1
|
Mokhayeri Y, Taherpour N, Shahbazi F, Ghorbani SS, Fallah S, Etemad K, Izadi N, Mehri A, Farhadi-Babadi K, Rahimi E, Feyzi R, Seifi A, Hashemi Nazari SS. Estimation of outpatient SARS-CoV-2 reinfection and recurrence rates and associated factors among COVID-19 hospitalized patients over one-year old: a multicenter retrospective cohort study. BMC Infect Dis 2024; 24:999. [PMID: 39294562 PMCID: PMC11411993 DOI: 10.1186/s12879-024-09872-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 09/03/2024] [Indexed: 09/20/2024] Open
Abstract
INTRODUCTION Reinfection with SARS-Cov-2 after recovery can occur that most of them don't require hospitalization. The aim of this study is estimation of out-patient COVID-19 reinfection and recurrence rates and its associated factors among Iranian patients with history of confirmed SARS-Cov-2 infection and hospitalization. METHODS This study is a retrospective cohort conducted from May 2021 to May 2022 in Iran. The national Medical Care Monitoring Center (MCMC) database, obtained from the Ministry of Health and Medical Education, includes all information about confirmed COVID-19 patients who are hospitalized and diagnosed during the pandemic. Using probability proportional to size sampling from 31 provinces, 1,532 patients over one years of age with a history of hospitalization in the MCMC data are randomly selected. After that, interviews by phone are performed with all of the selected patients using a researcher-made questionnaire about the occurrence of overall reinfection without considering the time of infection occurrence, reinfection occurring at least 90 days after the discharge and recurrence (occurring within 90 days after discharge). Univariate and multivariable Cox regression analyses are performed to assess the factors associated with each index. All of the analyses are performed using Stata software version 16. RESULTS In general, 1,532 phone calls are made, out of which 1,095 individuals are willing to participate in the study (response rate ≃ 71%). After assessing the 1,095 patients with a positive history of COVID-19, the rates of non-hospitalized overall SARS-Cov-2 reinfection, reinfection and recurrence are 122.64, 114.09, and 8.55 per 1,000 person-years, respectively. The age range of 19-64 years (aHR:3.93, 95%CI : 1.24-12.41) and COVID-19-related healthcare worker (aHR: 3.67, 95%CI: 1.77-7.61) are identified as risk factors for reinfection, while having comorbidity, being fully vaccinated, and having a partial pressure of oxygen (PaO2) ≥ 93 mmHg during the initial infection are identified as factors that reduce the risk of non-hospitalized reinfection. CONCLUSION Reinfection due to COVID-19 is possible because of the weakened immune system for various reasons and the mutation of the virus. Vaccination, timely boosters, and adherence to preventive measures can help mitigate this risk.
Collapse
Affiliation(s)
- Yaser Mokhayeri
- Cardiovascular Research Center, Shahid Rahimi Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Niloufar Taherpour
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shahbazi
- Department of Epidemiology, School of Health, Hamadan University of Medical Sciences Hamadan, Hamadan, Iran
| | - Sahar Sotoodeh Ghorbani
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Fallah
- Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Koorosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Izadi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kosar Farhadi-Babadi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Rahimi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Feyzi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin Ave, Tehran, 198353-5511, Iran.
