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Smolic M, Dawood R, Salum G, Abd El Meguid M, Omran M, Smolic R. Therapeutic Interventions for COVID-19. POST COVID-19 - EFFECTS ON HUMAN HEALTH 2023. [DOI: 10.5772/intechopen.111543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
SARS-CoV-2, a novel coronavirus, is currently represented a major public health concern. The high transmission rate of this virus increases the mortality rate worldwide. To date, significant efforts and restricted regulations were performed around the world to control this crisis effectively, but unfortunately, there is no specific and successful therapy for COVID-19. Many approaches have been repurposed for SARS-CoV-2 treatment such as antivirals and anti-inflammatories. Furthermore, antibody therapies are one of the main and important approaches of SARS-CoV-2 infection treatment. In recent trials, various immunotherapeutic interventions such as convalescent plasma therapy and monoclonal antibodies, as well as immunomodulatory agents are being proposed. However, the development of a vaccine that provides durable protective immunity will be the most effective therapy for controlling possible epidemics of this virus. The current review summarized all the proposed therapeutic approaches together with information on their safety and efficacy in treating COVID-19, as well as the vaccine candidates. The provided comprehensive information regarding the applied therapeutic strategies against COVID-19 might help the scientific community in any progress toward the treatment of COVID-19 infection.
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Mastruzzo C, Commodari E, Grasso U, La Rosa VL, Balsamo D, Circo C, Oliveri R. Early Stage Combination Treatment with Methylprednisolone Pulse and Remdesivir for Severe COVID-19 Pneumonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1081. [PMID: 36673839 PMCID: PMC9859517 DOI: 10.3390/ijerph20021081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND This study evaluated the clinical outcomes of patients with severe COVID-19 pneumonia treated with remdesivir plus standard corticosteroid treatment (SCT) or with remdesivir plus high-dose corticosteroid pulse therapy (HDCPT). METHODS One hundred and two patients with severe COVID-19 pneumonia and respiratory failure were included. The patients were divided into two cohorts. The first comprised patients who received remdesivir and SCT, consisting of 6 mg dexamethasone daily for up to 10 days or until hospital discharge. The second included patients who received remdesivir and HDCPT, composed of 250 mg iv of methylprednisolone for three days, followed by a slow reduction in the dose of steroids. The severity of hypoxemia was assessed using the SaO2/FiO2 peripheral oxygen saturation index. RESULTS 55 received remdesivir plus HDCPT, and 47 received remdesivir plus SCT. Mortality at 30 days was significantly lower among patients who received remdesivir plus HDCPT (4/55) than among those who did not (15/47). In patients who received remdesivir plus HDCPT, 7.3% required invasive mechanical ventilation and admission to the ICU and 36.4% non-invasive ventilation versus 29.8% and 61.7%, respectively, among those treated with remdesivir plus SCT. Remdesivir plus HDCPT induced a significantly faster improvement in the SaO2/FiO2 index. CONCLUSION Early combination treatment with remdesivir plus HDCPT reduced in-hospital mortality and the need for admission to the ICU. Furthermore, it improved the SaO2/FiO2 index faster in patients with severe COVID-19 pneumonia.
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Affiliation(s)
- Claudio Mastruzzo
- Unit of Respiratory Diseases, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
| | - Umberto Grasso
- Unit of Internal Medicine, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | | | - Daniela Balsamo
- Unit of Internal Medicine, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | - Cristina Circo
- Unit of Respiratory Diseases, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
| | - Rosario Oliveri
- Unit of Respiratory Diseases, Department of Medicine, Garibaldi Hospital, 95124 Catania, Italy
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Ozsurekci Y, Aykac K, Demir OO, Ilbay S, Kesici S, Karakaya J, Cengiz AB. Methylprednisolone use in children with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2. Pediatr Int 2023; 65:e15603. [PMID: 37615374 DOI: 10.1111/ped.15603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness and optimal use of corticosteroids in children with severe coronavirus disease 2019 (COVID-19) pneumonia, for which effective treatment is still lacking with respect to this population. METHODS We conducted a retrospective study and included patients (aged < 18 years) with severe COVID-19 pneumonia and/or acute respiratory distress syndrome (ARDS) who received standard doses (2-4 mg/kg/day) and high doses (>250 mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid treatments with a propensity score and compared the side effects of different MPZ doses and patient survival. RESULTS Fifty-nine patients were included: 61% were male, the median age was 8, interquartile range (IQR) 2-15) years. The overall survival was 84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and 92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p = 0.67). The demographic, clinical, and laboratory data did not differ significantly after propensity score matching, apart from bradycardia, which was a prominent feature of the high-dose group. The clinical and radiological response rates on day 7 were higher and the need for invasive mechanical ventilation (IMV) was lower in the high-dose group. CONCLUSION The patients with high-dose MPZ had better clinical and radiological responses than those with standard-dose MPZ, although the mortality rate did not differ between standard and high-dose regimens of MPZ.
