicting severe MBrixa scores. Compared to ACE I/I polymorphism, D/D polymorphism significantly increased the risk of severe CXR infiltrates, OR 7.7 (95% CI: 1.9-30.1), and p = 0.002. Significant independent predictors of severe CXR infiltrates include hypertension (OR 7.71), PTX3 (OR 1.20), and ACE D/D polymorphism (OR 18.72). Hypertension (OR 6.91), PTX3 (OR 1.47), and ACE I/I polymorphism (OR 0.09) are significant predictors of poor outcomes.

CONCLUSION

PTX3 and ACE D/D polymorphism are significant predictors of the severity of COVID-19 pneumonia. PTX3 is a significant predictor of death.

Reopening the Bavarian State Opera Safely: Hygiene Strategies and Incidence of COVID-19 in Artistic Staff During Theater Season 2020/2021

Due to the drastically rising coronavirus disease (COVID-19) incidence since March 2020, social life was shut down across the globe, and most opera houses were closed. As a result, there are limited data on SARS-CoV-2 infections among artists. The Bavarian State Opera has been reopened in September 2020. This study aimed to identify the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among employees in the Bavarian State Opera. In addition, the various hygiene strategies for the work groups within the institution are described. During the study period from September 1, 2020 to July 31, 2021, 10,061 nasopharyngeal swabs were obtained from 1,460 artistic staff members in a rolling system. During the entire study period, 61 individuals tested positive for SARS-CoV-2. None of the patients had a severe disease course. Compared to the seven-day-incidence per 100,000 German inhabitants, the estimated corresponding incidence among employees was lower at 37 weeks and higher or equal at 9 weeks. Among the infected individuals, 58.3% were symptomatic, 23.3% were presymptomatic, and 18.3% were asymptomatic. Forty-five percent of employees reported that they had been infected in their private environment, 41.7% suspected that their colleagues were the main contact, and 13.3% were unsure about the origin of their infection. Twenty-four diseased employees were ballet dancers, eight from the orchestra, seven from the administration, seven from the choir singers, six from the costume department, 10 from technical support, and one guest solo singer. In the 2020/2021 theater season, increased SARS-CoV-2 infections and large disease outbreaks were avoided at the Bavarian State Opera. Hygiene strategies, that existed since the beginning, was specifically designed for various work areas in the opera. Regular, mandatory PCR testing and follow-up of positive cases with the issuance of quarantine were performed. Using this disease management approach, artistic work at and reopening of the Bavarian State Opera was feasible with a well-controlled risk.

Impact and evolution of risk factors associated with hospitalization and mortality due to COVID-19 during the six epidemic waves in Mexico

Objectives

This study aims to analyze and compare the main risk factors for hospitalization and deaths due to COVID-19 during the six epidemic waves from February 2020 to June 2023 in Mexico.

Methods

First, a descriptive analysis of the risk factors that led to hospitalization and mortality due to COVID-19 was performed. Next, the degree of relationship of each risk factor with hospitalization and death was determined using Cramer's V coefficient. Finally, logistic regression models were applied to estimate the odds ratios of the most statistically significant risk factors for hospitalization and mortality.

Results

A direct relationship between age and the possibility of hospitalization and death due to COVID-19 was found. Moreover, the comorbidities most likely to lead to hospitalization and death were pneumonia, hypertension, diabetes, obesity and CKD. It is also remarkable that the second factor of death is endotracheal intubation.

Conclusion

The COVID-19 pandemic in Mexico revealed the reality of an epidemiological scenario where infectious diseases and chronic degenerative diseases coexist and interrelate.

Quantitative sensory testing defines the trajectory of sensory neuropathy after severe COVID-19

AIMS

To assess sensory neuropathy development after severe COVID-19.

METHODS

Patients with severe COVID-19 underwent assessment of neuropathic symptoms, tendon reflexes, and quantitative sensory testing to evaluate vibration (VPT), cold (CPT), warm (WPT) and heat perception thresholds (HPT) within 1-3 weeks of admission and after 1-year.