| |
Collapse
|
2
|
Rahayu DRP, Rusli M, Bramantono B, Widyoningroem A. Association between chest X-ray score and clinical outcome in COVID-19 patients: A study on modified radiographic assessment of lung edema score (mRALE) in Indonesia. NARRA J 2024; 4:e691. [PMID: 38798849 PMCID: PMC11125424 DOI: 10.52225/narra.v4i1.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/03/2024] [Indexed: 05/29/2024]
Abstract
Radiological examinations such as chest X-rays (CXR) play a crucial role in the early diagnosis and determining disease severity in coronavirus disease 2019 (COVID-19). Various CXR scoring systems have been developed to quantitively assess lung abnormalities in COVID-19 patients, including CXR modified radiographic assessment of lung edema (mRALE). The aim of this study was to determine the relationship between mRALE scores and clinical outcome (mortality), as well as to identify the correlation between mRALE score and the severity of hypoxia (PaO2/FiO2 ratio). A retrospective cohort study was conducted among hospitalized COVID-19 patients at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from February to April 2022. All CXR data at initial admission were scored using the mRALE scoring system, and the clinical outcomes at the end of hospitalization were recorded. Of the total 178 COVID-19 patients, 62.9% survived after completing the treatment. Patients within non-survived had significantly higher quick sequential organ failure assessment (qSOFA) score (p<0.001), lower PaO2/FiO2 ratio (p=0.004), and higher blood urea nitrogen (p<0.001), serum creatinine (p<0.008) and serum glutamic oxaloacetic transaminase (p=0.001) levels. There was a significant relationship between mRALE score and clinical outcome (survived vs deceased) (p=0.024; contingency coefficient of 0.184); and mRALE score of ≥2.5 served as a risk factor for mortality among COVID-19 patients (relative risk of 1.624). There was a significant negative correlation between the mRALE score and PaO2/FiO2 ratio based on the Spearman correlation test (r=-0.346; p<0.001). The findings highlight that the initial mRALE score may serve as an independent predictor of mortality among hospitalized COVID-19 patients as well as proves its potential prognostic role in the management of COVID-19.
Collapse
Affiliation(s)
- Dwi RP. Rahayu
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Musofa Rusli
- Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Tropical Medicine and Infectious Disease, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Bramantono Bramantono
- Division of Tropical Medicine and Infectious Disease, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Division of Tropical Medicine and Infectious Disease, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Anita Widyoningroem
- Department of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Radiology, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
3
|
Bastidas-Goyes AR, Tuta-Quintero E, Aguilar MF, Mora AV, Aponte HC, Villamizar JM, Galeano S, Mejia P, Muñoz M, Paredes S, Pumarejo D, Barragan MDM. Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19. BMC Pulm Med 2024; 24:68. [PMID: 38308270 PMCID: PMC10835882 DOI: 10.1186/s12890-023-02807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/07/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. METHODS A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. RESULTS A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546-0.632) and 0.567 (95% CI: 0.526-0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628-0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582-0.667) and 0.706 (95% CI: 0.669-0.742), respectively. CONCLUSION PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19.
Collapse
Affiliation(s)
- Alirio R Bastidas-Goyes
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia.
| | - Eduardo Tuta-Quintero
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria F Aguilar
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Angélica V Mora
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | | | - Jesus M Villamizar
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Susana Galeano
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Paola Mejia
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria Muñoz
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Sara Paredes
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Doris Pumarejo
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria Del Mar Barragan
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| |
Collapse
|
4
|
Libra A, Ciancio N, Sambataro G, Sciacca E, Muscato G, Marino A, Vancheri C, Spicuzza L. Use of Remdesivir in Patients Hospitalized for COVID-19 Pneumonia: Effect on the Hypoxic and Inflammatory State. Viruses 2023; 15:2101. [PMID: 37896877 PMCID: PMC10612076 DOI: 10.3390/v15102101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Remdesivir is one of the most attractive options for patients with hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). The aim of our study was to evaluate the effect of remdesivir on the hypoxic and inflammatory state in patients with moderate to severe COVID-19. We retrospectively enrolled 112 patients admitted for COVID-19 pneumonia, requiring low-flow oxygen, 57 treated with remdesivir plus standard of care (SoC) and 55 treated only with SoC that were similar for demographic and clinical data. We evaluated changes in hypoxemia and inflammatory markers at admission (Day 0) and after 5 days of treatment (Day 5) and the clinical course of the disease. From Day 0 to Day 5, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) increased from 222 ± 62 to 274 ± 97 (p < 0.0001) in the remdesivir group and decreased from 223 ± 62 to 183 ± 76 (p < 0.05) in the SoC group. Interleukine-6 levels decreased in the remdesivir (45.9 to 17.5 pg/mL, p < 0.05) but not in the SoC group. Remdesivir reduced the need for ventilatory support and the length of hospitalization. In conclusion, compared to standard care, remdesivir rapidly improves hypoxia and inflammation, causing a better course of the disease in moderate to severe COVID-19.