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Affiliation(s)
- Yasemin Ozsurekci
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Kubra Aykac
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Osman Oguz Demir
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Sare Ilbay
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Selman Kesici
- Hacettepe University Faculty of Medicine, Department of Pediatric Intensive Care, Ankara, Turkey
| | - Jale Karakaya
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Turkey
| | - Ali Bulent Cengiz
- Hacettepe University Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
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Silva RCMC, Vasconcelos LR, Travassos LH. The different facets of heme-oxygenase 1 in innate and adaptive immunity. Cell Biochem Biophys 2022; 80:609-631. [PMID: 36018440 DOI: 10.1007/s12013-022-01087-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 07/20/2022] [Indexed: 11/26/2022]
Abstract
Heme oxygenase (HO) enzymes are responsible for the main oxidative step in heme degradation, generating equimolar amounts of free iron, biliverdin and carbon monoxide. HO-1 is induced as a crucial stress response protein, playing protective roles in physiologic and pathological conditions, due to its antioxidant, anti-apoptotic and anti-inflammatory effects. The mechanisms behind HO-1-mediated protection are being explored by different studies, affecting cell fate through multiple ways, such as reduction in intracellular levels of heme and ROS, transcriptional regulation, and through its byproducts generation. In this review we focus on the interplay between HO-1 and immune-related signaling pathways, which culminate in the activation of transcription factors important in immune responses and inflammation. We also discuss the dual interaction of HO-1 and inflammatory mediators that govern resolution and tissue damage. We highlight the dichotomy of HO-1 in innate and adaptive immune cells development and activation in different disease contexts. Finally, we address different known anti-inflammatory pharmaceuticals that are now being described to modulate HO-1, and the possible contribution of HO-1 in their anti-inflammatory effects.
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Affiliation(s)
- Rafael Cardoso Maciel Costa Silva
- Laboratory of Immunoreceptors and Signaling, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiz Ricardo Vasconcelos
- Cellular Signaling and Cytoskeletal Function Laboratory, The Francis Crick Institute, London, UK
| | - Leonardo Holanda Travassos
- Laboratory of Immunoreceptors and Signaling, Instituto de Biofísica Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Dafni M, Karampeli M, Michelakis I, Manta A, Spanoudaki A, Mantzos D, Krontira S, Georgiadou V, Lioni A, Tzavara V. Treatment with 3-day methylprednisolone pulses in severe cases of COVID-19 compared with the standard regimen protocol of dexamethasone. J Investig Med 2022; 70:1423-1428. [PMID: 35379701 PMCID: PMC9002257 DOI: 10.1136/jim-2021-002274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/08/2023]
Abstract
Since the outbreak of COVID-19, research has been focused on establishing effective treatments, especially for patients with severe pneumonia and hyperinflammation. The role and dose of corticosteroids remain obscure. We evaluated 58 patients with severe COVID-19 during two periods. 24 patients who received methylprednisolone pulses (250 mg/day intravenously for 3 days) were compared with 34 patients treated according to the standard dexamethasone protocol of 6 mg/day. Among non-intubated patients, the duration of hospitalization was shorter for those who received methylprednisolone pulses (9.5 vs 13.5, p<0.001). In a subgroup analysis of patients who required intubation, those treated with the dexamethasone protocol demonstrated a relative risk=1.89 (p=0.09) for dying, in contrast to the other group which showed a tendency towards extubation and discharge from the hospital. A 'delayed' need for intubation was also observed (6 vs 2 days, p=0.06). Treatment with methylprednisolone pulses significantly reduced hospitalization time. Although there was no statistically significant influence on the necessity for intubation, methylprednisolone pulses revealed a tendency to delay intubation and hospital discharges. This treatment could benefit patients in the hyperinflammatory phase of the disease.
