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Vazirani R, Delia MA, Blanco-Ponce E, Martín-García AC, Fernández-Cordón C, Uribarri A, Andrés M, Vedia O, Sionis A, Corbí-Pascual M, Salamanca J, Pérez-Castellanos A, Carmona JDM, Raposeiras-Roubín S, Aritza-Conty D, Lopez-País J, Guillén-Marzo M, Lluch-Requerey C, Escudier JM, Martínez-Sellés M, Núñez-Gil IJ. Renal impairment and outcome in Takotsubo syndrome: Insights from a national multicentric cohort. Int J Cardiol 2024; 405:131971. [PMID: 38490270 DOI: 10.1016/j.ijcard.2024.131971] [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: 01/27/2024] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Data on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive. OBJECTIVE To assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS. MATERIAL AND METHODS Patients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization. RESULTS The prevalence of CKD and ARF in the whole RETAKO cohort was 5.4% and 11.7%, respectively. Compared to Q1 (Cr <0.71), patients within Q4 (Cr > 1.1) had lower left ventricular ejection fraction on admission (38.5 ± 12 vs 43.3 ± 11.3, p = 0.002) and higher bleeding rates during hospitalization (6.7% vs 2%, p = 0.005). In addition, compared to Q1, Q4 patients have a greater incidence of cardiogenic shock (17.3% vs 5.6%, p < 0.001), and a higher rate of 5-year all-cause death and major adverse cardiovascular events (31.5% vs 15.8%, p < 0.001 and 22.5% vs 9.3%, p < 0.001, respectively). CONCLUSIONS TTS patients with CKD have a higher incidence of ARF and exhibit greater Cr on admission, which were linked with higher rates of cardiogenic shock, bleeding during hospitalization as well as major adverse cardiovascular events and all-cause death during a 5-year follow-up.
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Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain.
| | | | | | - Aitor Uribarri
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Mireia Andrés
- Department of Cardiology, Hospital de Vall d'Hebron, Barcelona, Spain
| | - Oscar Vedia
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Alessandro Sionis
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, II-B Sant Pau, Universitat Autònoma de Barcleona, CIBER-CV, Barcelona, Spain.
| | | | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain
| | | | - José David Martínez Carmona
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Malaga, Spain, Instituto de Investigación Biomédica de Málaga-IBIMA, CIBERCV
| | | | - David Aritza-Conty
- Department of Cardiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Javier Lopez-País
- Department of Cardiology, Hospital Universitario de Orense, Orense, Spain
| | - Marta Guillén-Marzo
- Department of Cardiology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | | | | | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, CIBERCV, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid and School of Medicine, Universidad Complutense, Madrid, Spain.
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid and School of Medicine, Universidad Complutense, Madrid, Spain.
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Tanaka H, Chubachi S, Asakura T, Namkoong H, Azekawa S, Otake S, Nakagawara K, Fukushima T, Lee H, Watase M, Sakurai K, Kusumoto T, Masaki K, Kamata H, Ishii M, Hasegawa N, Okada Y, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Prognostic significance of chronic kidney disease and impaired renal function in Japanese patients with COVID-19. BMC Infect Dis 2024; 24:527. [PMID: 38796423 PMCID: PMC11128123 DOI: 10.1186/s12879-024-09414-w] [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: 07/01/2023] [Accepted: 05/17/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND Renal impairment is a predictor of coronavirus disease (COVID-19) severity. No studies have compared COVID-19 outcomes in patients with chronic kidney disease (CKD) and patients with impaired renal function without a prior diagnosis of CKD. This study aimed to identify the impact of pre-existing impaired renal function without CKD on COVID-19 outcomes. METHODS This retrospective study included 3,637 patients with COVID-19 classified into three groups by CKD history and estimated glomerular filtration rate (eGFR) on referral: Group 1 (n = 2,460), normal renal function without a CKD history; Group 2 (n = 905), impaired renal function without a CKD history; and Group 3 (n = 272), history of CKD. We compared the clinical characteristics of these groups and assessed the effect of CKD and impaired renal function on critical outcomes (requirement for respiratory support with high-flow oxygen devices, invasive mechanical ventilation, or extracorporeal membrane oxygen, and death during hospitalization) using multivariable logistic regression. RESULTS The prevalence of comorbidities (hypertension, diabetes, and cardiovascular disease) and incidence of inflammatory responses (white blood counts, and C-reactive protein, procalcitonin, and D-dimer levels) and complications (bacterial infection and heart failure) were higher in Groups 2 and 3 than that in Group 1. The incidence of critical outcomes was 10.8%, 17.7%, and 26.8% in Groups 1, 2, and 3, respectively. The mortality rate and the rate of requiring IMV support was lowest in Group 1 and highest in Group 3. Compared with Group 1, the risk of critical outcomes was higher in Group 2 (adjusted odds ratio [aOR]: 1.32, 95% confidence interval [CI]: 1.03-1.70, P = 0.030) and Group 3 (aOR: 1.94, 95% CI: 1.36-2.78, P < 0.001). Additionally, the eGFR was significantly associated with critical outcomes in Groups 2 (odds ratio [OR]: 2.89, 95% CI: 1.64-4.98, P < 0.001) and 3 (OR: 1.87, 95% CI: 1.08-3.23, P = 0.025) only. CONCLUSIONS Clinicians should consider pre-existing CKD and impaired renal function at the time of COVID-19 diagnosis for the management of COVID-19.
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Affiliation(s)
- Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan.
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan.
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ho Lee
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Tatsuya Kusumoto
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Katsunori Masaki
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hirofumi Kamata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Ryuji Koike
- Health Science Research and Development Center (HeRD), Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Wang X, Cao X, Liang S, Cai G. Clinical Presentation and Outcomes of Hospitalized Patients with Chronic Kidney Disease and COVID-19 Variant Omicron. Ther Clin Risk Manag 2024; 20:275-288. [PMID: 38779588 PMCID: PMC11110823 DOI: 10.2147/tcrm.s458859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose To investigate the clinical characteristics of hospitalized patients with chronic kidney disease (CKD) and novel coronavirus (SARS-CoV-2) infection and identify potential risk factors that contribute to mortality. Patients and Methods This is a retrospective study, conducted on patients with CKD who were admitted to the First Medical Center of the People's Liberation Army General Hospital between December 1, 2022, and February 28, 2023. All patients were also infected with SARS-CoV-2. We analyzed the clinical characteristics of patients, and the patients were categorized into a survival group and a death group whose characteristics were compared. Cox regression analysis was used to identify risk factors that affected patient prognosis. Results A total of 406 patients were enrolled in this study, including 298 males (73.4%). The average age was 80.5 (67.0, 88.0) years, and the patients had an average estimated glomerular filtration rate (eGFR) of 50.3 (25.0-79.0) mL/min/1.73m². A total of 158 individuals died during hospitalization, resulting in a mortality rate of 38.9%. Renal function was worse in the death group than in the survival group (P < 0.001). Patients in the death group had more severe COVID-19 disease and higher CKD staging than those in the survival group (all P values < 0.001). Multivariate Cox regression analysis identified several risk factors that affected patient mortality, including being male, a higher resting heart rate (RHR) upon admission, dyspnea, a low lymphocyte count (Lym), a high international standardized ratio (INR), a high Acute Physiology and Chronic Health Evaluation II (APACHE II) score, heart failure, and the need for mechanical ventilation during the disease. Conclusion Hospitalized patients with CKD who were infected with SARS-CoV-2 (38.9%) had a relatively high mortality rate (38.9%). Furthermore, a marked correlation was observed between a reduced eGFR and an increased risk of mortality.
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Affiliation(s)
- Xiaolong Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
| | - Xueying Cao
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
| | - Shuang Liang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, People’s Republic of China
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Chang YY, Wei AC. Transcriptome and machine learning analysis of the impact of COVID-19 on mitochondria and multiorgan damage. PLoS One 2024; 19:e0297664. [PMID: 38295140 PMCID: PMC10830027 DOI: 10.1371/journal.pone.0297664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
The effects of coronavirus disease 2019 (COVID-19) primarily concern the respiratory tract and lungs; however, studies have shown that all organs are susceptible to infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 may involve multiorgan damage from direct viral invasion through angiotensin-converting enzyme 2 (ACE2), through inflammatory cytokine storms, or through other secondary pathways. This study involved the analysis of publicly accessible transcriptome data from the Gene Expression Omnibus (GEO) database for identifying significant differentially expressed genes related to COVID-19 and an investigation relating to the pathways associated with mitochondrial, cardiac, hepatic, and renal toxicity in COVID-19. Significant differentially expressed genes were identified and ranked by statistical approaches, and the genes derived by biological meaning were ranked by feature importance; both were utilized as machine learning features for verification. Sample set selection for machine learning was based on the performance, sample size, imbalanced data state, and overfitting assessment. Machine learning served as a verification tool by facilitating the testing of biological hypotheses by incorporating gene list adjustment. A subsequent in-depth study for gene and pathway network analysis was conducted to explore whether COVID-19 is associated with cardiac, hepatic, and renal impairments via mitochondrial infection. The analysis showed that potential cardiac, hepatic, and renal impairments in COVID-19 are associated with ACE2, inflammatory cytokine storms, and mitochondrial pathways, suggesting potential medical interventions for COVID-19-induced multiorgan damage.
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Affiliation(s)
- Yu-Yu Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - An-Chi Wei
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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AlShehhi A, Almansoori TM, Alsuwaidi AR, Alblooshi H. Utilizing machine learning for survival analysis to identify risk factors for COVID-19 intensive care unit admission: A retrospective cohort study from the United Arab Emirates. PLoS One 2024; 19:e0291373. [PMID: 38206939 PMCID: PMC10783720 DOI: 10.1371/journal.pone.0291373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The current situation of the unprecedented COVID-19 pandemic leverages Artificial Intelligence (AI) as an innovative tool for addressing the evolving clinical challenges. An example is utilizing Machine Learning (ML) models-a subfield of AI that take advantage of observational data/Electronic Health Records (EHRs) to support clinical decision-making for COVID-19 cases. This study aimed to evaluate the clinical characteristics and risk factors for COVID-19 patients in the United Arab Emirates utilizing EHRs and ML for survival analysis models. METHODS We tested various ML models for survival analysis in this work we trained those models using a different subset of features extracted by several feature selection methods. Finally, the best model was evaluated and interpreted using goodness-of-fit based on calibration curves,Partial Dependence Plots and concordance index. RESULTS The risk of severe disease increases with elevated levels of C-reactive protein, ferritin, lactate dehydrogenase, Modified Early Warning Score, respiratory rate and troponin. The risk also increases with hypokalemia, oxygen desaturation and lower estimated glomerular filtration rate and hypocalcemia and lymphopenia. CONCLUSION Analyzing clinical data using AI models can provide vital information for clinician to measure the risk of morbidity and mortality of COVID-19 patients. Further validation is crucial to implement the model in real clinical settings.
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Affiliation(s)
- Aamna AlShehhi
- Biomedical Engineering Department,College of Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hiba Alblooshi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Ayubi E, Alemi M, Torkamanasadi F, Khosronezhad S, Faghih Soleimani M, Khazaei S. The prognostic value of estimated glomerular filtration rate on admission for death within 30 days among COVID-19 inpatients using fractional polynomial and spline smoothing. Int Urol Nephrol 2023; 55:2657-2666. [PMID: 36988864 PMCID: PMC10050809 DOI: 10.1007/s11255-023-03575-4] [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: 01/07/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The common regression models included estimated glomerular filtration rate (eGFR) in the continuous and categorical form for predicting the mortality in COVID-19 inpatients. However, the relationship may be non-linear, and categorizing implies a loss of information. This study aimed to assess the effect of eGFR on admission on death within 30 days among COVID-19 inpatients using flexible and smooth transformations of eGFR and compare the results against the common models. METHODS A retrospective study was conducted on hospitalized COVID-19 patients between April 2019 and July 2019 in Hamadan, Western Iran. The effect of eGFR on the death within 30 days was evaluated using different modeling: categorization, linear, unrestricted cubic spline (USC) with 4 knots, and fractional polynomial (FP). The results adjusted for older age and intensive care unit (ICU) admission. Discrimination power and model performance of the best-fitting model was evaluated using the area under the ROC (AUROC) and Brier score. RESULTS In total, 2945 patients (median age 61 years; interquartile range 48-73 years) were included, of whom the mortality rate was 9.23%. The relationship between the eGFR and death within 30 days is non-linear, so the degree-2 FP with powers (- 2, - 1) is the best-fitting model. Using the FP model, the risk increased exponentially in eGFR < 45 and then increased linearly and slowly. The AUROC of the FP model involving eGFR, older age, and ICU admission was 0.92 (95% CI 0.90-0.93) with a Brier score of 0.09. CONCLUSION There is a non-linear and asymmetric relationship between eGFR and death within 30 days among COVID-19 inpatients. Kidney function can be measured in COCID-19 patients on admission to know better understanding about prognosis of the patients.
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Affiliation(s)
- Erfan Ayubi
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
| | - Mohsen Alemi
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
| | - Fatemeh Torkamanasadi
- Department of Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
- Infectious Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
| | - Saman Khosronezhad
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
| | - Mobin Faghih Soleimani
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran
| | - Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Shaheed Fahmideh Ave., Hamadan, Islamic Republic of Iran.
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Islamic Republic of Iran.