RESULTS

32 participants with severe COVID-19 aged 68.6 ± 12.4 (18.8 % diabetes) were assessed. At baseline, numbness and neuropathic pain were present in 56.3 % and 43.8 % of participants, respectively. On the feet, VPT, WPT, and HPT were abnormal in 81.3 %, CPT was abnormal in 50.0 % and HPT on the face was abnormal in 12.5 % of patients. At 1-year follow-up, the prevalence of abnormal VPT (81.3 % vs 50.0 %, P < 0.01), WPT (81.3 % vs 43.8 %, P < 0.01), and HPT (81.3 % vs 50.0 %, P < 0.01) decreased, with no change in CPT (P = 0.21) on the feet or HPT on the face (P = 1.0). Only participants without diabetes recovered from an abnormal VPT, CPT, and WPT. Patients with long-COVID (37.5 %) had comparable baseline VPT, WPT and CPT with those without long-COVID (P = 0.07-0.69).

CONCLUSIONS

Severe COVID-19 is associated with abnormal vibration and thermal thresholds which are sustained for up to 1 year in patients with diabetes. Abnormal sensory thresholds have no association with long-COVID development.

Sex differences in vision and hearing impairments across age and European regions : Findings from SHARE

AIM

Although sensory impairments are common conditions among older people, research often fails to consider the role of sex. We examined sex differences in vision impairment and hearing impairment across age and European regions.

METHODS

We conducted a cross-sectional study based on a pooled sample of 65,656 females and 54,881 males aged 50 years and older participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Logistic regression models with robust standard errors providing odds ratios (OR) and 95% confidence intervals (CI) were used to examine associations.

RESULTS

European females had generally higher odds of vision impairment (OR 1.16, 95% CI 1.12-1.21) but lower odds of hearing impairment than European males (OR 0.70, 95% CI 0.67-0.73). The female disadvantage in vision increased with advancing age, whereas the female advantage in hearing decreased. No overall sex difference in vision was found in northern Europe, but females had more vision impairments than males in southern (OR 1.23, 95% CI 1.14-1.32), western (OR 1.14, 95% CI 1.08-1.21) and eastern (OR 1.10, 95% CI 1.02-1.20) Europe. Females were healthier than males in terms of hearing in all regions, with the largest female advantage in northern Europe (OR 0.58, 95% CI 0.53-0.64).

CONCLUSION

Our findings demonstrate an overall consistent pattern of sex differences in sensory impairments across Europe showing an increasing female disadvantage in vision and a decreasing female advantage in hearing with advancing age.

The role of immune activation and antigen persistence in acute and long COVID

In late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) triggered the global coronavirus disease 2019 (COVID-19) pandemic. Although most infections cause a self-limited syndrome comparable to other upper respiratory viral pathogens, a portion of individuals develop severe illness leading to substantial morbidity and mortality. Furthermore, an estimated 10%-20% of SARS-CoV-2 infections are followed by post-acute sequelae of COVID-19 (PASC), or long COVID. Long COVID is associated with a wide variety of clinical manifestations including cardiopulmonary complications, persistent fatigue, and neurocognitive dysfunction. Severe acute COVID-19 is associated with hyperactivation and increased inflammation, which may be an underlying cause of long COVID in a subset of individuals. However, the immunologic mechanisms driving long COVID development are still under investigation. Early in the pandemic, our group and others observed immune dysregulation persisted into convalescence after acute COVID-19. We subsequently observed persistent immune dysregulation in a cohort of individuals experiencing long COVID. We demonstrated increased SARS-CoV-2-specific CD4+ and CD8+ T-cell responses and antibody affinity in patients experiencing long COVID symptoms. These data suggest a portion of long COVID symptoms may be due to chronic immune activation and the presence of persistent SARS-CoV-2 antigen. This review summarizes the COVID-19 literature to date detailing acute COVID-19 and convalescence and how these observations relate to the development of long COVID. In addition, we discuss recent findings in support of persistent antigen and the evidence that this phenomenon contributes to local and systemic inflammation and the heterogeneous nature of clinical manifestations seen in long COVID.