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Affiliation(s)
- Maria Dafni
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Maria Karampeli
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Ioannis Michelakis
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Aspasia Manta
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Anastasia Spanoudaki
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Dionysios Mantzos
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Sofia Krontira
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Victoria Georgiadou
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Athina Lioni
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
| | - Vasiliki Tzavara
- 1st Department of Internal Medicine, Korgialenio-Benakio Red Cross General Hospital, Athens, Greece
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6
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Hong S, Wang H, Zhang Z, Qiao L. The roles of methylprednisolone treatment in patients with COVID-19: A systematic review and meta-analysis. Steroids 2022; 183:109022. [PMID: 35346661 PMCID: PMC8956351 DOI: 10.1016/j.steroids.2022.109022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/01/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022]
Abstract
The roles of methylprednisolone in treatment of patients with COVID-19 remain unclear. The aim of this study was to evaluate the efficacy and safety of methylprednisolone in treatment of COVID-19 patients. PubMed, Cochrane and Web of Science were searched for studies comparing methylprednisolone and no glucocorticoids treatment in patients with COVID-19. Statistical pooling was reported as risk ratio (RR) or mean difference (MD) with corresponding 95 % confidence interval (CI). Thirty-three studies were eligible, including 5 randomized trials and 28 observational studies. Meta-analysis showed that compared with no glucocorticoids, methylprednisolone in treatment of COVID-19 patients was associated with reduced short-term mortality (RR 0.73; 95% CI 0.60-0.89), less need for ICU admission (RR 0.77; 95% CI 0.66-0.91) and mechanical ventilation (RR 0.69; 95% CI 0.57-0.84), increased 28-day ventilator-free days (MD 2.81; 95% CI 2.64-2.97), without increasing risk of secondary infections (RR 1.04; 95% CI 0.82-1.32), but could prolong duration of viral shedding (MD 1.03; 95% CI 0.25-1.82). Subgroup analyses revealed that low-dose (≤2mg/kg/day) methylprednisolone treatment for ≤ 7 days in severe COVID-19 patients was associated with relatively better clinical outcomes, without increasing duration of viral shedding. Compared with no glucocorticoids, methylprednisolone treatment in COVID-19 patients is associated with reduced short-term mortality and better clinical outcomes, without increasing secondary infections, but could slightly prolong duration of viral shedding. Patients with severe COVID-19 are more likely to benefit from short-term low-dose methylprednisolone treatment (1-2 mg/kg/day for ≤ 7 days).
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Affiliation(s)
- Shukun Hong
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China.
| | - Hongye Wang
- Department of Obstetrics and Gynecology, Shengli Oilfield Central Hospital, Dongying, China
| | - Zhaolong Zhang
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China.
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Oliveira LB, Mwangi VI, Sartim MA, Delafiori J, Sales GM, de Oliveira AN, Busanello ENB, Val FFDAE, Xavier MS, Costa FT, Baía-da-Silva DC, Sampaio VDS, de Lacerda MVG, Monteiro WM, Catharino RR, de Melo GC. Metabolomic Profiling of Plasma Reveals Differential Disease Severity Markers in COVID-19 Patients. Front Microbiol 2022; 13:844283. [PMID: 35572676 PMCID: PMC9094083 DOI: 10.3389/fmicb.2022.844283] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/14/2022] [Indexed: 01/08/2023] Open
Abstract
The severity, disabilities, and lethality caused by the coronavirus 2019 (COVID-19) disease have dumbfounded the entire world on an unprecedented scale. The multifactorial aspect of the infection has generated interest in understanding the clinical history of COVID-19, particularly the classification of severity and early prediction on prognosis. Metabolomics is a powerful tool for identifying metabolite signatures when profiling parasitic, metabolic, and microbial diseases. This study undertook a metabolomic approach to identify potential metabolic signatures to discriminate severe COVID-19 from non-severe COVID-19. The secondary aim was to determine whether the clinical and laboratory data from the severe and non-severe COVID-19 patients were compatible with the metabolomic findings. Metabolomic analysis of samples revealed that 43 metabolites from 9 classes indicated COVID-19 severity: 29 metabolites for non-severe and 14 metabolites for severe disease. The metabolites from porphyrin and purine pathways were significantly elevated in the severe disease group, suggesting that they could be potential prognostic biomarkers. Elevated levels of the cholesteryl ester CE (18:3) in non-severe patients matched the significantly different blood cholesterol components (total cholesterol and HDL, both p < 0.001) that were detected. Pathway analysis identified 8 metabolomic pathways associated with the 43 discriminating metabolites. Metabolomic pathway analysis revealed that COVID-19 affected glycerophospholipid and porphyrin metabolism but significantly affected the glycerophospholipid and linoleic acid metabolism pathways (p = 0.025 and p = 0.035, respectively). Our results indicate that these metabolomics-based markers could have prognostic and diagnostic potential when managing and understanding the evolution of COVID-19.