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Soltani D, Hadadi A, Karbalai Saleh S, Oraii A, Sadatnaseri A, Roozitalab M, Shajari Z, Ghaemmaghami SS, Ashraf H. The Association between Acute Cardiac Injury and Outcomes of Hospitalized Patients with COVID-19: Long-Term Follow-up Results from the Sina Hospital COVID-19 Registry, Iran. J Tehran Heart Cent 2023; 18:196-206. [PMID: 38146415 PMCID: PMC10748664 DOI: 10.18502/jthc.v18i3.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/14/2023] [Indexed: 12/27/2023] Open
Abstract
Background The present study aimed to investigate the association between acute cardiac injury (ACI) and outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19) in Iran. Methods The current cohort study enrolled all consecutive hospitalized patients with COVID-19 (≥ 18 y) who had serum high-sensitivity cardiac troponin-I (hs-cTnT) measurements on admission between March 2020 and March 2021. ACI was determined as hs-cTnT levels exceeding the 99th percentile of normal values. Data on demographics, comorbidities, clinical and laboratory characteristics, and outcomes were collected from Web-based electronic health records. Results The study population consisted of 1413 hospitalized patients with COVID-19, of whom 319 patients (22.58%) presented with ACI. The patients with ACI had a significantly higher mortality rate than those without ACI (48.28% vs 15.63%; P<0.001) within a mean follow-up of 218.86 days from symptom onset. ACI on admission was independently associated with mortality (HR, 1.44; P=0.018). In multivariable logistic regression, age (OR, 1.034; P<0.001), preexisting cardiac disease (OR, 1.49; P=0.035), preexisting malignancy (OR, 2.01; P=0.030), oxygen saturation reduced to less than 90% (OR, 2.15; P<0.001), leukocytosis (OR, 1.45; P=0.043), lymphopenia (OR, 1.49; P=0.020), reduced estimated glomerular filtration rates (eGFRs) (OR, 0.99; P=0.008), and treatment with intravenous immunoglobulin during hospitalization (OR, 4.03; P=0.006) were independently associated with ACI development. Conclusion ACI occurrence on admission was associated with long-term mortality in our hospitalized patients with COVID-19. The finding further underscores the significance of evaluating ACI occurrence on admission, particularly in individuals more prone to ACI, including older individuals and those with preexisting comorbidities, reduced oxygen saturation, and increased inflammatory responses.
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Affiliation(s)
- Danesh Soltani
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Hadadi
- Department of Infectious Diseases, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Karbalai Saleh
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Oraii
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Sadatnaseri
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Roozitalab
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shajari
- Department of Cardiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Haleh Ashraf
- Cardiac Primary Prevention Research Center (CPPRC), Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Research Development Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Schiffl H, Lang SM. Long-term interplay between COVID-19 and chronic kidney disease. Int Urol Nephrol 2023:10.1007/s11255-023-03528-x. [PMID: 36828919 PMCID: PMC9955527 DOI: 10.1007/s11255-023-03528-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE The COVID-19 pandemic may have an impact on the long-term kidney function of survivors. The clinical relevance is not clear. METHODS This review summarises the currently published data. RESULTS There is a bidirectional relationship between chronic kidney disease and COVID-19 disease. Chronic kidney diseases due to primary kidney disease or chronic conditions affecting kidneys increase the susceptibility to COVID-19 infection, the risks for progression and critical COVID-19 disease (with acute or acute-on-chronic kidney damage), and death. Patients who have survived COVID-19 face an increased risk of worse kidney outcomes in the post-acute phase of the disease. Of clinical significance, COVID-19 may predispose surviving patients to chronic kidney disease, independently of clinically apparent acute kidney injury (AKI). The increased risk of post-acute renal dysfunction of COVID-19 patients can be graded according to the severity of the acute infection (non-hospitalised, hospitalised or ICU patients). The burden of chronic kidney disease developing after COVID-19 is currently unknown. CONCLUSION Post-acute COVID-19 care should include close attention to kidney function. Future prospective large-scale studies are needed with long and complete follow-up periods, assessing kidney function using novel markers of kidney function/damage, urinalysis and biopsy studies.
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Affiliation(s)
- Helmut Schiffl
- Universitätsklinikum LMU München, Medizinische Klinik IV, München, Germany.
| | - Susanne M. Lang
- grid.275559.90000 0000 8517 6224Klinik für Innere Medizin V, Universitätsklinikum Jena, Jena, Germany
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Venkatram S, Dileep A, Fortuzi K, Allena N, Diaz-Fuentes G. Comparison of patients admitted to an inner-city intensive care unit across 3 COVID-19 waves. Medicine (Baltimore) 2023; 102:e33069. [PMID: 36827070 PMCID: PMC9949371 DOI: 10.1097/md.0000000000033069] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
To expand our limited knowledge of COVID-19-related outcomes in patients admitted to inner-city intensive care unit (ICU across multiple infection waves. This retrospective study compared patients admitted to the ICU in Bronx, NY, during 3 COVID-19 waves (March 2020 to February 2022). Outcomes included in hospital mortality, length of stay (LOS), use of mechanical ventilation, and discharge disposition. The study included 716 patients (343, 276, and 97 in the first, second, and third COVID-19 waves, respectively). The number of days on mechanical ventilation and LOS were lower in the first wave. Of the 345 discharged patients, 37% went home directly, whereas 11% were discharged to a skill nursing facility. More patients went home during the second and third waves. Mortality decreased from the first to the third waves (57%-37%; P < .001). Predictors of mortality included age, male gender, COPD, shock, acute kidney injury (AKI), dialysis requirement, and mechanical ventilation. The decreased mortality and better discharge disposition of these inner-city patients during the second and third waves is encouraging, as this population historically had a high COVID-19-related mortality risk.
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Affiliation(s)
- Sindhaghatta Venkatram
- Associate Professor of Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
- * Correspondence: Sindhaghatta Venkatram, Associate Professor of Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, 1650 Grand Concourse, Bronx, NY 10457, USA (e-mail: )
| | - Arundhati Dileep
- Pulmonary Fellow, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
| | - Ked Fortuzi
- Pulmonary Fellow, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, NY, USA
| | - Nishant Allena
- Resident Department of Medicine, BronxCare Health System, Bronx, NY, USA
| | - Gilda Diaz-Fuentes
- Associate Professor, Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Bronx, NY, USA
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10
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COVID-19 and renal involvement: a prospective cohort study assessing the impact of mild SARS-CoV-2 infection on the kidney function of young healthy males. Int Urol Nephrol 2023; 55:201-209. [PMID: 35877031 PMCID: PMC9310686 DOI: 10.1007/s11255-022-03301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 07/07/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE COVID-19 frequently affects the kidneys with symptoms ranging from mild proteinuria to progressive acute kidney injury. This prospective study aimed to assess the short- and long-term impact of asymptomatic and mild COVID-19 on the renal function of healthy young adults, and to determine the correlation between viral load and kidney function among these patients. METHODS This was a prospective cohort study conducted over a period of 6 months. Patients were followed-up at baseline, and then after 3 and 6 months, respectively. Real-time PCR cycle threshold (CT) was used to determine the viral load and disease activity. Patients were classified into two groups with either asymptomatic COVID-19 or mild pneumonia. The assessment parameters were variables that could directly or indirectly relate to the renal function. RESULTS A total of 48 patients were included and evaluated. The majority of patients (62.5%) had asymptomatic COVID-19 disease. Patients with mild pneumonia had significantly higher serum creatinine (SCr) at the time of COVID-19 diagnosis (beta = 12.836, 95% CI = 2.405-23.268, P = 0.019), after 3 months (beta = 14.345, 95% CI = 1.149-27.542, P = 0.035), and after 6 months (beta = 14.100, 95% CI = 0.730-27.470, P = 0.040) compared to asymptomatic patients. Mild pneumonia was also significantly associated with lower serum albumin level at the time of COVID-19 diagnosis (beta = - 6.317, 95% CI = - 9.448-- 3.185, P < 0.001). CONCLUSION Mild COVID-19 is associated with mild renal involvement without AKI. Changes in the renal function appear to be related to reduced creatinine clearance and possible albumin leakage in the acute phase of the disease. The reduction in creatinine clearance is not predicted by viral load, and it appears to be a long-term effect of the disease that can last for at least 6 months.
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11
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Rezaeifar A, Tabatabaee A, Siavash M, Akbari M. Is there any link between Hyperphosphatemia, Hypoalbuminemia, and Hypocalcemia with Hospital Outcomes in COVID-19 Patients? Int J Prev Med 2023; 14:3. [PMID: 36942037 PMCID: PMC10023836 DOI: 10.4103/ijpvm.ijpvm_369_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/28/2021] [Indexed: 03/23/2023] Open
Abstract
Background Disturbed biochemical factors have been observed in viral infections including SARS, Ebola virus, and now COVID-19. This study aimed to evaluate the association between Calcium axis' derangements and hospital duration, ICU admission, mechanical ventilation, and death in patients with COVID-19. Methods 428 hospitalized patients with COVID-19 were included in this study. On the first day of admission, the patients were extensively evaluated for biochemical and hormonal factors and followed up until discharge/death. The association between hyperphosphatemia, hypoalbuminemia, and hypocalcemia and major outcomes, including hospital duration, ICU admission, mechanical ventilation, and death, was investigated by logistic regression analysis. Results Hyperphosphatemia and hypoalbuminemia were present in 27 (6.3%) and 59 (13.8%) cases, respectively in the study population. The results of the present study reveal the relation of these factors with worse outcomes in COVID-19 patients; such as hospital duration, ICU admission, mechanical ventilation, and death. On the other hand, high frequency of hypocalcemia (59.1%, 253 subject) has no significant influence on the mentioned outcomes (All P values were greater than 0.05). Conclusions Poor outcomes were associated with hyperphosphatemia and hypoalbuminemia. It seems that we should evaluate the patients for derangements of phosphate, albumin, and calcium and try to treat them for all COVID-19 patients.
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Affiliation(s)
- Atefeh Rezaeifar
- Isfahan Endocrine and Metabolism Research Center (IEMRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aliye Tabatabaee
- Isfahan Endocrine and Metabolism Research Center (IEMRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansour Siavash
- Isfahan Endocrine and Metabolism Research Center (IEMRC), Isfahan University of Medical Sciences, Isfahan, Iran
- Address for correspondence: Dr. Mansour Siavash, Isfahan Endocrine and Metabolism Research Center, Khorram Street, Jomhouri Square, Isfahan, Iran. E-mail:
| | - Mojtaba Akbari
- Isfahan Endocrine and Metabolism Research Center (IEMRC), Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Portuondo-Jiménez J, Gascón M, García J, Legarreta MJ, Villanueva A, Larrea N, García-Gutiérrez S, Munitiz E, Quintana JM. Influencia del índice de privación social en resultados durante la pandemia de COVID-19. GACETA SANITARIA 2023; 37:102301. [PMID: 37028280 PMCID: PMC10075210 DOI: 10.1016/j.gaceta.2023.102301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 04/08/2023]
Abstract
Objetivo Determinar la relación del índice de privación de la población con la utilización del sistema sanitario, la mala evolución y la mortalidad durante la pandemia de COVID-19. Método Estudio de cohorte retrospectivo de personas con infección por SARS-CoV-2 del 1 de marzo de 2020 al 9 de enero de 2022. Se recopilaron datos sociodemográficos, comorbilidad y tratamientos basales prescritos, otros datos basales y el índice de privación, estimado por sección censal. Se realizaron modelos multivariable de regresión logística multinivel para cada variable de resultado: fallecimiento, mala evolución (definida como fallecimiento o ingreso en la unidad de cuidados intensivos), ingreso y visitas a urgencias. Resultados La cohorte se compone de 371.237 personas con infección por SARS-CoV-2. En los modelos multivariable se observó un mayor riesgo de fallecimiento, de mala evolución, de ingreso hospitalario o de visita a urgencias en los quintiles de mayor privación en comparación con el quintil de menor privación. Para el riesgo de ser hospitalizado o de acudir a urgencias, en términos generales hubo diferencias entre todos los quintiles. También se observó que estas diferencias se daban en el primer y el tercer periodos de la pandemia para la mortalidad y la mala evolución, y en todos para el riesgo de ser ingresado o de acudir a urgencias. Conclusiones Los colectivos con mayor nivel de privación han tenido mayores tasas de mortalidad y de ingreso en comparación con los colectivos con unas tasas de privación más bajas. Es necesario realizar intervenciones que minimicen estas desigualdades.
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Affiliation(s)
- Janire Portuondo-Jiménez
- Osakidetza Servicio Vasco de Salud, Subdirección de Coordinación de Atención Primaria, Vitoria-Gasteiz, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios de Salud, Barakaldo, Bizkaia, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España.
| | - María Gascón
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Julia García
- Departamento de Salud del Gobierno Vasco, Oficina de Planificación, Organización y Evaluación Sanitaria, País Vasco, España
| | - María-José Legarreta
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Ane Villanueva
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Nere Larrea
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Susana García-Gutiérrez
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
| | - Endika Munitiz
- Instituto de Investigación Sanitaria Biocruces Bizkaia, Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios de Salud, Barakaldo, Bizkaia, España
| | - José M Quintana
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España; Osakidetza Servicio Vasco de Salud, Hospital Universitario Galdakao-Usansolo, Unidad de Investigación, Galdakao, Bizkaia, España; Red de Investigación de Servicios de Salud en Enfermedades Crónicas (REDISSEC), España; Instituto Kronikgune de Investigación en Servicios Sanitarios, Barakaldo, Bizkaia, España
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The Use of Mebendazole in COVID-19 Patients: An Observational Retrospective Single Center Study. Adv Virol 2022; 2022:3014686. [PMID: 36536779 PMCID: PMC9759380 DOI: 10.1155/2022/3014686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/16/2022] [Accepted: 08/26/2022] [Indexed: 12/14/2022] Open
Abstract
Background. An in-silico screen identified mebendazole with potential antiviral activity that could be a repurposed drug against SARS-CoV-2. Mebendazole is a well-tolerated and cheap antihelminthic agent that is readily available worldwide and thus could be a therapeutic tool in the fight against COVID-19. Methods. This is an observational retrospective study of PCR-confirmed COVID-19 patients who received mebendazole with the intention-to-treat. The study included an inpatient cohort (157 inpatients) and an outpatient cohort (185 outpatients). Of the 157 inpatients and 185 outpatients, 68 (43.3%) and 94 (50.8%) received mebendazole, respectively. Patients who presented within the same timeframe but did not receive mebendazole were used as controls. Patients received standard-of-care treatment including remdesivir, dexamethasone, and anticoagulants as deemed necessary by the treating physician. The following clinical outcomes were evaluated: for the inpatient cohort, length of stay (LOS) at the hospital, need for ventilation (combined invasive and noninvasive), and mortality; for the outpatient cohort, time to symptom resolution, need for hospitalization, and mortality. Results. For the inpatient cohort, the median age did not differ between the treatment and control groups; 62 (56, 67) vs. 62 (56, 68),
, and there was a comparable proportion of males in both groups; 43 (63%) vs. 55 (62%),
. The hospital LOS was 3.5 days shorter in the treatment group compared to the control group (
). There were fewer patients who required invasive or noninvasive ventilation in the treatment group, 2 (2.9%) vs. 7 (7.9%), and the mortality rate is lower in the treatment group, 3 (4.4%) vs. 8 (9.0%), though the differences did not reach statistical significance. For the outpatient cohort, the median age was lower in the treatment group compared with the control group; 40 (34, 48) vs. 48 (41, 54),
. There was a comparable proportion of males between both groups; 50 (53%) vs. 52 (57%),
. Patients in the treatment group were 3.3 days closer to symptom resolution (
). There were numerically fewer patients requiring hospitalization in the treatment group compared with the control group, 3 (3.2%) vs. 6 (6.6%), though this did not reach statistical significance (
). Conclusion. In this retrospective observational study, the use of mebendazole in COVID-19 patients was associated with shorter hospitalizations in the inpatient cohort and shorter durations of symptom resolution in the outpatient cohort. The findings from this small observational study are hypothesis-generating and preclude drawing conclusions about clinical efficacy. Further studies are needed to examine the role of mebendazole in the treatment of COVID-19 patients.