Collapse
Affiliation(s)
- Alessandro Libra
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Nicola Ciancio
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Enrico Sciacca
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Giuseppe Muscato
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Andrea Marino
- Department of Biomedical and Biotechnological Sciences, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy;
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Lucia Spicuzza
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| |
Collapse
|
5
|
Pan J, Bu W, Guo T, Geng Z, Shao M. Development and validation of an in-hospital mortality risk prediction model for patients with severe community-acquired pneumonia in the intensive care unit. BMC Pulm Med 2023; 23:303. [PMID: 37592285 PMCID: PMC10436447 DOI: 10.1186/s12890-023-02567-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND A high mortality rate has always been observed in patients with severe community-acquired pneumonia (SCAP) admitted to the intensive care unit (ICU); however, there are few reported predictive models regarding the prognosis of this group of patients. This study aimed to screen for risk factors and assign a useful nomogram to predict mortality in these patients. METHODS As a developmental cohort, we used 455 patients with SCAP admitted to ICU. Logistic regression analyses were used to identify independent risk factors for death. A mortality prediction model was built based on statistically significant risk factors. Furthermore, the model was visualized using a nomogram. As a validation cohort, we used 88 patients with SCAP admitted to ICU of another hospital. The performance of the nomogram was evaluated by analysis of the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, and decision curve analysis (DCA). RESULTS Lymphocytes, PaO2/FiO2, shock, and APACHE II score were independent risk factors for in-hospital mortality in the development cohort. External validation results showed a C-index of 0.903 (95% CI 0.838-0.968). The AUC of model for the development cohort was 0.85, which was better than APACHE II score 0.795 and SOFA score 0.69. The AUC for the validation cohort was 0.893, which was better than APACHE II score 0.746 and SOFA score 0.742. Calibration curves for both cohorts showed agreement between predicted and actual probabilities. The results of the DCA curves for both cohorts indicated that the model had a high clinical application in comparison to APACHE II and SOFA scoring systems. CONCLUSIONS We developed a predictive model based on lymphocytes, PaO2/FiO2, shock, and APACHE II scores to predict in-hospital mortality in patients with SCAP admitted to the ICU. The model has the potential to help physicians assess the prognosis of this group of patients.
Collapse
Affiliation(s)
- Jingjing Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Respiratory Intensive Care Unit, Anhui Chest Hospital, Hefei, China
| | - Wei Bu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Guo
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, China
| | - Zhi Geng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China.
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| |
Collapse
|
6
|
Regolo M, Sorce A, Vaccaro M, Colaci M, Stancanelli B, Natoli G, Motta M, Isaia I, Castelletti F, Giangreco F, Fichera D, Aparo P, Lanzafame A, Russo M, Santangelo N, Noto P, Malatino L. Assessing Humoral Immuno-Inflammatory Pathways Associated with Respiratory Failure in COVID-19 Patients. J Clin Med 2023; 12:4057. [PMID: 37373750 DOI: 10.3390/jcm12124057] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
All severe cases of SARS-CoV-2 infections are characterized by a high risk of disease progression towards ARDS, leading to a bad outcome. Respiratory symptoms in COVID-19 patients often do not correspond to disease's worsening. In our sample, median age was 74 years (72-75) and 54% were men. The median period of hospitalization was 9 days. Firstly, we observed a significant asynchronous trend of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in 764 selected among 963 patients, who were consecutively recruited in two hospitals (Cannizzaro, S. Marco) in Catania, Italy. NLR values in deceased patients showed an increase from baseline over time. By contrast, CRP tended to fall from baseline to median day of hospitalization in all three subgroups, but steeply increased at the end of hospitalization only in ICU-admitted patients. Then, we evaluated the relationships between NLR and CRP as continuous variables with PaO2/FiO2 ratio (P/F). NLR was an independent predictor of mortality (HR: 1.77, p < 0.0001), while ICU admission was more significantly associated with CRP (HR: 1.70, p < 0.0001). Finally, age, neutrophils, CRP, and lymphocytes are significantly and directly linked to P/F, while the influence of inflammation on P/F, reflected by CRP, was also mediated by neutrophils.