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Affiliation(s)
- Lucas Barbosa Oliveira
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Victor Irungu Mwangi
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil
| | - Marco Aurélio Sartim
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Programas de Pós-Graduação em Imunologia Básica e Aplicada (PPGIBA), Universidade Federal do Amazonas (UFAM), Manaus, Brazil.,Pró-reitoria de Pesquisa e Pós-graduação, Universidade Nilton Lins, Manaus, Brazil
| | - Jeany Delafiori
- Laboratório Innovare de Biomarcadores, Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Geovana Manzan Sales
- Laboratório Innovare de Biomarcadores, Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Arthur Noin de Oliveira
- Laboratório Innovare de Biomarcadores, Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Estela Natacha Brandt Busanello
- Laboratório Innovare de Biomarcadores, Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Fernando Fonseca de Almeida E Val
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Mariana Simão Xavier
- Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fabio Trindade Costa
- Laboratório Innovare de Biomarcadores, Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Djane Clarys Baía-da-Silva
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Vanderson de Souza Sampaio
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Marcus Vinicius Guimarães de Lacerda
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil.,Instituto de Pesquisas Leônidas & Maria Deane (FIOCRUZ-Amazonas), Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
| | - Rodrigo Ramos Catharino
- Laboratório Innovare de Biomarcadores, Faculdade de Ciências Farmacêuticas, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Gisely Cardoso de Melo
- Programa de Pós-Graduação em Medicina Tropical (PPGMT), Universidade do Estado do Amazonas (UEA), Manaus, Brazil.,Fundação de Medicina Tropical Heitor Vieira Dourado (FMT-HVD), Manaus, Brazil
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Yamanaka S, Morikawa K, Azuma H, Yamanaka M, Shimada Y, Wada T, Matano H, Yamada N, Yamamura O, Hayashi H. Machine-Learning Approaches for Predicting the Need of Oxygen Therapy in Early-Stage COVID-19 in Japan: Multicenter Retrospective Observational Study. Front Med (Lausanne) 2022; 9:846525. [PMID: 35280897 PMCID: PMC8904892 DOI: 10.3389/fmed.2022.846525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/27/2022] [Indexed: 12/23/2022] Open
Abstract
Background Early prediction of oxygen therapy in patients with coronavirus disease 2019 (COVID-19) is vital for triage. Several machine-learning prognostic models for COVID-19 are currently available. However, external validation of these models has rarely been performed. Therefore, most reported predictive performance is optimistic and has a high risk of bias. This study aimed to develop and validate a model that predicts oxygen therapy needs in the early stages of COVID-19 using a sizable multicenter dataset. Methods This multicenter retrospective study included consecutive COVID-19 hospitalized patients confirmed by a reverse transcription chain reaction in 11 medical institutions in Fukui, Japan. We developed and validated seven machine-learning models (e.g., penalized logistic regression model) using routinely collected data (e.g., demographics, simple blood test). The primary outcome was the need for oxygen therapy (≥1 L/min or SpO2 ≤ 94%) during hospitalization. C-statistics, calibration slope, and association measures (e.g., sensitivity) evaluated the performance of the model using the test set (randomly selected 20% of data for internal validation). Among these seven models, the machine-learning model that showed the best performance was re-evaluated using an external dataset. We compared the model performances using the A-DROP criteria (modified version of CURB-65) as a conventional method. Results Of the 396 patients with COVID-19 for the model development, 102 patients (26%) required oxygen therapy during hospitalization. For internal validation, machine-learning models, except for the k-point nearest neighbor, had a higher discrimination ability than the A-DORP criteria (P < 0.01). The XGboost had the highest c-statistic in the internal validation (0.92 vs. 0.69 in A-DROP criteria; P < 0.001). For the external validation with 728 temporal independent datasets (106 patients [15%] required oxygen therapy), the XG boost model had a higher c-statistic (0.88 vs. 0.69 in A-DROP criteria; P < 0.001). Conclusions Machine-learning models demonstrated a more significant performance in predicting the need for oxygen therapy in the early stages of COVID-19.