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Abstract
PURPOSE OF REVIEW While it is now widely established acute kidney injury (AKI) is a common and important complication of coronavirus disease (COVID-19) disease, there is marked variability in its reported incidence and outcomes. This narrative review provides a mid-2022 summary of the latest epidemiological evidence on AKI in COVID-19. RECENT FINDINGS Large observational studies and meta-analyses report an AKI incidence of 28-34% in all inpatients and 46-77% in intensive care unit (ICU). The incidence of more severe AKI requiring renal replacement therapy (RRT) in ICU appears to have declined over time, in data from England and Wales RRT use declined from 26% at the start of the pandemic to 14% in 2022. The majority of survivors apparently recover their kidney function by hospital discharge; however, these individuals appear to remain at increased risk of future AKI, estimated glomerular filtration rate (eGFR) decline and chronic kidney disease. Importantly even in the absence of overt AKI a significant proportion of survivors of COVID-19 hospitalisation had reduced eGFR on follow-up. SUMMARY This review summarises the epidemiology, risk factors, outcomes and treatment of COVID-19-associated AKI across the global pandemic. In particular the long-term impact of COVID-19 disease on kidney health is uncertain and requires further characterisation.
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15
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Chang YC, Lee DJ, Wei CLH, Pa CH, Chen CC, Chen HC, Chang YT, Wang HE, Chu P, Lu KC, Wu CC. SARS-CoV-2 versus other minor viral infection on kidney injury in asymptomatic and mildly symptomatic patients. Virulence 2022; 13:1349-1357. [PMID: 35924838 PMCID: PMC9354764 DOI: 10.1080/21505594.2022.2107602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has become a global pandemic since December 2019. Most of the patients are mild or asymptomatic and recovered well as those suffered from other respiratory viruses. SARS-CoV-2 infection is supposed to demonstrate more sequelae. Acute kidney injury (AKI) is common among COVID-19 patients and is associated with disease severity and outcomes. Only a few studies focused on a detailed analysis of kidney damage in asymptomatic or mildly symptomatic COVID-19 patients. Whether any minor viral infection is likely to exhibit similar minor effect on renal function as COVID-19 is still unclear, and the definite pathophysiology of viral invasion is not fully understood. Currently, the proposed mechanisms of AKI include direct effects of virus on kidney, dysregulated immune response, or as a result of multi-organs failure have been proposed. This study will discuss the difference between COVID-19 and other viruses, focusing on proposed mechanisms, biomarkers and whether it matters with clinical significance.
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Affiliation(s)
- Ya-Chieh Chang
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Internal Medicine, Division of Nephrology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ding-Jie Lee
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Ling Helen Wei
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Han Pa
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Chou Chen
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsi-Chih Chen
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Tien Chang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Han-En Wang
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pauling Chu
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Department of Medicine, Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chia-Chao Wu
- Department of Internal Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
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16
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Gupta K, Solanki D, Shah T, Patel T, Panchal D. Predictors Associated with In-hospital Mortality among COVID-19 Patients during the Second Wave in a Tertiary Care Hospital, Gujarat, India: A Retrospective Observational Study. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022; 70:11-12. [PMID: 37355941 DOI: 10.5005/japi-11001-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2023]
Abstract
BACKGROUND Fatalities due to coronavirus disease 2019 (COVID-19) have already crossed to more than 5 million globally so far. Hence, it is crucial for us to identify the risk factors associated with hospital deaths starting from first contact which can help to give timely treatment to the targeted population. OBJECTIVES This retrospective cohort study was conducted to identify various factors related to in-hospital mortality related to COVID-19 in our region. MATERIALS AND METHODS The present study was a single-center, retrospective cohort study of 675 adult patients, admitted with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between 1st April and 25th May 2021 in our tertiary care hospital. Baseline demographic profile, comorbidities, clinical characteristics, and investigatory findings were analyzed for increased odds of mortality. RESULTS A total of 181 (26.8%) patients died and 494 (73.2%) survived. There were 65.4% of males and no difference was found between genders in terms of mortality. Comorbidities associated with in-hospital death in our cohort were age group ≥50 years (p<0.001), diabetes (p<0.0007), and renal injury (p<0.0001). More than half of the patients died during the first week of admission. Breathlessness (83%) was the most common symptom in non-survivors. Neutrophil-to-lymphocyte ratio (NLR), S. creatinine, D-dimer, ferritin, and C-reactive protein (CRP) were increased significantly among the patients who died. Multivariate logistic regression revealed age ≥50 years [adjusted odds ratio (AOR) 2.30, 95% confidence interval (CI) 1.45-3.64] and oxygen (O2) saturation <94% at the time of admission (AOR 2.62, 95% CI 1.75-3.93) were associated with mortality. CONCLUSION Overall in-hospital mortality was 26.8%. Higher age and low O2 saturation were the major risk factors associated with in-hospital mortality.
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Affiliation(s)
- Kinnari Gupta
- Assistant Professor, Department of Community Medicine
| | | | - Tejas Shah
- Associate Professor, Department of Cardiology
| | | | - Dharmendra Panchal
- Assistant Professor, Department of Medicine, Dr M. K. Shah Medical College and Research Centre, Ahmedabad, Gujarat, India
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17
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Babel N, Hugo C, Westhoff TH. Vaccination in patients with kidney failure: lessons from COVID-19. Nat Rev Nephrol 2022; 18:708-723. [PMID: 35999285 PMCID: PMC9397175 DOI: 10.1038/s41581-022-00617-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/06/2023]
Abstract
Infection is the second leading cause of death in patients with chronic kidney disease (CKD). Adequate humoral (antibody) and cellular (T cell-driven) immunity are required to minimize pathogen entry and promote pathogen clearance to enable infection control. Vaccination can generate cellular and humoral immunity against specific pathogens and is used to prevent many life-threatening infectious diseases. However, vaccination efficacy is diminished in patients with CKD. Premature ageing of the immune system and chronic systemic low-grade inflammation are the main causes of immune alteration in these patients. In the case of SARS-CoV-2 infection, COVID-19 can have considerable detrimental effects in patients with CKD, especially in those with kidney failure. COVID-19 prevention through successful vaccination is therefore paramount in this vulnerable population. Although patients receiving dialysis have seroconversion rates comparable to those of patients with normal kidney function, most kidney transplant recipients could not generate humoral immunity after two doses of the COVID-19 vaccine. Importantly, some patients who were not able to produce antibodies still had a detectable vaccine-specific T cell response, which might be sufficient to prevent severe COVID-19. Correlates of protection against SARS-CoV-2 have not been established for patients with kidney failure, but they are urgently needed to enable personalized vaccination regimens.
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Affiliation(s)
- Nina Babel
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Center for Translational Medicine and Immune Diagnostics Laboratory, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Center for Advanced Therapies (BeCAT) and Berlin Institute of Health, Berlin, Germany.
| | - Christian Hugo
- Medizinische Klinik und Poliklinik III, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timm H Westhoff
- Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University Bochum, Herne, Germany
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Geetha D, Kronbichler A, Rutter M, Bajpai D, Menez S, Weissenbacher A, Anand S, Lin E, Carlson N, Sozio S, Fowler K, Bignall R, Ducharlet K, Tannor EK, Wijewickrama E, Hafidz MIA, Tesar V, Hoover R, Crews D, Varnell C, Danziger-Isakov L, Jha V, Mohan S, Parikh C, Luyckx V. Impact of the COVID-19 pandemic on the kidney community: lessons learned and future directions. Nat Rev Nephrol 2022; 18:724-737. [PMID: 36002770 PMCID: PMC9400561 DOI: 10.1038/s41581-022-00618-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.
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Affiliation(s)
- Duvuru Geetha
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | | | - Megan Rutter
- Department of Lifespan and Population Health, University of Nottingham, Nottingham, UK
| | - Divya Bajpai
- Department of Nephrology, Seth Gordhandas Sunderdas Medical College (GSMC) and the King Edward Memorial (KEM) Hospital, Mumbai, India
| | - Steven Menez
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annemarie Weissenbacher
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Shuchi Anand
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Standford, California, USA
| | - Eugene Lin
- Department of Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California, USA
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Research, The Danish Heart Foundation, Copenhagen, Denmark
| | - Stephen Sozio
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Fowler
- Principal, Voice of the Patient Inc, St. Louis, Missouri, USA
| | - Ray Bignall
- Division of Nephrology and Hypertension, Nationwide Children's Hospital and Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Kathryn Ducharlet
- Department of Renal Medicine, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Department of Nephrology and Palliative Care, St Vincent's Hospital Melbourne, Australia and Department of Medicine, University of Melbourne, Parkville, Australia
| | - Elliot K Tannor
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Renal Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Eranga Wijewickrama
- Consultant Nephrologist and Professor in the Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- University Medical Unit, National Hospital of Sri Lanka and National Institute of Nephrology, Dialysis & Transplantation, Colombo, Sri Lanka
| | | | - Vladimir Tesar
- Department of Nephrology, Charles University, Prague, Czech Republic
| | - Robert Hoover
- Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Deidra Crews
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles Varnell
- Division of Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Paediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Lara Danziger-Isakov
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Chirag Parikh
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Valerie Luyckx
- Associate Scientist, Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Honorary Associate Professor, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Nephrologist, University Childrens Hospital, Zurich, Switzerland
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19
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Humoral Response to Hepatitis B and COVID-19 Vaccine among Maintenance Hemodialysis Patients. Vaccines (Basel) 2022; 10:vaccines10101670. [PMID: 36298535 PMCID: PMC9610516 DOI: 10.3390/vaccines10101670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022] Open
Abstract
Maintenance hemodialysis (MHD) patients have impaired immunological responses to pathogens and vaccines. In this study, we compared the humoral response to HBV and COVID-19 vaccines in a cohort of MHD patients. Demographic and clinical characteristics of vaccine responders and non-responders were also compared, and the association between the humoral responses to both vaccines was evaluated. The cohort included 94 MHD patients who were vaccinated at least once for HBV and twice for COVID-19. Among the 94 patients, 28 (29.8%) did not develop protective titers to HBV. Hypertension, coronary heart disease, and heart failure were more common in non-responders. Among MHD patients, 85% had positive IgG anti-spike SARS-CoV-2 levels 6 months after two doses of BNT162b2 (Pfizer/Biotech) vaccine. Age and immunosuppressive therapy were the main predictors of humoral response to COVID-19 vaccine. We did not find any association between non-responders to HBV and non-responders to COVID-19 vaccine. There was no difference in IgG anti-spike titers between HBV responders and non-responders (505 ± 644 vs. 504 ± 781, p = 0.9) Our results suggest that reduced humoral response to hepatitis B is not associated with reduced response to COVID-19 vaccine. Different risk-factors were associated with poor immune response to HBV and to COVID-19 vaccines.
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20
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Su W, Miao H, Guo Z, Chen Q, Huang T, Ding R. Associations between the use of aspirin or other antiplatelet drugs and all-cause mortality among patients with COVID-19: A meta-analysis. Front Pharmacol 2022; 13:989903. [PMID: 36278186 PMCID: PMC9581252 DOI: 10.3389/fphar.2022.989903] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction: Whether aspirin or other antiplatelet drugs can reduce mortality among patients with coronavirus disease (COVID-19) remains controversial.Methods: We identified randomized controlled trials, prospective cohort studies, and retrospective studies on associations between aspirin or other antiplatelet drug use and all-cause mortality among patients with COVID-19 in the PubMed database between March 2019 and September 2021. Newcastle–Ottawa Scale and Cochrane Risk of Bias Assessment Tool were used to assess the risk of bias. The I2 statistic was used to assess inconsistency among trial results. The summary risk ratio (RR) and odds ratio (OR) were obtained through the meta-analysis.Results: The 34 included studies comprised three randomized controlled trials, 27 retrospective studies, and 4 prospective cohort studies. The retrospective and prospective cohort studies showed low-to-moderate risks of bias per the Newcastle–Ottawa Scale score, while the randomized controlled trials showed low-to-high risks of bias per the Cochrane Risk of Bias Assessment Tool. The randomized controlled trials showed no significant effect of aspirin use on all-cause mortality in patients with COVID-19 {risk ratio (RR), 0.96 [95% confidence interval (CI) 0.90–1.03]}. In retrospective studies, aspirin reduced all-cause mortality in patients with COVID-19 by 20% [odds ratio (OR), 0.80 (95% CI 0.70–0.93)], while other antiplatelet drugs had no significant effects. In prospective cohort studies, aspirin decreased all-cause mortality in patients with COVID-19 by 15% [OR, 0.85 (95% CI 0.80–0.90)].Conclusion: The administration of aspirin may reduce all-cause mortality in patients with COVID-19.