The implications of globalization on COVID-19 vaccination in Europe

Although globalization has left its mark on economic dynamism, causing conditionalities among various aspects (market openness, production networks, technological and information developments, migratory flows, international cooperation, humanitarian support, etc.), the less pleasant side of it should not be omitted, i.e. the emergence of the framework for the faster diffusion of epidemiological diseases. Thus, with the onset of the SARS-CoV-2 virus, its widespread circulation is a serious challenge for the provision of efficient solutions to combat it, especially in countries with fragile health systems, poor institutional quality and lack of resources. In this paper we aim to investigate the implications of globalization on the COVID-19 vaccination of the population. The period under analysis is January 1, 2021-January 1, 2022, using montly data, and the object of our study are 48 European states. To capture the relationship between globalization and the vaccination rate, we applied regression models, including a number of factors that may influence the progress of vaccination. In order to test the robustness of the results, the two-stage least squares (2SLS) regressions was used. The regression models developed underlined that globalization impacts the degree of vaccination. More globalized economies are more competitive in COVID-19 management, and the significance of this effect comes from better interconnection in global markets and easier access to medical discoveries. At the same time, countries with a higher vaccination rate are associated with higher levels of development. Based on the results obtained, we proposed some policy recommendations to increase the propensity to vaccinate, ensure equity in the distribution of vaccines and provide financial support to developing countries.

Detection of anti-SARS-CoV-2-Spike/RBD antibodies in vaccinated elderly from residential care facilities in Romania, April 2021

Introduction

SARS-CoV-2 infection rates and related mortality in elderly from residential care facilities are high. The aim of this study was to explore the immune status after COVID-19 vaccination in people 65 years and older.

Methods

The study involved volunteer participants living in residential care facilities. The level of anti-Spike/RBD antibodies was measured at 2-12 weeks after complete vaccination, using chemiluminescent microparticle immunoassay (SARS-CoV-2 IgG II Quant Abbott).

Results

We have analyzed 635 serum samples collected from volunteers living in 21 Residential Care Facilities. With one exception, in which the vaccination was done with the Moderna vaccine, all volunteers received the Pfizer-Comirnaty vaccine. Individuals enrolled in the study had ages between 65-110 years (median 79 years). Of the people tested, 54.8% reported at least one comorbidity and 59.2% reported having had COVID-19 before vaccination. The presence of anti-S/RBD antibodies at a protective level was detected in 98.7% of those tested (n = 627 persons) with a wide variation of antibody levels, from 7.1 to 5,680 BAU/ml (median 1287 BAU/ml). Antibody levels appeared to be significantly correlated to previous infection (r = 0.302, p = 0.000).

Conclusions

The study revealed the presence of anti-SARS CoV-2 antibodies in a significant percentage of those tested (98.7%). Of these, more than half had high antibody levels. Pre-vaccination COVID-19 was the only factor found to be associated with higher anti-S/RBD levels. The significant response in elderly people, even in those with comorbidities, supports the vaccination measure for this category, irrespective of associated disabilities or previous infection.

Assessment of the Humoral Immune Response Following COVID-19 Vaccination in Healthcare Workers: A One Year Longitudinal Study

The continuous variability of SARS-CoV-2 and the rapid waning of specific antibodies threatens the efficacy of COVID-19 vaccines. We aimed to evaluate antibody kinetics one year after SARS-CoV-2 vaccination with an mRNA vaccine in healthcare workers (HCW), with or without a booster. A marked decline in anti-Spike(S)/Receptor Binding Domain (RBD) antibody levels was registered during the first eight months post-vaccination, followed by a transitory increase after the booster. At three months post-booster an increased antibody level was maintained only in HCW vaccinated after a prior infection, who also developed a higher and long-lasting level of anti-S IgA antibodies. Still, IgG anti-nucleocapsid (NCP) fades five months post-SARS-CoV-2 infection. Despite the decline in antibodies one-year post-vaccination, 68.2% of HCW preserved the neutralization capacity against the ancestral variant, with a decrease of only 17.08% in the neutralizing capacity against the Omicron variant. Nevertheless, breakthrough infections were present in 6.65% of all participants, without any correlation with the previous level of anti-S/RBD IgG. Protection against the ancestral and Omicron variants is maintained at least three months after a booster in HCW, possibly reflecting a continuous antigenic stimulation in the professional setting.