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Affiliation(s)
- Syunsuke Yamanaka
- Department of Emergency Medicine and General Internal Medicine, University of Fukui Hospital, Fukui, Japan
| | | | - Hiroyuki Azuma
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Maki Yamanaka
- Department of Emergency Medicine, Tannan Regional Medical Center, Sabae, Japan
| | - Yoshimitsu Shimada
- Department of Emergency Medicine, Japanese Red Cross Fukui Hospital, Fukui, Japan
| | - Toru Wada
- Department of Emergency Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
| | - Hideyuki Matano
- Department of Emergency Medicine, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Naoki Yamada
- Department of Emergency Medicine and General Internal Medicine, University of Fukui Hospital, Fukui, Japan
| | - Osamu Yamamura
- Department of Community Medicine, Faculty of Medicine, University of Fukui Hospital, Fukui, Japan
| | - Hiroyuki Hayashi
- Department of Emergency Medicine and General Internal Medicine, University of Fukui Hospital, Fukui, Japan
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9
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Caiazzo E, Rezig AOM, Bruzzese D, Ialenti A, Cicala C, Cleland JGF, Guzik TJ, Maffia P, Pellicori P. Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials. Pharmacol Res 2022; 176:106053. [PMID: 34979235 PMCID: PMC8719379 DOI: 10.1016/j.phrs.2021.106053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. OBJECTIVES to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. METHODS We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. RESULTS No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 - 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. CONCLUSIONS Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.
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Affiliation(s)
- Elisabetta Caiazzo
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Asma O M Rezig
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Dario Bruzzese
- Department of Public health, University of Naples Federico II, Naples, Italy
| | - Armando Ialenti
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carla Cicala
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - John G F Cleland
- Robertson Centre for Biostatistics, and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, UK; National Heart & Lung Institute, Imperial College London, UK
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy; Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, UK.
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10
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Okano H, Furuya R, Niida S, Minami S, Horiuchi H, Suzuki N, Otsuka T, Miyazaki H. Methylprednisolone pulse therapy for critically ill patients with coronavirus disease 2019: A
single‐center
retrospective observational study. Acute Med Surg 2022; 9:e782. [PMID: 36092466 PMCID: PMC9448714 DOI: 10.1002/ams2.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Hiromu Okano
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
- International University of Health and Welfare Graduate School of Public Health Tokyo Japan
| | - Ryosuke Furuya
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
- Department of Emergency Medicine, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Shoko Niida
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
- Department of Emergency Medicine, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Sakura Minami
- Department of Emergency Medicine, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Hiroshi Horiuchi
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
| | - Naoya Suzuki
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
- Department of Emergency Medicine, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Tsuyoshi Otsuka
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
- Department of Emergency Medicine, Graduate School of Medicine Yokohama City University Yokohama Japan
| | - Hiroshi Miyazaki
- Department of Emergency and Critical Care Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan
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TUFAN A, MATUCCI CERINIC M. Immune dysfunction in COVID-19 and judicious use of antirheumatic drugs for the treatment of hyperinflammation. Turk J Med Sci 2021; 51:3391-3404. [PMID: 34844296 PMCID: PMC8771052 DOI: 10.3906/sag-2110-179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/27/2021] [Indexed: 11/17/2022] Open
Abstract
In the Wuhan province of China, almost two years ago, in December 2019, the novel Coronavirus 2019 has caused a severe involvement of the lower respiratory tract leading to an acute life-threatening respiratory syndrome, coronavirus disease-19 (COVID-19). Subsequently, coronavirus 2 (SARS-CoV-2) rapidly spread to the entire world causing a pandemic and affected every single person on earth either directly or indirectly with destroying all facets of social life and economy. Since the announcement of COVID-19 as a global pandemic, we have witnessed tremendous scientific work on all aspects of COVID-19 across the globe, which has never been witnessed before. The most remarkable achievement would be the introduction of vaccines, which provide protection from the severe infection and is the only premise for the control of disease. However, despite the tremendous work, the number of treatments either antiviral or immunomodulatory for infected patients are considerably limited, yet disease is causing substantial morbidity and mortality. COVID-19 follows heterogenous disease course among infected individuals, and dysregulated immune system is primarily responsible for the worse outcomes. Immune deficiency, being on corticosteroids for inflammatory diseases, delayed interferon response and advanced age adversely influence prognosis with impairing viral clearance. On the other hand, exuberant immune response with features of cytokine storm is the leading cause of death, which can be alleviated by use of either general immunosuppression with corticosteroids or selective neutralization of potent pro-inflammatory cytokines such as interleukin (IL)-1 and IL-6. Herein, we summarized the potential effective immunomodulatory treatments emphasizing in which patient population it is the most suitable, which dose should be administered, and which is the most appropriate timepoint to administer the drug during the course of the disease.