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Affiliation(s)
- Wanting Su
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - He Miao
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhaotian Guo
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qianhui Chen
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
- *Correspondence: Tao Huang, ; Renyu Ding,
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
- *Correspondence: Tao Huang, ; Renyu Ding,
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21
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Abd Alsalam AS, Esmaeel NA. Correlation of Biomarkers in Severe COVID-19 Patients Cross-sectional Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: In patients with coronavirus disease-19 (COVID-19), serious biomarkers (liver function tests and renal functions tests) (urea, creatinine, GOT, GPT, and LDH) are determined immediate to assess in prognosis of the severity of disease.
AIM: The aim of the study was to determine correlation between biomarkers (liver function tests and renal functions tests) (urea, creatinine, GOT, GPT, and LDH) among COVID-19 patients.
METHODS: A cross-sectional study, a total of 90 COVID-19 patients who attending in the Al-Hussein Medical City in Karbala, Iraq, participated in the present study within a month’s time in late December 2021 to early January of 2022. All COVID-19 patients with positive SARS-COV-2 real-time RT-PCR results were reviewed. The patients were classifying according SPO2 into three groups (mild, moderate, and severe groups). The demographic data (sex, age, and SPO2) were collected while the biomarkers (liver function tests and renal functions tests) for all patients were done by bio-base instrument (ACCENT-200 ALAT KIT).
RESULTS: The white blood cell “WBC” and neutrophil in moderate and severe groups had substantially greater counts (p = 0.005) when compared with mild group while lymphocytes were considerably decreased in the severe and moderate groups (p = 0.005). In the moderate group, there was positive significant correlation among neutrophils and serum LDH (r = 0.451*, p = 0.014). There was no significant correlation between neutrophils and liver function tests. Furthermore, in the moderate patient group, a strong positively correlating notably among lymphocytes and serum LDH. Moreover, the concentration of serum GOT, GPT, and LDH (p = 0.05, p = 0.08, and p = 0.5) was higher levels in severe group when compared to moderate and mild groups, on the other hand, the renal function tests (urea and creatinine) were high serum levels in severe group than mild and moderate groups.
CONCLUSION: The serum concentration of urea, creatinine, GOPT, GPT, and LDH was high in severe COVID-19 patients group, although there was no statistically significant in ALP, GPT, and urea among COVID-19 patient’s groups (mild, moderate, and severe group). The present study found no significant correlation between biomarkers (liver function tests and renal function test).
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22
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Yüksel E, Arac S, Deniz Altintaş D. Predictors of mortality in COVID-19 induced acute kidney injury. Ther Apher Dial 2022; 26:897-907. [PMID: 35691010 PMCID: PMC9347688 DOI: 10.1111/1744-9987.13895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/30/2022] [Accepted: 06/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to investigate the predictors of mortality in patients with COVID-19-induced acute kidney injury (COV-AKI). METHODS We enrolled 803 patients who developed COV-AKI. The patients were divided into two groups: survivors and nonsurvivors. RESULTS A multivariate logistic regression analysis showed that age (p < 0.001), increased admission C-reactive protein (p = 0.016), procalcitonin (p = 0.019), creatine kinase (p = 0.04), KDIGO stage 1 versus 2 AKI (p < 0.001), KDIGO stage 1 versus 3 (p < 0.001), the need for renal replacement therapy (p = 0.002) and highest creatinine (p = 0.004) were significantly associated with increased inhospital mortality. However, the mortality of patients with AKI on admission (p = 0.002) was found to be lower than those who developed AKI after hospitalization. CONCLUSIONS Among patients with COV-AKI, high-inflammatory response and severe AKI were associated with significantly higher mortality.
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Affiliation(s)
- Enver Yüksel
- Department of Nephrology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Songül Arac
- Emergency Medicine, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Derya Deniz Altintaş
- Department of Radiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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23
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Blain H, Tuaillon E, Gamon L, Pisoni A, Miot S, Delpui V, Si‐Mohamed N, Niel C, Rolland Y, Montes B, Groc S, Rafasse S, Dupuy A, Gros N, Muriaux D, Picot M, Bousquet J. Receptor binding domain-IgG levels correlate with protection in residents facing SARS-CoV-2 B.1.1.7 outbreaks. Allergy 2022; 77:1885-1894. [PMID: 34652831 PMCID: PMC8652754 DOI: 10.1111/all.15142] [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: 09/10/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022]
Abstract
Background Limited information exists on nursing home (NH) residents regarding BNT162b2 vaccine efficacy in preventing SARS‐CoV‐2 and severe COVID‐19, and its association with post‐vaccine humoral response. Methods 396 residents from seven NHs suffering a SARS‐CoV‐2 B.1.1.7 (VOC‐α) outbreak at least 14 days after a vaccine campaign were repeatedly tested using SARS‐CoV‐2 real‐time reverse‐transcriptase polymerase chain reaction on nasopharyngeal swab test (RT‐qPCR). SARS‐CoV‐2 receptor‐binding domain (RBD) of the S1 subunit (RBD‐IgG) was measured in all residents. Nucleocapsid antigenemia (N‐Ag) was measured in RT‐qPCR‐positive residents and serum neutralizing antibodies in vaccinated residents from one NH. Results The incidence of positive RT‐qPCR was lower in residents vaccinated by two doses (72/317; 22.7%) vs one dose (10/31; 32.3%) or non‐vaccinated residents (21/48; 43.7%; p < .01). COVID‐19–induced deaths were observed in 5 of the 48 non‐vaccinated residents (10.4%), in 2 of the 31 who had received one dose (6.4%), and in 3 of the 317 (0.9%) who had received two doses (p = .0007). Severe symptoms were more common in infected non‐vaccinated residents (10/21; 47.6%) than in infected vaccinated residents (15/72; 21.0%; p = .002). Higher levels of RBD‐IgG (n = 325) were associated with a lower SARS‐CoV‐2 incidence. No in vitro serum neutralization activity was found for RBD‐IgG levels below 1050 AU/ml. RBD‐IgG levels were inversely associated with N‐Ag levels, found as a risk factor of severe COVID‐19. Conclusions Two BNT162b2 doses are associated with a 48% reduction of SARS‐CoV‐2 incidence and a 91.3% reduction of death risk in residents from NHs facing a VOC‐α outbreak. Post‐vaccine RBD‐IgG levels correlate with BNT162b2 protection against SARS‐CoV‐2 B.1.1.7.
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Affiliation(s)
- Hubert Blain
- Department of Internal Medicine and Geriatrics MUSE University Montpellier France
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM EFS Antilles University, University Hospital Montpellier France
| | - Lucie Gamon
- Clinical Research and Epidemiology Unit University Hospital Montpellier France
| | - Amandine Pisoni
- Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM EFS Antilles University, University Hospital Montpellier France
| | - Stéphanie Miot
- Department of Internal Medicine and Geriatrics MUSE University Montpellier France
| | - Valentin Delpui
- Department of Internal Medicine and Geriatrics MUSE University Montpellier France
| | - Nejm Si‐Mohamed
- Department of Internal Medicine and Geriatrics MUSE University Montpellier France
| | - Clémence Niel
- Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM EFS Antilles University, University Hospital Montpellier France
| | - Yves Rolland
- Gérontopôle de Toulouse INSERM 1027 Toulouse France
| | - Brigitte Montes
- Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM EFS Antilles University, University Hospital Montpellier France
| | - Soraya Groc
- Pathogenesis and Control of Chronic and Emerging Infections University of Montpellier INSERM EFS Antilles University, University Hospital Montpellier France
| | - Sophia Rafasse
- CEMIPAI University of Montpellier UAR3725 CNRS Montpellier France
- Institute of Research in Infectiology of Montpellier (IRIM) University of Montpellier UMR9004 CNRS Montpellier France
| | - Anne‐Marie Dupuy
- Biochemistry and Hormonology Laboratory University Hospital Montpellier France
| | - Nathalie Gros
- CEMIPAI University of Montpellier UAR3725 CNRS Montpellier France
- Institute of Research in Infectiology of Montpellier (IRIM) University of Montpellier UMR9004 CNRS Montpellier France
| | - Delphine Muriaux
- CEMIPAI University of Montpellier UAR3725 CNRS Montpellier France
- Institute of Research in Infectiology of Montpellier (IRIM) University of Montpellier UMR9004 CNRS Montpellier France
| | | | - Jean Bousquet
- Department of Dermatology and Allergy Universitätsmedizin Berlin Germany
- University Hospital Montpellier France
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24
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La Porta E, Baiardi P, Fassina L, Faragli A, Perna S, Tovagliari F, Tallone I, Talamo G, Secondo G, Mazzarello G, Esposito V, Pasini M, Lupo F, Deferrari G, Bassetti M, Esposito C. The role of kidney dysfunction in COVID-19 and the influence of age. Sci Rep 2022; 12:8650. [PMID: 35606394 PMCID: PMC9125966 DOI: 10.1038/s41598-022-12652-0] [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] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is strongly influenced by age and comorbidities. Acute kidney injury (AKI) is a frequent finding in COVID-19 patients and seems to be associated to mortality and severity. On the other hand, the role of kidney dysfunction in COVID-19 is still debated. We performed a retrospective study in a cohort of 174 hospitalized COVID-19 patients in Italy from March 3rd to May 21st 2020, to investigate the role of kidney dysfunction on COVID-19 severity and mortality. Moreover, we examined in depth the relationship between kidney function, age, and progression of COVID-19, also using different equations to estimate the glomerular filtration rate (GFR). We performed logistic regressions, while a predictive analysis was made through a machine learning approach. AKI and death occurred respectively in 10.2% and 19.5%, in our population. The major risk factors for mortality in our cohort were age [adjusted HR, 6.2; 95% confidence interval (CI) 1.8-21.4] and AKI [3.36 (1.44-7.87)], while, in these relationships, GFR at baseline mitigated the role of age. The occurrence of AKI was influenced by baseline kidney function, D-dimer, procalcitonin and hypertension. Our predictive analysis for AKI and mortality reached an accuracy of ≥ 94% and ≥ 91%, respectively. Our study scales down the role of kidney function impairment on hospital admission , especially in elderly patients. BIS-1 formula demonstrated a worse performance to predict the outcomes in COVID-19 patients when compared with MDRD and CKD-EPI.
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Affiliation(s)
- Edoardo La Porta
- Division of Nephrology, Dialysis and Transplantation, Scientific Institute for Research and Health Care, IRCCS Istituto Giannina Gaslini, via Gerolamo Gaslini 5, 16147, Genoa, Italy.
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy.
| | - Paola Baiardi
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Lorenzo Fassina
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Alessandro Faragli
- Department of Cardiology, Charité-University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Simone Perna
- Department of Biology, Sakhir Campus, College of Science, University of Bahrain, Sakhir, Bahrain
| | | | - Ilaria Tallone
- Nephrology Department, Ospedale San Paolo, Savona, Italy
| | | | | | - Giovanni Mazzarello
- Infectious Disease Clinic Genoa University, Ospedale San Martino, Genoa, Italy
| | - Vittoria Esposito
- Nephrology and Dialysis Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Matteo Pasini
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Francesca Lupo
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Giacomo Deferrari
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Matteo Bassetti
- Infectious Disease Clinic Genoa University, Ospedale San Martino, Genoa, Italy
| | - Ciro Esposito
- Nephrology and Dialysis Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- University of Pavia, Pavia, Italy
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25
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El-Battrawy I, Longo F, Núñez Gil IJ, Abumayyaleh M, Gianesin B, Estrada V, Aparisi Á, Arroyo-Espliguero R, Balocco M, Barella S, Beccaria A, Bonetti F, Casale M, De Michele E, Denotti AR, Fidone C, Fortini M, Gamberini MR, Graziadei G, Lisi R, Massa A, Marcon A, Rubinski B, Miano M, Motta I, Pinto VM, Piperno A, Mariani R, Putti MC, Quota A, Ribersani M, Marziali M, Roberti D, Rosso R, Tartaglione I, Vitucci A, Voi V, Zecca M, Romero R, Marouneld C, Fernández-Rozas I, Espejo C, Marhaeni W, Garcia Aguado M, Cappellini MD, Perrotta S, De Franceschi L, Piga A, Forni GL, Akin I. Thalassaemia is paradoxically associated with a reduced risk of in-hospital complications and mortality in COVID-19: Data from an international registry. J Cell Mol Med 2022; 26:2520-2528. [PMID: 35355397 PMCID: PMC9077285 DOI: 10.1111/jcmm.17026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/18/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022] Open
Abstract
Although numerous patient-specific co-factors have been shown to be associated with worse outcomes in COVID-19, the prognostic value of thalassaemic syndromes in COVID-19 patients remains poorly understood. We studied the outcomes of 137 COVID-19 patients with a history of transfusion-dependent thalassaemia (TDT) and transfusion independent thalassaemia (TIT) extracted from a large international cohort and compared them with the outcomes from a matched cohort of COVID-19 patients with no history of thalassaemia. The mean age of thalassaemia patients included in our study was 41 ± 16 years (48.9% male). Almost 81% of these patients suffered from TDT requiring blood transfusions on a regular basis. 38.7% of patients were blood group O. Cardiac iron overload was documented in 6.8% of study patients, whereas liver iron overload was documented in 35% of study patients. 40% of thalassaemia patients had a history of splenectomy. 27.7% of study patients required hospitalization due to COVID-19 infection. Amongst the hospitalized patients, one patient died (0.7%) and one patient required intubation. Continuous positive airway pressure (CPAP) was required in almost 5% of study patients. After adjustment for age-, sex- and other known risk factors (cardiac disease, kidney disease and pulmonary disease), the rate of in-hospital complications (supplemental oxygen use, admission to an intensive care unit for CPAP therapy or intubation) and all-cause mortality was significantly lower in the thalassaemia group compared to the matched cohort with no history of thalassaemia. Amongst thalassaemia patients in general, the TIT group exhibited a higher rate of hospitalization compared to the TDT group (p = 0.001). In addition, the rate of complications such as acute kidney injury and need for supplemental oxygen was significantly higher in the TIT group compared to the TDT group. In the multivariable logistic regression analysis, age and history of heart or kidney disease were all found to be independent risk factors for increased in-hospital, all-cause mortality, whereas the presence of thalassaemia (either TDT or TIT) was found to be independently associated with reduced all-cause mortality. The presence of thalassaemia in COVID-19 patients was independently associated with lower in-hospital, all-cause mortality and few in-hospital complications in our study. The pathophysiology of this is unclear and needs to be studied in vitro and in animal models.