Development and Validation of a Predictive Nomogram with Age and Laboratory Findings for Severe COVID-19 in Hunan Province, China

Purpose

To identify more objectively predictive factors of severe outcome among patients hospitalized for coronavirus disease 2019 (COVID-19).

Patients and Methods

A retrospective cohort of 479 hospitalized patients diagnosed with COVID-19 in Hunan Province was selected. The prognostic effects of factors such as age and laboratory indicators were analyzed using the Kaplan–Meier method and Cox proportional hazards model. A prognostic nomogram model was established to predict the progression of patients with COVID-19.

Results

A total of 524 patients in Hunan province with COVID-19 from December 2019 to October 2020 were retrospectively recruited. Among them, 479 eligible patients were randomly assigned into the training cohort (n = 383) and validation cohort (n = 96), at a ratio of 8:2. Sixty-eight (17.8%) and 15 (15.6%) patients developed severe COVID-19 after admission in the training cohort and validation cohort, respectively. The differences in baseline characteristics were not statistically significant between the two cohorts with regard to age, sex, and comorbidities (P > 0.05). Multivariable analyses included age, C-reactive protein, fibrinogen, lactic dehydrogenase, neutrophil-to-lymphocyte ratio, urea, albumin-to-globulin ratio, and eosinophil count as predictive factors for patients with progression to severe COVID-19. A nomogram was constructed with sufficient discriminatory power (C index = 0.81), and proper consistency between the prediction and observation, with an area under the ROC curve of 0.81 and 0.86 in the training and validation cohort, respectively.

Conclusion

We proposed a simple nomogram for early detection of patients with non-severe COVID-19 but at high risk of progression to severe COVID-19, which could help optimize clinical care and personalized decision-making therapies.

Prevalence and prognostic significance of chronic respiratory diseases among hospitalized patients with COVID-19 infection: a single-center study

Background

WHO recognized the COVID-19 outbreak in China as a pandemic crisis on March 11, 2020. Patients with chronic respiratory diseases (CRDs) have limited physiological reserve; this lead to the assumption that COVID-19 infection in such patients could carry worse prognosis.

Aim of study

To detect the prevalence and prognostic significance of CRDs among hospitalized patients with COVID-19 infection.

Methods

The study was carried out at Minia Cardiothoracic University Hospital; all hospitalized COVID-19 patients during the period from January 2021 to August 2021 were included.

Patients were subjected to full medical history taking, full blood count, inflammatory markers (CRP, serum ferritin, serum lactate dehydrogenase (LDH), serum D-dimer, PCR for COVID-19 infection), and HRCT chest.

Need for and duration of mechanical ventilation whether invasive or non-invasive, duration of hospital stay, and condition at hospital discharge were recorded.

Diagnosis for chronic respiratory disease was considered when patients have documented previous history and investigations compatible with the diagnosis, e.g., previous pulmonary function tests, chest CT, or sleep study.

Results

Comorbid chronic respiratory diseases were present in 57 patients (17.6%). Regarding presenting symptoms, no significant difference exists between patients with and without CRDs except for sputum production which was more frequent among patients with underlying CRDs.

Elevated inflammatory markers (ferritin, D-dimer, and LDH) were more frequently observed in patients without CRDs (p < 0.0001, 0.033, and 0.008, respectively).

COVID-19 with comorbid CRDs patients were more hypoxemic at presentation than other patients (p = 0.032).

There was significant number of COVID-19 patients with CRDs were discharged on home oxygen therapy (p = 0.003).

Regarding mortality in our cohort of patients, no significant difference exist between patients with and without CRDs (p 0.374)

Among patients with comorbid CRDs, the highest mortality was observed on patients with OSA followed by ILDS and then COPD.

Conclusion

The presence of CRD was not found to be a poor prognostic value of COVID-19. Inflammatory markers (ferritin, D-dimer, and LDH) were significantly higher in COVID-19 patients without CRD than COVID-19 with CRD.

Frailty and chronic respiratory disease: the need for a multidisciplinary care model

Background.

Frailty is a state of increased vulnerability to various health stressors but little information is summarized about frailty in patients with specific chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and asthma.

Objective.

We aimed to describe the burden of frailty on patients with chronic respiratory disorders and to discuss the need for multidisciplinary care services.