Collapse
Affiliation(s)
- Matteo Regolo
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Alessandra Sorce
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, University of Palermo, 90133 Palermo, Italy
| | - Mauro Vaccaro
- Department of Emergency Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Michele Colaci
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Benedetta Stancanelli
- Unit of Internal Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Giuseppe Natoli
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Massimo Motta
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Ivan Isaia
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Federica Castelletti
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Federica Giangreco
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Daniela Fichera
- Department of Emergency Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Paola Aparo
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Alessandra Lanzafame
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Mario Russo
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Nicola Santangelo
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Paola Noto
- Department of Emergency Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| |
Collapse
|
7
|
Casano N, Santini SJ, Vittorini P, Sinatti G, Carducci P, Mastroianni CM, Ciardi MR, Pasculli P, Petrucci E, Marinangeli F, Balsano C. Application of machine learning approach in emergency department to support clinical decision making for SARS-CoV-2 infected patients. J Integr Bioinform 2023; 20:jib-2022-0047. [PMID: 36877860 PMCID: PMC10561065 DOI: 10.1515/jib-2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
To support physicians in clinical decision process on patients affected by Coronavirus Disease 2019 (COVID-19) in areas with a low vaccination rate, we devised and evaluated the performances of several machine learning (ML) classifiers fed with readily available clinical and laboratory data. Our observational retrospective study collected data from a cohort of 779 COVID-19 patients presenting to three hospitals of the Lazio-Abruzzo area (Italy). Based on a different selection of clinical and respiratory (ROX index and PaO2/FiO2 ratio) variables, we devised an AI-driven tool to predict safe discharge from ED, disease severity and mortality during hospitalization. To predict safe discharge our best classifier is an RF integrated with ROX index that reached AUC of 0.96. To predict disease severity the best classifier was an RF integrated with ROX index that reached an AUC of 0.91. For mortality prediction the best classifier was an RF integrated with ROX index, that reached an AUC of 0.91. The results obtained thanks to our algorithms are consistent with the scientific literature an accomplish significant performances to forecast safe discharge from ED and severe clinical course of COVID-19.
Collapse
Affiliation(s)
- Nicolò Casano
- School of Emergency Medicine, Interdisciplinary BioMedical group on Artificial Intelligence, IBMAI, Department MeSVA, University of L’Aquila, L’Aquila, Italy
| | - Silvano Junior Santini
- School of Emergency Medicine, Interdisciplinary BioMedical group on Artificial Intelligence, IBMAI, Department MeSVA, University of L’Aquila, L’Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| | - Pierpaolo Vittorini
- School of Emergency Medicine, Interdisciplinary BioMedical group on Artificial Intelligence, IBMAI, Department MeSVA, University of L’Aquila, L’Aquila, Italy
| | - Gaia Sinatti
- School of Emergency Medicine, Interdisciplinary BioMedical group on Artificial Intelligence, IBMAI, Department MeSVA, University of L’Aquila, L’Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| | - Paolo Carducci
- School of Emergency Medicine, Interdisciplinary BioMedical group on Artificial Intelligence, IBMAI, Department MeSVA, University of L’Aquila, L’Aquila, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, L’Aquila, Italy
| | - Clara Balsano
- School of Emergency Medicine, Interdisciplinary BioMedical group on Artificial Intelligence, IBMAI, Department MeSVA, University of L’Aquila, L’Aquila, Italy
- Francesco Balsano Foundation, Via Giovanni Battista Martini 6, 00198, Rome, Italy
| |
Collapse
|
8
|
Skendros P, Germanidis G, Mastellos DC, Antoniadou C, Gavriilidis E, Kalopitas G, Samakidou A, Liontos A, Chrysanthopoulou A, Ntinopoulou M, Kogias D, Karanika I, Smyrlis A, Cepaityte D, Fotiadou I, Zioga N, Mitroulis I, Gatselis NK, Papagoras C, Metallidis S, Milionis H, Dalekos GN, Willems L, Persson B, Manivel VA, Nilsson B, Connolly ES, Iacobelli S, Papadopoulos V, Calado RT, Huber-Lang M, Risitano AM, Yancopoulou D, Ritis K, Lambris JD. Complement C3 inhibition in severe COVID-19 using compstatin AMY-101. SCIENCE ADVANCES 2022; 8:eabo2341. [PMID: 35977025 PMCID: PMC9385148 DOI: 10.1126/sciadv.abo2341] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Complement C3 activation contributes to COVID-19 pathology, and C3 targeting has emerged as a promising therapeutic strategy. We provide interim data from ITHACA, the first randomized trial evaluating a C3 inhibitor, AMY-101, in severe COVID-19 (PaO2/FiO2 ≤ 300 mmHg). Patients received AMY-101 (n = 16) or placebo (n = 15) in addition to standard of care. AMY-101 was safe and well tolerated. Compared to placebo (8 of 15, 53.3%), a higher, albeit nonsignificant, proportion of AMY-101-treated patients (13 of 16, 81.3%) were free of supplemental oxygen at day 14. Three nonresponders and two placebo-treated patients succumbed to disease-related complications. AMY-101 significantly reduced CRP and ferritin and restrained thrombin and NET generation. Complete and sustained C3 inhibition was observed in all responders. Residual C3 activity in the three nonresponders suggested the presence of a convertase-independent C3 activation pathway overriding the drug's inhibitory activity. These findings support the design of larger trials exploring the potential of C3-based inhibition in COVID-19 or other complement-mediated diseases.