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Affiliation(s)
- Ibrahim El-Battrawy
- University of Mannheim, Mannheim, Germany.,Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Filomena Longo
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación, Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | | | - Vicente Estrada
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación, Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | | | - Manuela Balocco
- SSD Talassemia. Ospedale Pediatrico Microcitemico A. Cao, Cagliari, Italy
| | | | | | - Federico Bonetti
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Elisa De Michele
- Unità operativa semplice Studio Emoglobinopatie Simt, Ragusa, Italy
| | - Anna Rita Denotti
- SSD Talassemia. Ospedale Pediatrico Microcitemico A. Cao, Cagliari, Italy
| | - Carmelo Fidone
- Azienda Ospedaliero-Universitaria S.Anna di Ferrara, Ferrara, Italy
| | - Monica Fortini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giovanna Graziadei
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, Catania, Italy
| | | | - Antonella Massa
- ASST-Monza, S.Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Alessia Marcon
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Irene Motta
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | | - Michela Ribersani
- Azienda Ospedaliero-Universitaria Policlinico "Vittorio Emanuele", Catania, Italy
| | - Marco Marziali
- Azienda Ospedaliera Universitaria Policlinico, Bari, Italy
| | - Domenico Roberti
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Vincenzo Voi
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Marco Zecca
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rodolfo Romero
- HOSPITAL UNIVERSITARIO LA PAZ, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | - Carolina Espejo
- Pediatrics Department, Hematology-Oncology Division, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Wulandewi Marhaeni
- Cardiology Department, Hospital Puerta de Hierro de Majadahonda, Majadahonda, Madrid, Spain
| | - Marcos Garcia Aguado
- Department of Cardiology, BG Universitätsklinikum Bochum, Ruhr-Universität Bochum, Bochum, Germany
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Antonio Piga
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Carter B, Ramsay EA, Short R, Goodison S, Lumsden J, Khan A, Braude P, Vilches-Moraga A, Quinn TJ, McCarthy K, Hewitt J, Myint PK, Bruce E, Einarsson A, McCrorie K, Aggrey K, Bilan J, Hartrop K, Murphy C, McGovern A, Clini E, Guaraldi G, Verduri A, Bisset C, Alexander R, Kelly J, Murphy C, Mutasem TEJ, Singh S, Paxton D, Harris W, Moug S, Galbraith N, Bhatti E, Edwards J, Duffy S, Espinoza MFR, Kneen T, Dafnis A, Allafi H, Vidal MN, Price A, Pearce L, Lee T, Sangani S, Garcia M, Davey C, Jones S, Lunstone K, Cavenagh A, Silver C, Telford T, Simmons R. Prognostic value of estimated glomerular filtration rate in hospitalised older patients (over 65) with COVID-19: a multicentre, European, observational cohort study. BMC Geriatr 2022; 22:119. [PMID: 35151257 PMCID: PMC8840680 DOI: 10.1186/s12877-022-02782-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
Background The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality. Methods Patient clinical and demographic data was taken from the COVID-19 in Older People (COPE) study during two periods (February–June 2020 and October 2020–March 2021, respectively). Kidney function on admission was measured using estimated glomerular filtration rate (eGFR). The primary outcomes were time to mortality and 28-day mortality. Secondary outcome was length of hospital stay. Data were analysed with multilevel Cox proportional hazards regression, and multilevel logistic regression and adjusted for individual patient clinical and demographic characteristics. Results One thousand eight hundred two patients (55.0% male; median [IQR] 80 [73–86] years) were included in the study. 28-day mortality was 42.3% (n = 742). 48% (n = 801) had evidence of renal impairment on admission. Using a time-to-event analysis, reduced renal function was associated with increased in-hospital mortality (compared to eGFR ≥ 60 [Stage 1&2]): eGFR 45–59 [Stage 3a] aHR = 1.26 (95%CI 1.02–1.55); eGFR 30–44 [Stage 3b] aHR = 1.41 (95%CI 1.14–1.73); eGFR 1–29 [Stage 4&5] aHR = 1.42 (95%CI 1.13–1.80). In the co-primary outcome of 28-day mortality, mortality was associated with: Stage 3a adjusted odds ratio (aOR) = 1.18 (95%CI 0.88–1.58), Stage 3b aOR = 1.40 (95%CI 1.03–1.89); and Stage 4&5 aOR = 1.65 (95%CI 1.16–2.35). Conclusion eGFR on admission is a good independent predictor of mortality in hospitalised older patients with COVID-19 population. We found evidence of a dose-response between reduced renal function and increased mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02782-5.
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Kidney Dysfunction and Its Progression in Patients Hospitalized Duo to COVID-19: Contribution to the Clinical Course and Outcomes. J Clin Med 2021; 10:jcm10235522. [PMID: 34884225 PMCID: PMC8658310 DOI: 10.3390/jcm10235522] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
The disease caused by coronavirus SARS-CoV-2 (COVID-19) can affect almost all organs of the human body, including kidneys. We conducted a one-center study to comprehensively analyze the effects of kidney involvement on the course and outcomes in patients hospitalized with COVID-19, depending on the estimated glomerular filtration rate (eGFR) at admission. Out of the 1958 patients, 1342 (68.54%) had eGFR ≥ 60 mL/min/1.73 m2 (group A) and 616 (31.46%) had eGFR < 60 mL/min/1.73 m2 (group B). Group B was additionally divided into subgroups B1, B2, and B3 based on eGFR. We found that mortality rates during hospitalization, as well as after 90 and 180 days, were much higher in group B than group A. The highest mortality was observed in the B2 subgroup with eGFR of 15-29. The mortality of B patients was associated with comorbidities, respiratory dysfunction, immunological impairment, and more frequent development of AKI. AKI had a negative impact on patients' survival, regardless of the initial renal function. At discharge, 7.4% of patients had serum creatinine levels 30% higher, or more, as compared to admission. The disease course and outcomes in COVID-19 patients are associated with baseline eGFR; however, AKI during hospitalization is a more significant predictor of poor prognosis regardless of the initial renal function.
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Mirijello A, Piscitelli P, de Matthaeis A, Inglese M, D’Errico MM, Massa V, Greco A, Fontana A, Copetti M, Florio L, Leone MA, Prencipe MA, Aucella F, De Cosmo S. Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients. J Clin Med 2021; 10:jcm10225224. [PMID: 34830506 PMCID: PMC8619033 DOI: 10.3390/jcm10225224] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. METHODS We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. RESULTS Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson's Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02-2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10-1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). CONCLUSIONS Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.
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Affiliation(s)
- Antonio Mirijello
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (P.P.); (A.d.M.); (M.I.)
- Correspondence: (A.M.); (S.D.C.)
| | - Pamela Piscitelli
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (P.P.); (A.d.M.); (M.I.)
| | - Angela de Matthaeis
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (P.P.); (A.d.M.); (M.I.)
| | - Michele Inglese
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (P.P.); (A.d.M.); (M.I.)
| | - Maria Maddalena D’Errico
- Unit of Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (M.M.D.); (V.M.); (A.G.)
| | - Valentina Massa
- Unit of Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (M.M.D.); (V.M.); (A.G.)
| | - Antonio Greco
- Unit of Geriatrics, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (M.M.D.); (V.M.); (A.G.)
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (A.F.); (M.C.)
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (A.F.); (M.C.)
| | - Lucia Florio
- Unit of Neurology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (L.F.); (M.A.L.)
| | - Maurizio Angelo Leone
- Unit of Neurology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (L.F.); (M.A.L.)
| | - Michele Antonio Prencipe
- Unit of Nephrology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (M.A.P.); (F.A.)
| | - Filippo Aucella
- Unit of Nephrology, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (M.A.P.); (F.A.)
| | - Salvatore De Cosmo
- Unit of Internal Medicine, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (P.P.); (A.d.M.); (M.I.)
- Correspondence: (A.M.); (S.D.C.)
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Kim J, Hong K, Gómez Gómez RE, Kim S, Chun BC. Lack of Evidence of COVID-19 Being a Risk Factor of Alopecia Areata: Results of a National Cohort Study in South Korea. Front Med (Lausanne) 2021; 8:758069. [PMID: 34722594 PMCID: PMC8550157 DOI: 10.3389/fmed.2021.758069] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Concerns about alopecia areata (AA) in coronavirus disease 2019 (COVID-19) patients have emerged among dermatologists. However, most of the extant kinds of literature have limited implications by relying on cross-sectional studies with restricted study subjects without the control group. Objective: Our study aims to investigate the risk of developing AA among COVID-19 patients in South Korea using national representative data. Methods: We used the National Health Insurance Service COVID-19 cohort database, comprising COVID-19 patients and the control group, all of whom were diagnosed from January 1, 2020, to June 4, 2020. Patients were defined as individuals who were confirmed as COVID-19 positive, regardless of disease severity. Controls were defined as those who were confirmed as COVID-19 negatives. People with a history of AA during the period 2015-2019 were excluded. The primary endpoint was a new diagnosis of AA (ICD-10-Code: L63). The adjusted incidence rate ratio (IRR) of developing AA was estimated using a log-link Poisson regression model based on incidence density. The model adjusted for (1) age and sex and (2) demographic variables (age, sex, place of residence, and income level). Results: A total of 226,737 individuals (7,958 [3.5%] cases and 218,779 [96.5%] controls) were included in the final analysis. The ratio of newly diagnosed AA was 18/7,958 (0.2%) in cases and 195/218,779 (0.1%) in controls. IRRs of COVID-19 patients having newly diagnosed AA compared to controls were 0.78 (95% CI: 0.48-1.27) when age and sex were adjusted for and 0.60 (95% CI: 0.35-1.03) when all demographic variables were adjusted for. Conclusion: Diagnosis of COVID-19 was not significantly associated with the development of AA even after appropriately adjusting for covariates.
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Affiliation(s)
- Jeehyun Kim
- Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.,Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, South Korea
| | - Kwan Hong
- Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Raquel Elizabeth Gómez Gómez
- Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Soojin Kim
- Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.,Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, South Korea
| | - Byung Chul Chun
- Graduate School of Public Health, Korea University, Seoul, South Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea.,Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul, South Korea
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Longhitano E, Nardi C, Calabrese V, Messina R, Mazzeo G, Venanzi Rullo E, Ceccarelli M, Chatrenet A, Saulnier P, Torreggiani M, Nunnari G, Piccoli GB, Santoro D. Hypernatraemia and low eGFR at hospitalization in COVID-19 patients: a deadly combination. Clin Kidney J 2021; 14:2227-2233. [PMID: 34603699 PMCID: PMC8394821 DOI: 10.1093/ckj/sfab122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the general population and the burden of pre-existing comorbidities has heavily affected the outcome of the infection. Hyponatraemia has been frequently described. Conversely, hypernatraemia has rarely been described in COVID-19. Methods The studied cohort encompasses all COVID-19 patients consecutively admitted to the Messina Hospital, Italy, during the first wave of the epidemic. Since healthcare structures were not overwhelmed at that time, indications for hospitalization were homogeneous throughout the study period. Serum sodium levels, kidney function [estimated glomerular filtration rate (eGFR)], demographic and clinical characteristics were recorded at admission. Correlation between mortality, sodium and eGFR was evaluated by survival curves and univariate and multivariate regression models. Results Baseline biochemical and clinical data at the time of admission were available for 115 COVID-19-confirmed patients. The median age at admission was 73 years (48% men), with a median Charlson Comorbidity Index of 4. A total of 23.5% of patients presented with a sodium level ≥146 mmol/L, while 7.8% had sodium <135 mmol/L. Hypernatraemic patients were older, with higher comorbidity. Age, hypernatraemia and reduced eGFR were associated with increased mortality in both univariate and multivariate regression models (P < 0.001). The combination of hypernatraemia and reduced renal function at admission had an odds ratio of 47.67 (95% confidence interval 10.08–225.43) of dying compared with patients with an eGFR ≥60 mL/min and sodium <145 mmol/L. Conclusions Our study suggests that the association between hypernatraemia and reduced eGFR at referral is a highly relevant prognostic marker for death during hospitalization. The role of this association should be further tested in larger, multicentre cohorts.