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Affiliation(s)
- Abdurrahman TUFAN
- Division of Rheumatology, Department of Internal Medicine, Gazi University, AnkaraTurkey
| | - Marco MATUCCI CERINIC
- Division of Rheumatology AOUC, Department of Experimental and Clinical Medicine, University of Florence , FlorenceItaly
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, MilanItaly
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12
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Buso R, Cinetto F, Dell’Edera A, Veneran N, Facchini C, Biscaro V, Schiavon S, Vian E, Grossi U, Zanus G, Giobbia M, Scarpa R, Agostini C, Rattazzi M, Felice C. Comparison between Dexamethasone and Methylprednisolone Therapy in Patients with COVID-19 Pneumonia Admitted to Non-Intensive Medical Units. J Clin Med 2021; 10:jcm10245812. [PMID: 34945108 PMCID: PMC8703463 DOI: 10.3390/jcm10245812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Data on different steroid compounds for the treatment of hospitalized COVID-19 (coronavirus disease 2019) patients are still limited. The aim of this study was to compare COVID-19 patients admitted to non-intensive units and treated with methylprednisolone or dexamethasone. (2) Methods: This was a single-center retrospective study that included consecutive patients with COVID-19 hospitalized in medical wards during the second wave of the pandemic. Thirty-day mortality and the need for intensive or semi-intensive care were the main clinical outcomes analyzed in patients receiving methylprednisolone (60 mg/day) compared with dexamethasone (6 mg/day). Secondary outcomes included complication rates, length of hospital stay, and time to viral clearance. (3) Results: Two-hundred-forty-six patients were included in the analysis, 110 treated with dexamethasone and 136 with methylprednisolone. No statistically significant differences were found between the two groups of patients regarding 30-day mortality (OR 1.35, CI95% 0.71-2.56, p = 0.351) and the need for intensive or semi-intensive care (OR 1.94, CI95% 0.81-4.66, p = 0.136). The complication rates, length of hospital stay, and time to viral clearance did not significantly differ between the two groups. (4) Conclusions: In patients hospitalized for COVID-19 in non-intensive units, the choice of different steroid compounds, such as dexamethasone or methylprednisolone, did not affect the main clinical outcomes.
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Affiliation(s)
- Roberta Buso
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Francesco Cinetto
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
- Department of Medicine, DIMED, University of Padova, 35122 Padova, Italy
| | - Alessandro Dell’Edera
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Nicola Veneran
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Cesarina Facchini
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Valeria Biscaro
- Microbiology Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (V.B.); (S.S.); (E.V.)
| | - Stefania Schiavon
- Microbiology Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (V.B.); (S.S.); (E.V.)
| | - Elisa Vian
- Microbiology Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (V.B.); (S.S.); (E.V.)
| | - Ugo Grossi
- Surgery 2 Unit, DISCOG, Ca’ Foncello University Hospital, University of Padua, 31100 Treviso, Italy; (U.G.); (G.Z.)
| | - Giacomo Zanus
- Surgery 2 Unit, DISCOG, Ca’ Foncello University Hospital, University of Padua, 31100 Treviso, Italy; (U.G.); (G.Z.)
| | - Mario Giobbia
- Infective Disease Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy;
| | - Riccardo Scarpa
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Carlo Agostini
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
- Department of Medicine, DIMED, University of Padova, 35122 Padova, Italy
| | - Marcello Rattazzi
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
- Department of Medicine, DIMED, University of Padova, 35122 Padova, Italy
- Correspondence: or ; Tel.: +39-0498211867 or +39-0422322207; Fax: +39-0498754179
| | - Carla Felice
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
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