Collapse
Affiliation(s)
- Panagiotis Skendros
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Germanidis
- First Department of Internal Medicine, AHEPA University Hospital, and Basic and Translational Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Christina Antoniadou
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Gavriilidis
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgios Kalopitas
- First Department of Internal Medicine, AHEPA University Hospital, and Basic and Translational Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Samakidou
- Department of Medicine and Research Laboratory of Internal Medicine, National and European Expertise Center of Greece in Autoimmune Liver Diseases (ERN Rare-Liver), General University Hospital of Larissa, Larissa, Greece
| | - Angelos Liontos
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Akrivi Chrysanthopoulou
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Maria Ntinopoulou
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Dionysios Kogias
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioanna Karanika
- First Department of Internal Medicine, AHEPA University Hospital, and Basic and Translational Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Smyrlis
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Dainora Cepaityte
- First Department of Internal Medicine, AHEPA University Hospital, and Basic and Translational Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iliana Fotiadou
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikoleta Zioga
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Mitroulis
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National and European Expertise Center of Greece in Autoimmune Liver Diseases (ERN Rare-Liver), General University Hospital of Larissa, Larissa, Greece
| | - Charalampos Papagoras
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, AHEPA University Hospital, and Basic and Translational Research Unit, Special Unit for Biomedical Research and Education (SUBRE), School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National and European Expertise Center of Greece in Autoimmune Liver Diseases (ERN Rare-Liver), General University Hospital of Larissa, Larissa, Greece
| | - Loek Willems
- R&D Department, Hycult Biotechnology, Uden, Netherlands
| | - Barbro Persson
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Vivek Anand Manivel
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Bo Nilsson
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - E. Sander Connolly
- Department of Neurological Surgery, Columbia University, New York, NY, USA
| | - Simona Iacobelli
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Vasileios Papadopoulos
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Rodrigo T. Calado
- Department of Medical Imaging, Hematology and Oncology, University of São Paulo, School of Medicine, Ribeirão Preto, Brazil
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma-Immunology, Ulm University Hospital, Ulm, Germany
| | - Antonio M. Risitano
- AORN Moscati Avellino, Italy and Federico II University of Naples, Naples, Italy
| | | | - Konstantinos Ritis
- First Department of Internal Medicine and Laboratory of Molecular Hematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - John D. Lambris
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
- Corresponding author.
| |
Collapse
|
9
|
Xu L, Yang CS, Liu Y, Zhang X. Effective Regulation of Gut Microbiota With Probiotics and Prebiotics May Prevent or Alleviate COVID-19 Through the Gut-Lung Axis. Front Pharmacol 2022; 13:895193. [PMID: 35548347 PMCID: PMC9081431 DOI: 10.3389/fphar.2022.895193] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/31/2022] [Indexed: 12/14/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) can disrupt the gut microbiota balance, and patients usually have intestinal disorders. The intestine is the largest immune organ of the human body, and gut microbes can affect the immune function of the lungs through the gut-lung axis. Many lines of evidence support the role of beneficial bacteria in enhancing human immunity, preventing pathogen colonization, and thereby reducing the incidence and severity of infection. In this article, we review the possible approach of modulating microbiota to help prevent and treat respiratory tract infections, including COVID-19, and discuss the possibility of using probiotics and prebiotics for this purpose. We also discuss the mechanism by which intestinal micro-flora regulate immunity and the effects of probiotics on the intestinal micro-ecological balance. Based on this understanding, we propose the use of probiotics and prebiotics to modulate gut microbiota for the prevention or alleviation of COVID-19 through the gut-lung axis.