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Affiliation(s)
- Elisa Longhitano
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Chiara Nardi
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Vincenzo Calabrese
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Roberta Messina
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Giuliana Mazzeo
- Section of Anesthesiology, Department of Human Pathology of Adult and Childhood 'G Barresi', A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Antoine Chatrenet
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Laboratory 'Movement, Interactions, Performance' (EA 4334), Le Mans University, Le Mans, France
| | - Patrick Saulnier
- Département de Biostatistiques et Méthodologie, Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | - Giuseppe Nunnari
- Section of Anesthesiology, Department of Human Pathology of Adult and Childhood 'G Barresi', A.O.U. 'G. Martino', University of Messina, Messina, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. 'G. Martino', University of Messina, Messina, Italy
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Wong KCY, Xiang Y, Yin L, So HC. Uncovering Clinical Risk Factors and Predicting Severe COVID-19 Cases Using UK Biobank Data: Machine Learning Approach. JMIR Public Health Surveill 2021; 7:e29544. [PMID: 34591027 PMCID: PMC8485986 DOI: 10.2196/29544] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/24/2021] [Accepted: 07/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background COVID-19 is a major public health concern. Given the extent of the pandemic, it is urgent to identify risk factors associated with disease severity. More accurate prediction of those at risk of developing severe infections is of high clinical importance. Objective Based on the UK Biobank (UKBB), we aimed to build machine learning models to predict the risk of developing severe or fatal infections, and uncover major risk factors involved. Methods We first restricted the analysis to infected individuals (n=7846), then performed analysis at a population level, considering those with no known infection as controls (ncontrols=465,728). Hospitalization was used as a proxy for severity. A total of 97 clinical variables (collected prior to the COVID-19 outbreak) covering demographic variables, comorbidities, blood measurements (eg, hematological/liver/renal function/metabolic parameters), anthropometric measures, and other risk factors (eg, smoking/drinking) were included as predictors. We also constructed a simplified (lite) prediction model using 27 covariates that can be more easily obtained (demographic and comorbidity data). XGboost (gradient-boosted trees) was used for prediction and predictive performance was assessed by cross-validation. Variable importance was quantified by Shapley values (ShapVal), permutation importance (PermImp), and accuracy gain. Shapley dependency and interaction plots were used to evaluate the pattern of relationships between risk factors and outcomes. Results A total of 2386 severe and 477 fatal cases were identified. For analyses within infected individuals (n=7846), our prediction model achieved area under the receiving-operating characteristic curve (AUC–ROC) of 0.723 (95% CI 0.711-0.736) and 0.814 (95% CI 0.791-0.838) for severe and fatal infections, respectively. The top 5 contributing factors (sorted by ShapVal) for severity were age, number of drugs taken (cnt_tx), cystatin C (reflecting renal function), waist-to-hip ratio (WHR), and Townsend deprivation index (TDI). For mortality, the top features were age, testosterone, cnt_tx, waist circumference (WC), and red cell distribution width. For analyses involving the whole UKBB population, AUCs for severity and fatality were 0.696 (95% CI 0.684-0.708) and 0.825 (95% CI 0.802-0.848), respectively. The same top 5 risk factors were identified for both outcomes, namely, age, cnt_tx, WC, WHR, and TDI. Apart from the above, age, cystatin C, TDI, and cnt_tx were among the top 10 across all 4 analyses. Other diseases top ranked by ShapVal or PermImp were type 2 diabetes mellitus (T2DM), coronary artery disease, atrial fibrillation, and dementia, among others. For the “lite” models, predictive performances were broadly similar, with estimated AUCs of 0.716, 0.818, 0.696, and 0.830, respectively. The top ranked variables were similar to above, including age, cnt_tx, WC, sex (male), and T2DM. Conclusions We identified numerous baseline clinical risk factors for severe/fatal infection by XGboost. For example, age, central obesity, impaired renal function, multiple comorbidities, and cardiometabolic abnormalities may predispose to poorer outcomes. The prediction models may be useful at a population level to identify those susceptible to developing severe/fatal infections, facilitating targeted prevention strategies. A risk-prediction tool is also available online. Further replications in independent cohorts are required to verify our findings.
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Affiliation(s)
- Kenneth Chi-Yin Wong
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Yong Xiang
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Liangying Yin
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Hon-Cheong So
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China.,KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Kunming Institute of Zoology and The Chinese University of Hong Kong, Kunming, China.,CUHK Shenzhen Research Institute, Shenzhen, China.,Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.,Margaret K.L. Cheung Research Centre for Management of Parkinsonism, The Chinese University of Hong Kong, Hong Kong, China.,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.,Hong Kong Branch of the Chinese Academy of Sciences Center for Excellence in Animal Evolution and Genetics, The Chinese University of Hong Kong, Hong Kong, China
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Kong KA, Jung S, Yu M, Park J, Kang IS. Association Between Cardiovascular Risk Factors and the Severity of Coronavirus Disease 2019: Nationwide Epidemiological Study in Korea. Front Cardiovasc Med 2021; 8:732518. [PMID: 34568465 PMCID: PMC8458703 DOI: 10.3389/fcvm.2021.732518] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Acute respiratory viral infections can result in cardiovascular involvement, with such patients having a significantly higher mortality rate than those without cardiovascular involvement. Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, it is important to determine whether cardiovascular risk factors are associated with the severity of COVID-19. Methods: These nationwide data were provided by the Korea Disease Control and Prevention Agency. We defined a patient as having a “critical illness” if they required more than invasive mechanical ventilation and “fatal illness” if they died. Results: Among the total 5,307 patients, 2,136 (40.8%) were male. The critical illness rate was 5.1% (males: 6.7, females: 4.0%) and the fatality rate was 4.54%. The multivariable analysis showed that age ≥60 years, male sex, diabetes mellitus, hypertension, heart failure, chronic kidney disease, cancer, and dementia were independent risk factors for critical illness. The risk scoring model showed the significance of multiple risk factors. Patients with four risk factors; old age (≥60 years), male sex, hypertension, and diabetes mellitus had a more than a 100 times higher risk for severe COVID-19 than those without these risk factors (OR; 95% confidence interval, 104; 45.6–240.6 for critical, 136.2; 52.3–3547.9 for fatal illness). Conclusions: This study demonstrated that cardiovascular risk factors are also significant risk factors for severe COVID-19. In particular, patients who have multiple cardiovascular risk factors are more likely to progress to severe COVID-19. Therefore, early and appropriate treatment of these patients is crucial.
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Affiliation(s)
- Kyoung Ae Kong
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sodam Jung
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Mina Yu
- Division of Nephrology, Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Junbeom Park
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - In Sook Kang
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
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Arcari L, Ciolina F, Cacciotti L, Danti M, Camastra G, Manzo D, Musarò S, Pironi B, Marazzi G, Santini C, Ansalone G, Sbarbati S. Semiquantitative ChestCT Severity Score Predicts Failure of Noninvasive Positive-Pressure Ventilation in Patients Hospitalized for COVID-19 Pneumonia. J Cardiothorac Vasc Anesth 2021; 36:2278-2286. [PMID: 34627709 PMCID: PMC8434692 DOI: 10.1053/j.jvca.2021.09.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 12/21/2022]
Abstract
Objective Noninvasive positive-pressure ventilation (NPPV) emerged as an efficient tool for treatment of COVID-19 pneumonia. The factors influencing NPPV failure still are elusive. The aim of the study was to investigate the relationships between semiquantitative chest computed tomography (CT) scoring and NPPV failure and mortality in patients with COVID-19. Design Observational study. Setting Nonintensive care setting. Participants A total of 112 patients consecutively admitted for COVID-19 pneumonia. Interventions Usual care including various degrees of respiratory support. Measurements and Main Results The semiquantitative CT score was calculated at hospital admission. Subgroups were identified according to the ventilation strategy used (oxygen delivered by Venturi mask n = 53; NPPV-responder n = 38; NPPV-failure n = 21). The study's primary endpoint was the use of NPPV. The secondary endpoints were NPPV failure and in-hospital death, respectively. CT score progressively increased among groups (six v nine v 14, p < 0.05 among all). CT score was an independent predictor of all study endpoints (primary endpoint: 1.25 [95% confidence interval {CI} 1.1-1.4], p = 0.001; NPPV failure: 1.41 [95% CI 1.18-1.69], p < 0.001; in-hospital mortality: 1.21 [95% CI 1.07-1.38], p = 0.003). According to receiver operator characteristics curve analysis, CT score was the most accurate variable for prediction of NPPV failure (area under the curve 0.862 with p < 0.001; p < 0.05 v other variables). Conclusions The authors reported the common and effective use of NPPV in patients with COVID-19 pneumonia. In the authors’ population, a semiquantitative chest CT analysis at hospital admission accurately identified those patients responding poorly to NPPV.
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Affiliation(s)
- Luca Arcari
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy.
| | | | - Luca Cacciotti
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Giovanni Camastra
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Daniele Manzo
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Salvatore Musarò
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Bruno Pironi
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Claudio Santini
- Covid-Internal Medicine Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Gerardo Ansalone
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
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Panchal D, Kataria J, Patel K, Crowe K, Pai V, Azizogli AR, Kadian N, Sanyal S, Roy A, Dodd-O J, Acevedo-Jake AM, Kumar VA. Peptide-Based Inhibitors for SARS-CoV-2 and SARS-CoV. ADVANCED THERAPEUTICS 2021; 4:2100104. [PMID: 34514085 PMCID: PMC8420164 DOI: 10.1002/adtp.202100104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/14/2021] [Indexed: 12/20/2022]
Abstract
The COVID‐19 (coronavirus disease) global pandemic, caused by the spread of the SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus 2) virus, currently has limited treatment options which include vaccines, anti‐virals, and repurposed therapeutics. With their high specificity, tunability, and biocompatibility, small molecules like peptides are positioned to act as key players in combating SARS‐CoV‐2, and can be readily modified to match viral mutation rate. A recent expansion of the understanding of the viral structure and entry mechanisms has led to the proliferation of therapeutic viral entry inhibitors. In this comprehensive review, inhibitors of SARS and SARS‐CoV‐2 are investigated and discussed based on therapeutic design, inhibitory mechanistic approaches, and common targets. Peptide therapeutics are highlighted, which have demonstrated in vitro or in vivo efficacy, discuss advantages of peptide therapeutics, and common strategies in identifying targets for viral inhibition.
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Affiliation(s)
- Disha Panchal
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Jeena Kataria
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Kamiya Patel
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Kaytlyn Crowe
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Varun Pai
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Abdul-Rahman Azizogli
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Neil Kadian
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Sreya Sanyal
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Abhishek Roy
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Joseph Dodd-O
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Amanda M Acevedo-Jake
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
| | - Vivek A Kumar
- Department of Biomedical Engineering New Jersey Institute of Technology Newark NJ 07102 USA.,Department of Biomedical Engineering Department of Chemical Biological and Pharmaceutical Engineering New Jersey Institute of Technology Newark NJ 07102 USA
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Khatri M, Charytan DM, Parnia S, Petrilli CM, Michael J, Liu D, Tatapudi V, Jones S, Benstein J, Horwitz LI. Outcomes among Hospitalized Chronic Kidney Disease Patients with COVID-19. KIDNEY360 2021; 2:1107-1114. [PMID: 35368350 PMCID: PMC8786103 DOI: 10.34067/kid.0006852020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/04/2021] [Indexed: 02/04/2023]
Abstract
Background Patients with CKD ha ve impaired immunity, increased risk of infection-related mortality, and worsened COVID-19 outcomes. However, data comparing nondialysis CKD and ESKD are sparse. Methods Patients with COVID-19 admitted to three hospitals in the New York area, between March 2 and August 27, 2020, were retrospectively studied using electronic health records. Patients were classified as those without CKD, those with nondialysis CKD, and those with ESKD, with outcomes including hospital mortality, ICU admission, and mortality rates. Results Of 3905 patients, 588 (15%) had nondialysis CKD and 128 (3%) had ESKD. The nondialysis CKD and ESKD groups had a greater prevalence of comorbidities and higher admission D-dimer levels, whereas patients with ESKD had lower C-reactive protein levels at admission. ICU admission rates were similar across all three groups (23%-25%). The overall, unadjusted hospital mortality was 25%, and the mortality was 24% for those without CKD, 34% for those with nondialysis CKD, and 27% for those with ESKD. Among patients in the ICU, mortality was 56%, 64%, and 56%, respectively. Although patients with nondialysis CKD had higher odds of overall mortality versus those without CKD in univariate analysis (OR, 1.58; 95% CI, 1.31 to 1.91), this was no longer significant in fully adjusted models (OR, 1.11; 95% CI, 0.88 to 1.40). Also, ESKD status did not associate with a higher risk of mortality compared with non-CKD in adjusted analyses, but did have reduced mortality when compared with nondialysis CKD (OR, 0.57; 95% CI, 0.33 to 0.95). Mortality rates declined precipitously after the first 2 months of the pandemic, from 26% to 14%, which was reflected in all three subgroups. Conclusions In a diverse cohort of patients with COVID-19, we observed higher crude mortality rates for patients with nondialysis CKD and, to a lesser extent, ESKD, which were not significant after risk adjustment. Moreover, patients with ESKD appear to have better outcom es than those with nondialysis CKD.
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Affiliation(s)
- Minesh Khatri
- New York University Long Island School of Medicine, Mineola, New York
| | - David M. Charytan
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Sam Parnia
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | | | - Jeffrey Michael
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - David Liu
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Vasishta Tatapudi
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Simon Jones
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Judith Benstein
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Leora I. Horwitz
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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Clinical outcomes of hospitalized COVID-19 patients with renal injury: a multi-hospital observational study from Wuhan. Sci Rep 2021; 11:15205. [PMID: 34312430 PMCID: PMC8313555 DOI: 10.1038/s41598-021-94570-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023] Open
Abstract
Renal injury is common in patients with coronavirus disease 2019 (COVID‐19). We aimed to determine the relationship of estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI) with the characteristics, progression, and prognosis of COVID-19 in-patients. We retrospectively reviewed 1851 COVID-19 patients admitted to 3 hospitals in Wuhan, China. Clinical, laboratory, radiological, treatment, complication, and outcome data were analyzed. Patients were stratified according to levels of eGFR (≥ 90 vs. 60–89 vs. < 60 mL/min/1.73 m2). The risk of reaching the composite endpoint—intensive care unit admission, invasive ventilation, or death—was compared. On admission, 25.5% patients had renal impairment (eGFR < 90 mL/min/1.73 m2), but only 2.6% patients had chronic kidney disease (CKD). The overall in-hospital AKI incidence was 6.7%. Severe illness and comorbidities (hypertension, diabetes, CKD, and cardiovascular/cerebrovascular diseases) were more common among patients with low eGFR (< 90 mL/min/1.73 m2). Despite the more frequent use of intensive oxygen therapy, continuous blood purification, and glucocorticoid treatment, the prognosis of these patients was unsatisfactory, with the incidence of the composite endpoint (15.4% vs. 19.6% vs. 54.5%; P = 0.000) and complications (AKI, respiratory failure, cardiac injury, coagulation disorders, sepsis, etc.) increasing with decreasing eGFR. Kaplan–Meier survival analysis revealed that patients with eGFR < 90 mL/min/1.73 m2 or AKI had significantly escalated risks of reaching the composite endpoint. Multivariate regression analysis showed that renal insufficiency (eGFR < 60 mL/min/1.73 m2) on admission and in-hospital AKI independently predicted poor prognosis among COVID-19 in-patients. And renal impairment on admission was a greater predictor of poor prognosis in non-elderly patients than that in elderly patients. Early and continuous renal-function monitoring and early AKI diagnosis are necessary to predict and prevent the progression of COVID-19.