Methods.

PubMed and Cochrane Central databases were systematically reviewed for studies reporting outcomes associated with frailty in COPD, IPF, and asthma. Electronic databases were searched for relevant articles published in English from 2010 up to July 2020. Appraisal was carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines.

Results.

A total of 31 articles met all inclusion criteria with 24 of them at level IV, 1 at level V, and 6 at level VI. Frailty is likely to negatively affect quality of life and to increase the risk of mortality, especially in elderly with COPD, IPF and asthma. Each disease has a particular effect on the balance between health status, respiratory impairment and frailty. A greater understanding of frailty phenotype across different ages, as well as in a range of long-term conditions, is of great necessity in both clinical and research settings. Limited conformity was observed between different methodologies and nature of chronic diseases studied, leading to a further difficulty to extract homogeneous information.

Conclusion.

Literature shows that frailty is prevalent in COPD, IPF, and asthma, after adjusting for shared risk factors. Our findings suggest that frailty should be approached as an entity per se’, in order to assess real mortality risk, alongside respiratory disease severity and the presence of comorbidities. Health care professionals need knowledge, skills and multidisciplinary collaboration to buffer the impact of frailty on everyday practice.

Cardiovascular Disease Complicating COVID-19 in the Elderly

SARS-CoV-2, a single-stranded RNA coronavirus, causes an illness known as coronavirus disease 2019 (COVID-19). The highly transmissible virus gains entry into human cells primarily by the binding of its spike protein to the angiotensin-converting enzyme 2 receptor, which is expressed not only in lung tissue but also in cardiac myocytes and the vascular endothelium. Cardiovascular complications are frequent in patients with COVID-19 and may be a result of viral-associated systemic and cardiac inflammation or may arise from a virus-induced hypercoagulable state. This prothrombotic state is marked by endothelial dysfunction and platelet activation in both macrovasculature and microvasculature. In patients with subclinical atherosclerosis, COVID-19 may incite atherosclerotic plaque disruption and coronary thrombosis. Hypertension and obesity are common comorbidities in COVID-19 patients that may significantly raise the risk of mortality. Sedentary behaviors, poor diet, and increased use of tobacco and alcohol, associated with prolonged stay-at-home restrictions, may promote thrombosis, while depressed mood due to social isolation can exacerbate poor self-care. Telehealth interventions via smartphone applications and other technologies that document nutrition and offer exercise programs and social connections can be used to mitigate some of the potential damage to heart health.

Chronic respiratory diseases are predictors of severe outcome in COVID-19 hospitalised patients: a nationwide study

Background

Influenza epidemics were initially considered to be a suitable model for the COVID-19 epidemic, but there is a lack of data concerning patients with chronic respiratory diseases (CRDs), who were supposed to be at risk of severe forms of COVID-19.

Methods

This nationwide retrospective cohort study describes patients with prior lung disease hospitalised for COVID-19 (March–April 2020) or influenza (2018–2019 influenza outbreak). We compared the resulting pulmonary complications, need for intensive care and in-hospital mortality depending on respiratory history and virus.

Results

In the 89 530 COVID-19 cases, 16.03% had at least one CRD, which was significantly less frequently than in the 45 819 seasonal influenza patients. Patients suffering from chronic respiratory failure, chronic obstructive pulmonary disease, asthma, cystic fibrosis and pulmonary hypertension were under-represented, contrary to those with lung cancer, sleep apnoea, emphysema and interstitial lung diseases. COVID-19 patients with CRDs developed significantly more ventilator-associated pneumonia and pulmonary embolism than influenza patients. They needed intensive care significantly more often and had a higher mortality rate (except for asthma) when compared with patients with COVID-19 but without CRDs or patients with influenza.

Conclusions

Patients with prior respiratory diseases were globally less likely to be hospitalised for COVID-19 than for influenza, but were at higher risk of developing severe COVID-19 and had a higher mortality rate compared with influenza patients and patients without a history of respiratory illness.

There was a higher risk of developing severe COVID-19 and a higher mortality rate among patients with chronic respiratory diseases. This study suggests that these patients should have priority access to SARS-CoV-2 vaccination.https://bit.ly/3bcp2HC