Collapse
Affiliation(s)
- Lei Xu
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
| | - Chung S. Yang
- Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers The State University of New Jersey, Piscataway, NJ, United States
- *Correspondence: Chung S. Yang, ; Xin Zhang,
| | - Yanan Liu
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
| | - Xin Zhang
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
- *Correspondence: Chung S. Yang, ; Xin Zhang,
| |
Collapse
|
10
|
Ntalouka MP, Pantazopoulos I, Brotis AG, Pagonis A, Vatsiou I, Chatzis A, Rarras CN, Kotsi P, Gourgoulianis KI, Arnaoutoglou EM. Prognostic role of simple inflammatory biomarkers in patients with severe COVID-19: an observational study. Hippokratia 2022; 26:70-77. [PMID: 37188050 PMCID: PMC10177850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND/AIM Simple inflammatory biomarkers, such as neutrophil to lymphocyte ratio (NLR), could serve as prognosis indicators in patients with Coronavirus disease 2019 (COVID-19). The utility of on-admission inflammatory biomarkers in predicting outcomes was investigated in patients suffering from severe COVID-19 infection. METHODS We performed a retrospective study to assess the role of white blood count (WBC), neutrophils (N), lymphocyte (L), platelets (PLTs), C-reactive protein (CRP), reverse transcription polymerase chain reaction (RT-PCR), NLR (N/L), PLR (P/L), dv (derived variation of)-NLR (N/WBC-L), LNR (L/N), dv (derived variation of)-LNR (L/WBC-N), and CLR (CRP/L), in predicting the need for high-flow nasal cannula (HFNC) use, admission to Intensive Care Unit (ICU), and death in adult patients with severe COVID-19 admitted to the Department of Respiratory Medicine from April to September 2021. RESULTS One hundred and fifteen patients (60 % males) with a mean age of 57.7 ± 16.3 years were included. Thirty-seven patients (32.2 %) required escalation with HFNC, eight patients (7 %) were admitted to the ICU, and nine patients (7.8%) died. Based on univariate analysis, CRP [odds ratio (OR): 1.25, 95 % confidence interval (CI): 1.1-1.42), LNR (OR: 0.015, 95 % CI: 0.00-0.35), dv-NLR (OR: 5*106, 95 % CI: 26.7-9*109), CLR (OR: 7*1058, 95 % CI: 3*1025-2*1092), length of hospitalization (LOH; OR: 1.44, 95 % CI: 1.22-1.63), dyspnea at presentation (OR: 2.83, 95 % CI: 1.23-6.52), and ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) on admission (OR: 0.967, 95 % CI: 0.952-0.983) were independent predictors for oxygen requirements. However, the multivariate analysis showed that LNR (OR: 1.686e0-4, 95 % CI: 6.441e00-8-0.441), PaO2/FiO2 on admission (OR: 0.965, 95 % CI: 0.941-0.989), and LOH (OR: 1.717, 95 % CI: 1.274-2.314) were the most important predictor for HFNC use. Nasal congestion at presentation (OR: 11.5, 95 % CI: 1.61-82.8) was a unique and independent predictor for ICU admission. As far as death is concerned, the univariate analysis identified elevated CRP (OR: 1.11, 95 % CI: 1.0-1.24), low RT-PCR (OR: 0.829, 95 % CI: 0.688-0.999), high CLR (OR: 3.2*1033, 95 % CI: 5.8-1.8*1066), age (OR: 1.08, 95 % CI: 1.02-1.14), body mass index (BMI) over 30 (OR: 5.25, 95 % CI: 1.26-21.96), the chronic use of angiotensin-converting enzyme inhibitors (OR: 5.72, 95 % CI: 1.35-24.09), nitrates (OR: 14.85, 95 % CI: 1.81-121.8), diuretics (OR: 8.21, 95 % CI: 1.97-34.32), PaO2/FiO2 on admission (OR: 0.983, 95 % CI: 0.970-0.998), and nasal congestion at presentation (OR: 9.81, 95 % CI: 1.40-68.68) as independent predictors. However, the multivariate analysis pinpointed that obesity (BMI >30) (OR: 10.498, 95 % CI: 1.107-99.572) remained the most important predictor for death. CONCLUSION LNR and PaO2/FiO2 on admission could be used to timely identify patients requiring HFNC during hospitalization, while obesity (BMI >30) could be an independent predictor of death. Nasal congestion emerges as a unique predictor for ICU admission. HIPPOKRATIA 2022, 26 (2):70-77.