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Uribarri A, Núñez-Gil IJ, Aparisi Á, Arroyo-Espliguero R, Maroun Eid C, Romero R, Becerra-Muñoz VM, Feltes G, Molina M, García-Aguado M, Cerrato E, Capel-Astrua T, Alfonso-Rodríguez E, Castro-Mejía AF, Raposeiras-Roubín S, Espejo C, Pérez-Solé N, Bardají A, Marín F, Fabregat-Andrés Ó, D'ascenzo F, Santoro F, Akin I, Estrada V, Fernández-Ortiz A, Macaya C. [Atrial fibrillation in patients with COVID-19. Usefulness of the CHA 2DS 2-VASc score: an analysis of the international HOPE COVID-19 registry]. Rev Esp Cardiol 2021; 74:608-615. [PMID: 33678938 PMCID: PMC7923850 DOI: 10.1016/j.recesp.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/18/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality. METHODS Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHA2DS2-VASc score in these patients. RESULTS Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, P = .021) and respiratory insufficiency (75.9% vs 62.3%, P = .002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, P = .005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%CI, 1.003-1.519). CHA2DS2-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%CI, 0.147-0.675). CONCLUSIONS AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHA2DS2-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.
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Affiliation(s)
- Aitor Uribarri
- Servicio de Cardiología, Hospital Clinico Universitario de Valladolid, Valladolid, España
| | - Iván J Núñez-Gil
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Álvaro Aparisi
- Servicio de Cardiología, Hospital Clinico Universitario de Valladolid, Valladolid, España
| | | | - Charbel Maroun Eid
- Servicio de Urgencias, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Rodolfo Romero
- Servicio de Urgencias, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Víctor M Becerra-Muñoz
- Servicio de Cardiología, Hospital Clinico Universitario Virgen de la Victoria, Málaga, España
| | - Gisela Feltes
- Servicio de Cardiología, Hospital Nuestra Señora de América, Madrid, España
| | - María Molina
- Servicio de Cardiología, Hospital Universitario Severo Ochoa, Madrid, España
| | - Marcos García-Aguado
- Servicio de Cardiología, Hospital Puerta de Hierro de Majadahonda, Majadahonda, Madrid, España
| | - Enrico Cerrato
- Servizio di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turín, Italia
| | | | | | - Alex F Castro-Mejía
- Servicio de Cardiología, Hospital General del Norte de Guayaquil IESS Los Ceibos, Guayaquil, Ecuador
| | | | - Carolina Espejo
- Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Nerea Pérez-Solé
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, España
| | - Francisco Marín
- Servicio de Cardiología, Hospital de la Arrixaca, El Palmar, Murcia, España
| | | | | | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italia
| | - Ibrahim Akin
- Sektion Interventionelle Kardiologie, University Mannheim, Mannheim, Alemania
| | - Vicente Estrada
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Carlos Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Pecly IMD, Azevedo RB, Muxfeldt ES, Botelho BG, Albuquerque GG, Diniz PHP, Silva R, Rodrigues CIS. COVID-19 and chronic kidney disease: a comprehensive review. J Bras Nefrol 2021; 43:383-399. [PMID: 33836039 PMCID: PMC8428633 DOI: 10.1590/2175-8239-jbn-2020-0203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/07/2020] [Indexed: 12/23/2022] Open
Abstract
Kidney impairment in hospitalized patients with SARS-CoV-2 infection is associated with increased in-hospital mortality and worse clinical evolution, raising concerns towards patients with chronic kidney disease (CKD). From a pathophysiological perspective, COVID-19 is characterized by an overproduction of inflammatory cytokines (IL-6, TNF-alpha), causing systemic inflammation and hypercoagulability, and multiple organ dysfunction syndrome. Emerging data postulate that CKD under conservative treatment or renal replacement therapy (RRT) is an important risk factor for disease severity and higher in-hospital mortality amongst patients with COVID-19. Regarding RAAS blockers therapy during the pandemic, the initial assumption of a potential increase and deleterious impact in infectivity, disease severity, and mortality was not evidenced in medical literature. Moreover, the challenge of implementing social distancing in patients requiring dialysis during the pandemic prompted national and international societies to publish recommendations regarding the adoption of safety measures to reduce transmission risk and optimize dialysis treatment during the COVID-19 pandemic. Current data convey that kidney transplant recipients are more vulnerable to more severe infection. Thus, we provide a comprehensive review of the clinical outcomes and prognosis of patients with CKD under conservative treatment and dialysis, and kidney transplant recipients and COVID-19 infection.
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Affiliation(s)
- Inah Maria D. Pecly
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Rafael B. Azevedo
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Elizabeth S. Muxfeldt
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
- Universidade Federal do Rio de Janeiro, Hospital Universitário
Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Bruna G. Botelho
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Gabriela G. Albuquerque
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Pedro Henrique P. Diniz
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Rodrigo Silva
- Universidade Estácio de Sá, Curso de Medicina Rio de Janeiro, Campus
Centro I - Presidente Vargas, Rio de Janeiro, RJ, Brasil
| | - Cibele I. S. Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências
Médicas e da Saúde, São Paulo, SP, Brasil
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Uribarri A, Núñez-Gil IJ, Aparisi Á, Arroyo-Espliguero R, Maroun Eid C, Romero R, Becerra-Muñoz VM, Feltes G, Molina M, García-Aguado M, Cerrato E, Capel-Astrua T, Alfonso-Rodríguez E, Castro-Mejía AF, Raposeiras-Roubín S, Espejo C, Pérez-Solé N, Bardají A, Marín F, Fabregat-Andrés Ó, D'ascenzo F, Santoro F, Akin I, Estrada V, Fernández-Ortiz A, Macaya C. Atrial fibrillation in patients with COVID-19. Usefulness of the CHA 2DS 2-VASc score: an analysis of the international HOPE COVID-19 registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:608-615. [PMID: 33583755 PMCID: PMC7836821 DOI: 10.1016/j.rec.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/18/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2. Atrial fibrillation (AF) is common in acute situations, where it is associated with more complications and higher mortality. METHODS Analysis of the international HOPE registry (NCT04334291). The objective was to assess the prognostic information of AF in COVID-19 patients. A multivariate analysis and propensity score matching were performed to assess the relationship between AF and mortality. We also evaluated the impact on mortality and embolic events of the CHA2DS2-VASc score in these patients. RESULTS Among 6217 patients enrolled in the HOPE registry, 250 had AF (4.5%). AF patients had a higher prevalence of cardiovascular risk factors and comorbidities. After propensity score matching, these differences were attenuated. Despite this, patients with AF had a higher incidence of in-hospital complications such as heart failure (19.3% vs 11.6%, P=.021) and respiratory insufficiency (75.9% vs 62.3%, P=.002), as well as a higher 60-day mortality rate (43.4% vs 30.9%, P=.005). On multivariate analysis, AF was independently associated with higher 60-day mortality (hazard ratio, 1.234; 95%CI, 1.003-1.519). CHA2DS2-VASc score acceptably predicts 60-day mortality in COVID-19 patients (area ROC, 0.748; 95%CI, 0.733-0.764), but not its embolic risk (area ROC, 0.411; 95%CI, 0.147-0.675). CONCLUSIONS AF in COVID-19 patients is associated with a higher number of complications and 60-day mortality. The CHA2DS2-VASc score may be a good risk marker in COVID patients but does not predict their embolic risk.
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Affiliation(s)
- Aitor Uribarri
- Servicio de Cardiología, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
| | - Iván J Núñez-Gil
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Álvaro Aparisi
- Servicio de Cardiología, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | | | - Charbel Maroun Eid
- Servicio de Urgencias, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Rodolfo Romero
- Servicio de Urgencias, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Víctor M Becerra-Muñoz
- Servicio de Cardiología, Hospital Clinico Universitario Virgen de la Victoria, Málaga, Spain
| | - Gisela Feltes
- Servicio de Cardiología, Hospital Nuestra Señora de América, Madrid, Spain
| | - María Molina
- Servicio de Cardiología, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Marcos García-Aguado
- Servicio de Cardiología, Hospital Puerta de Hierro de Majadahonda, Majadahonda, Madrid, Spain
| | - Enrico Cerrato
- Servizio di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | | | - Alex F Castro-Mejía
- Servicio de Cardiología, Hospital General del Norte de Guayaquil IESS Los Ceibos, Guayaquil, Ecuador
| | | | - Carolina Espejo
- Servicio de Cardiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Nerea Pérez-Solé
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, Valencia, Spain
| | - Alfredo Bardají
- Servicio de Cardiología, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Francisco Marín
- Servicio de Cardiología, Hospital de la Arrixaca, El Palmar, Murcia, Spain
| | | | | | - Francesco Santoro
- Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy
| | - Ibrahim Akin
- Sektion Interventionelle Kardiologie, University Mannheim, Mannheim, Germany
| | - Vicente Estrada
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Macaya
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Mokarram P, Dalivand MM, Pizuorno A, Aligolighasemabadi F, Sadeghdoust M, Sadeghdoust E, Aduli F, Oskrochi G, Brim H, Ashktorab H. Clinical characteristics, gastrointestinal manifestations and outcomes of COVID-19 patients in Iran; does the location matters? World J Clin Cases 2021; 9:4654-4667. [PMID: 34222432 PMCID: PMC8223834 DOI: 10.12998/wjcc.v9.i18.4654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) started in Asia, and Iran was one of its first epicenters.
AIM To study the gastrointestinal (GI) symptoms and comorbidities associated with this pandemic in four different regions of Iran.
METHODS We analyzed data from severe acute respiratory syndrome coronavirus 2 positive patients evaluated at four hospitals of Iran (n = 91), including South (Shiraz), Southeast (Dezful), Rasht (North), and Northwest (Mashhad) between April and September 2020. Demographics, comorbidities and clinical findings including GI symptoms were collected. Statistical descriptive analysis and correlation analyses of symptoms, comorbidities, and mortality were performed.
RESULTS The average age of COVID-19 patients was 51.1 years, and 56% were male. Mortality rate was 17%. Cough with 84.6%, shortness of breath with 71.4%, fever with 52.7%, and loss of appetite with 43.9% were the main symptoms. Overall cardiac disease was the most common comorbidity with an average of 28.5% followed by hypertension (28.5%) and diabetes (25.2%). The highest comorbidity in North (Rasht) was diabetes (30%) and in South (Dezful) hypertension (37%). Shiraz leads cardiac disease with 43.4%. The most reported GI symptoms included nausea, diarrhea, vomiting, and abdominal pain, with 42.8%, 31.8%, 26.8%, and 12% prevalence, respectively. In addition, albumin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were elevated in 26.3%.
CONCLUSION Our results show hypertension and diabetes as the most common comorbidities, but their distribution was different in COVID-19 patients in the four studied regions of Iran. Nausea, diarrhea, and elevated liver enzymes were the most common GI symptoms. There was also a high mortality rate that was associated with high infection rates in Iran at the beginning of the pandemic.
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Affiliation(s)
- Pooneh Mokarram
- Autophagy Research Center, Department of Biochemistry, Shiraz University of Medical Sciences, Shiraz 71348, Iran
| | | | - Antonio Pizuorno
- Department of Medicine, La Universidad del Zulia, Faculty of Medicine, Maracaibo 4002, Venezuela
| | - Farnaz Aligolighasemabadi
- Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad 13131, Iran
| | - Mohammadamin Sadeghdoust
- Department of Internal Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad 13131, Iran
| | - Ebtesam Sadeghdoust
- Department of Internal Medicine, School of Medicine, Dezful University of Medical Sciences, Dezful 64616, Iran
| | - Farshad Aduli
- Department of Medicine, Howard University, Washington, DC 20060, United States
| | - Gholamreza Oskrochi
- Collage of Engineering and Technology, American University of the Middle East, Egaila 54200, Kuwait
| | - Hassan Brim
- Department of Medicine, Howard University, Washington, DC 20060, United States
| | - Hassan Ashktorab
- Department of Medicine, Howard University, Washington, DC 20060, United States
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41
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Portale G, Ciolina F, Arcari L, Giraldi GDL, Danti M, Pietropaolo L, Camastra G, Cordischi C, Urbani L, Proietti L, Cacciotti L, Santini C, Melandri S, Ansalone G, Sbarbati S, Sighieri C. Lung Ultrasound in COVID-19: Clinical Correlates and Comparison with Chest Computed Tomography. ACTA ACUST UNITED AC 2021; 3:2075-2081. [PMID: 34179691 PMCID: PMC8211720 DOI: 10.1007/s42399-021-00986-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/14/2022]
Abstract
Lung ultrasound (LUS) and chest computed tomography (chest CT) are largely employed to evaluate coronavirus disease 2019 (COVID-19) pneumonia. We investigated semi-quantitative LUS and CT scoring in hospitalized COVID-19 patients. LUS and chest CT were performed within 24 h upon admission. Both were analyzed according to semi-quantitative scoring systems. Subgroups were identified according to median LUS score. Patients within higher LUS score group were older (79 vs 60 years, p<0.001), had higher C-reactive protein (CRP) (7.2 mg/dl vs 1.3 mg/dl, p<0.001) and chest CT score (10 vs 4, p=0.027) as well as lower PaO2/FiO2 (286 vs 356, p=0.029) as compared to patients within lower scores. We found a significant correlation between scores (r=0.390, p=0.023). Both LUS and CT scores correlated directly with patients age (r=0.586, p<0.001 and r=0.399, p=0.021 respectively) and CRP (r=0.472, p=0.002 and r=0.518, p=0.002 respectively), inversely with PaO2/FiO2 (r=-0.485, p=0.003 and r=-0.440, p=0.017 respectively). LUS score only showed significant correlation with hs-troponin T, NT-pro-BNP, and creatinine (r=0.433, p=0.019; r=0.411, p=0.027, and r=0.497, p=0.001, respectively). Semi-quantitative bedside LUS is related to the severity of COVID-19 pneumonia similarly to chest CT. Correlation of LUS score with markers of cardiac and renal injury suggests that LUS might contribute to a more comprehensive evaluation of this heterogeneous population.