Collapse
Affiliation(s)
- M P Ntalouka
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - I Pantazopoulos
- Department of Emergency Medicine, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - A G Brotis
- Department of Neurosurgery, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - A Pagonis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - I Vatsiou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - A Chatzis
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - C N Rarras
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - P Kotsi
- Department of Transfusion Medicine, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - K I Gourgoulianis
- Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - E M Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| |
Collapse
|
11
|
Bonnesen B, Jensen JUS, Jeschke KN, Mathioudakis AG, Corlateanu A, Hansen EF, Weinreich UM, Hilberg O, Sivapalan P. Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation. Diagnostics (Basel) 2021. [DOI: doi.org/10.3390/diagnostics11122259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Patients admitted to hospital with coronavirus disease 2019 (COVID-19) may develop acute respiratory failure (ARF) with compromised gas exchange. These patients require oxygen and possibly ventilatory support, which can be delivered via different devices. Initially, oxygen therapy will often be administered through a conventional binasal oxygen catheter or air-entrainment mask. However, when higher rates of oxygen flow are needed, patients are often stepped up to high-flow nasal cannula oxygen therapy (HFNC), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or invasive mechanical ventilation (IMV). BiPAP, CPAP, and HFNC may be beneficial alternatives to IMV for COVID-19-associated ARF. Current evidence suggests that when nasal catheter oxygen therapy is insufficient for adequate oxygenation of patients with COVID-19-associated ARF, CPAP should be provided for prolonged periods. Subsequent escalation to IMV may be implemented if necessary.
Collapse
|
12
|
Bonnesen B, Jensen JUS, Jeschke KN, Mathioudakis AG, Corlateanu A, Hansen EF, Weinreich UM, Hilberg O, Sivapalan P. Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation. Diagnostics (Basel) 2021; 11:2259. [PMID: 34943496 PMCID: PMC8700515 DOI: 10.3390/diagnostics11122259] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
Patients admitted to hospital with coronavirus disease 2019 (COVID-19) may develop acute respiratory failure (ARF) with compromised gas exchange. These patients require oxygen and possibly ventilatory support, which can be delivered via different devices. Initially, oxygen therapy will often be administered through a conventional binasal oxygen catheter or air-entrainment mask. However, when higher rates of oxygen flow are needed, patients are often stepped up to high-flow nasal cannula oxygen therapy (HFNC), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or invasive mechanical ventilation (IMV). BiPAP, CPAP, and HFNC may be beneficial alternatives to IMV for COVID-19-associated ARF. Current evidence suggests that when nasal catheter oxygen therapy is insufficient for adequate oxygenation of patients with COVID-19-associated ARF, CPAP should be provided for prolonged periods. Subsequent escalation to IMV may be implemented if necessary.
Collapse
Affiliation(s)
- Barbara Bonnesen
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2200 Copenhagen, Denmark; (B.B.); (J.-U.S.J.)
| | - Jens-Ulrik Stæhr Jensen
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2200 Copenhagen, Denmark; (B.B.); (J.-U.S.J.)
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Klaus Nielsen Jeschke
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, 2650 Hvidovre, Denmark; (K.N.J.); (E.F.H.)
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester M23 9LT, UK;
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Alexandru Corlateanu
- Department of Respiratory Medicine, State University of Medicine and Pharmacy “Nicolae Testemitanu”, 2004 Chisinau, Moldova;
| | - Ejvind Frausing Hansen
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, 2650 Hvidovre, Denmark; (K.N.J.); (E.F.H.)
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, University of Aalborg, 9100 Aalborg, Denmark;
- The Clinical Institute, Aalborg University, 9220 Aalborg, Denmark
| | - Ole Hilberg
- Department of Medicine, Little Belt Hospital, 7100 Vejle, Denmark;
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Pradeesh Sivapalan
- Department of Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, 2200 Copenhagen, Denmark; (B.B.); (J.-U.S.J.)
| |
Collapse
|