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Affiliation(s)
- Grazia Portale
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Federica Ciolina
- Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Luca Arcari
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | | | - Massimiliano Danti
- Radiology Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Lorenzo Pietropaolo
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Giovanni Camastra
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Chiara Cordischi
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Laura Urbani
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Lidia Proietti
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
| | - Luca Cacciotti
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Claudio Santini
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Serena Melandri
- Internal Medicine Department, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Gerardo Ansalone
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Stefano Sbarbati
- Covid-Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Cinzia Sighieri
- Emergency Medicine Unit, Madre Giuseppina Vannini Hospital, Via di Acqua Bullicante 4, 00177 Rome, Italy
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42
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Pecly IMD, Azevedo RB, Muxfeldt ES, Botelho BG, Albuquerque GG, Diniz PHP, Silva R, Rodrigues CIS. A review of Covid-19 and acute kidney injury: from pathophysiology to clinical results. ACTA ACUST UNITED AC 2021; 43:551-571. [PMID: 34057983 PMCID: PMC8940122 DOI: 10.1590/2175-8239-jbn-2020-0204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 03/16/2021] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI) in hospitalized patients with COVID-19 is associated with higher mortality and a worse prognosis. Nevertheless, most patients with COVID-19 have mild symptoms, and about 5% can develop more severe symptoms and involve hypovolemia and multiple organ dysfunction syndrome. In a pathophysiological perspective, severe SARS-CoV-2 infection is characterized by numerous dependent pathways triggered by hypercytokinemia, especially IL-6 and TNF-alpha, leading to systemic inflammation, hypercoagulability, and multiple organ dysfunction. Systemic endotheliitis and direct viral tropism to proximal renal tubular cells and podocytes are important pathophysiological mechanisms leading to kidney injury in patients with more critical infection, with a clinical presentation ranging from proteinuria and/or glomerular hematuria to fulminant AKI requiring renal replacement therapies. Glomerulonephritis, rhabdomyolysis, and nephrotoxic drugs are also associated with kidney damage in patients with COVID-19. Thus, AKI and proteinuria are independent risk factors for mortality in patients with SARS-CoV-2 infection. We provide a comprehensive review of the literature emphasizing the impact of acute kidney involvement in the evolutive prognosis and mortality of patients with COVID-19.
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Affiliation(s)
- Inah Maria D Pecly
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Rafael B Azevedo
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Elizabeth S Muxfeldt
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil.,Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, Brasil
| | - Bruna G Botelho
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | | | | | - Rodrigo Silva
- Universidade Estácio de Sá, Curso de Medicina, Rio de Janeiro, RJ, Brasil
| | - Cibele I S Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, São Paulo, SP, Brasil
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Biomarkers Linked with Dynamic Changes of Renal Function in Asymptomatic and Mildly Symptomatic COVID-19 Patients. J Pers Med 2021; 11:jpm11050432. [PMID: 34069451 PMCID: PMC8159130 DOI: 10.3390/jpm11050432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 01/22/2023] Open
Abstract
The catastrophic coronavirus disease 2019 (COVID-19) pandemic is currently a critical global issue. One well-known complication of COVID-19 in severe cases is acute kidney injury, but no research has given a description of its impact on the kidney in patients with mild symptoms. We explore the renal function changes in mild COVID-19 patients. This retrospective, single-center study included 27 participants with laboratory-detected severe acute respiratory syndrome coronavirus two (SARS-CoV-2) infection who were admitted to the Tri-Service General Hospital from 4 February to 26 May 2020 and analyzed their clinical features, radiological findings, and laboratory data. Data collected upon admission and discharge showed a median estimated glomerular filtration rate (eGFR) of 106.7 mL/min/1.732 m2 and 112.2 mL/min/1.732 m2, respectively, with a p-value of 0.044. A correlation between renal function and the severity of infection was also found and was statistically significant upon admission. Patients with a lower lymphocyte count or higher C-reactive protein, neutrophil count, and neutrophil-to-lymphocyte ratio presented with a decreased eGFR during their early infection phase. The biomarkers (CRP and NLR) may be linked with dynamic changes of renal function in COVID-19 patients who are asymptomatic or have mild symptoms.
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44
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Harmful Effects of COVID-19 on Major Human Body Organs: A Review. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.2.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The world experienced the outbreak of a new pandemic disease in 2019, known as coronavirus (CoV) disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome-CoV-2 (SARS-CoV-2). The respiratory system is the organ system most commonly affected by COVID-19; however, several other organ systems have been reported to be affected. The SARS-CoV-2 RNA found in infected stub samples can cause lung contagion by binding to the angiotensin-converting enzyme-2 (ACE-2) receptor of the alveolar epithelial cells. The gut microbiota (GM) promote immunity, indicating that the alignment of the microbiota and corresponding metabolic processes in COVID-19 can help to identify novel biomarkers and new therapeutic targets for this disease. The cause of kidney damage in COVID-19 patients is possibly multifactorial, involving a complex mechanism that involves complement dysregulation and thrombotic microangiopathy, as well as the occurrence of a “cytokine storm” syndrome, which are immune responses that are abandoned and dysfunctional with unfavorable prognosis in severe COVID-19 cases. Furthermore, COVID-19 involves a continuous proliferation and activation of macrophages and lymphocytes. SARS-CoV-2 can also bind to the ACE-2 receptor expressed in the cerebral capillary endothelial cells that can invade the blood-brain wall, to penetrate the brain parenchyma. However, in the ongoing pandemic, there has been a surge in studies on a wide range of topics, including causes of respiratory failure, asymptomatic patients, intensive care patients, and survivors. This review briefly describes the damaging effects of COVID-19 on vital human organs and the inhibitory function of the ACE-2 receptor on the GM, which causes gut dysbiosis, and thus, this review discusses topics that have an opportunity for further investigation.
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45
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Narvel H, Sayed A, Narvel N, Yakkali S, Katchi T. Do Certain Biomarkers Predict Adverse Outcomes in Coronavirus Disease 2019? J Clin Med Res 2021; 13:195-203. [PMID: 34007357 PMCID: PMC8110220 DOI: 10.14740/jocmr4254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/22/2020] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Given the rapid spread of the disease, the World Health Organization (WHO) declared the 2019 - 2020 coronavirus outbreak a Public Health Emergency of International Concern (PHEIC) on January 30, 2020, and a pandemic on March 11, 2020. There have been several reports of the limited resources including the lack of intensive care unit (ICU) beds and mechanical ventilators. Thus, biomarkers that predict ICU stay and mortality will be an important tool to appropriately allocate the limited resources. The aim of this review was to identify laboratory markers that can effectively predict the risk of severe infection and increased mortality in COVID-19 cases. We conducted a systematic review of existing literature in six databases to evaluate the predictive value of various biomarkers. We used the keywords “COVID-19”, “SARS-CoV-2”, “Novel corona virus pneumonia”, “Biomarkers”, “Adverse outcomes”, “Mortality”, etc. among many others to refine our search. Several biomarkers were identified to be associated with adverse outcomes in the above studies. These biomarkers can be used as a tool to identify patients at increased risk for adverse outcomes so that the need for aggressive critical care in such patients is met.
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Affiliation(s)
- Hiba Narvel
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Anam Sayed
- Indian Institute of Medical Science and Research, Jalna, India
| | - Nida Narvel
- Indian Institute of Medical Science and Research, Jalna, India
| | | | - Tasleem Katchi
- Division of Cardiology, HCA-Aventura Hospital and Medical Center, Aventura, FL, USA
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46
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Venturini S, Orso D, Cugini F, Crapis M, Fossati S, Callegari A, Pellis T, Tonizzo M, Grembiale A, Rosso A, Tamburrini M, D'Andrea N, Vetrugno L, Bove T. Classification and analysis of outcome predictors in non-critically ill COVID-19 patients. Intern Med J 2021; 51:506-514. [PMID: 33835685 PMCID: PMC8250466 DOI: 10.1111/imj.15140] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients who could develop a severe form of COVID-19 must be considered of great importance to carry out adequate care and optimise the use of limited resources. AIMS To use several machine learning classification models to analyse a series of non-critically ill COVID-19 patients admitted to a general medicine ward to verify if any clinical variables recorded could predict the clinical outcome. METHODS We retrospectively analysed non-critically ill patients with COVID-19 admitted to the general ward of the hospital in Pordenone from 1 March 2020 to 30 April 2020. Patients' characteristics were compared based on clinical outcomes. Through several machine learning classification models, some predictors for clinical outcome were detected. RESULTS In the considered period, we analysed 176 consecutive patients admitted: 119 (67.6%) were discharged, 35 (19.9%) dead and 22 (12.5%) were transferred to intensive care unit. The most accurate models were a random forest model (M2) and a conditional inference tree model (M5) (accuracy = 0.79; 95% confidence interval 0.64-0.90, for both). For M2, glomerular filtration rate and creatinine were the most accurate predictors for the outcome, followed by age and fraction-inspired oxygen. For M5, serum sodium, body temperature and arterial pressure of oxygen and inspiratory fraction of oxygen ratio were the most reliable predictors. CONCLUSIONS In non-critically ill COVID-19 patients admitted to a medical ward, glomerular filtration rate, creatinine and serum sodium were promising predictors for the clinical outcome. Some factors not determined by COVID-19, such as age or dementia, influence clinical outcomes.
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Affiliation(s)
- Sergio Venturini
- Department of Infectious DiseasesASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Daniele Orso
- Department of MedicineUniversity of UdineUdineItaly
- Department of Anesthesia and Intensive CareASUFC Santa Maria della Misericordia University Hospital of UdineUdineItaly
| | - Francesco Cugini
- Department of Emergency MedicineASUFC Hospital of San DanieleUdineItaly
| | - Massimo Crapis
- Department of Infectious DiseasesASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Sara Fossati
- Department of Infectious DiseasesASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Astrid Callegari
- Department of Infectious DiseasesASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Tommaso Pellis
- Department of Anesthesia and Intensive CareASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Maurizio Tonizzo
- Department of Internal MedicineASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Alessandro Grembiale
- Department of Internal MedicineASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Alessia Rosso
- Department of Internal MedicineASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Mario Tamburrini
- Department of PneumologyASFO Santa Maria degli Angeli Hospital of PordenonePordenoneItaly
| | - Natascia D'Andrea
- Department of MedicineUniversity of UdineUdineItaly
- Department of Anesthesia and Intensive CareASUFC Santa Maria della Misericordia University Hospital of UdineUdineItaly
| | - Luigi Vetrugno
- Department of MedicineUniversity of UdineUdineItaly
- Department of Anesthesia and Intensive CareASUFC Santa Maria della Misericordia University Hospital of UdineUdineItaly
| | - Tiziana Bove
- Department of MedicineUniversity of UdineUdineItaly
- Department of Anesthesia and Intensive CareASUFC Santa Maria della Misericordia University Hospital of UdineUdineItaly
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47
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Ahmed FW, Kirresh OZ, Robinson AV, Majeed MS, Rouse D, Banatwalla R, Parthasarathy S, Sargent C, Castledine C, Chakera AJ. A Retrospective Study Assessing the Effect of Diabetes on Mortality in Patients With COVID-19 at a Teaching Hospital in the United Kingdom. Cureus 2021; 13:e13902. [PMID: 33880258 PMCID: PMC8046422 DOI: 10.7759/cureus.13902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim The aim of the study was to compare the clinical characteristics and outcomes (mortality, intensive care admission, mechanical ventilation, and length of stay, LoS) of patients with and without diabetes with confirmed COVID-19. Methods This retrospective study evaluated clinical and laboratory variables in adult inpatients from Brighton and Sussex University Hospitals NHS Trust with laboratory-confirmed COVID-19 between March 10, 2020, and June 30, 2020. Univariate and multivariate analyses were performed to compare the outcomes of patients with and without diabetes. Results Over 457 patients were included in this study (140 with diabetes and 317 without diabetes), of which 143 (31.9%) died. The median age was 80 years and were predominantly males (59.1%). Baseline characteristics at the time of COVID-19 diagnosis demonstrated that the patients with diabetes were younger than those without diabetes (p=0.008). Mortality increased with age. There was no difference in adverse outcomes in those with and without diabetes. However, subgroup analysis of patients aged ≤60 years demonstrated a significantly increased mortality in those with diabetes (p=0.016). Patients with diabetes had an increased length-of-stay compared to those without diabetes, which was more evident in those aged ≤60 years. Conclusion Age is the most important predictor of mortality. Patients with diabetes did not have increased mortality from COVID-19, which is likely due to their younger age in our cohort. More patients with diabetes stayed in the hospital longer than seven days than those without diabetes.
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Affiliation(s)
- Fahad W Ahmed
- Diabetes and Endocrinology, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | - Omar Z Kirresh
- Diabetes and Endocrinology, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | - Alyss V Robinson
- Diabetes and Endocrinology, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | - M S Majeed
- Diabetes and Endocrinology, Western Sussex Hospital NHS Foundation Trust, Worthing, GBR
| | - Dominique Rouse
- Diabetes and Endocrinology, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | - Rumaisa Banatwalla
- Diabetes and Endocrinology, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | - Sathish Parthasarathy
- Diabetes and Endocrinology, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | - Catherine Sargent
- Infectious Disease, Brighton and Sussex University Hospitals NHS Trust, Brighton, GBR
| | | | - Ali J Chakera
- Diabetes and Endocrinology, Brighton and Sussex County Hospitals NHS Trust, Brighton, GBR
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48
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Xu C, Zhang T, Zhu N, Han M. Characteristics of COVID-19 patients with preexisting CKD history. Int Urol Nephrol 2021; 53:2567-2575. [PMID: 33674950 PMCID: PMC7935001 DOI: 10.1007/s11255-021-02819-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/13/2021] [Indexed: 01/08/2023]
Abstract
Purpose This paper was intended to describe the characteristics of coronavirus disease 2019 (COVID-19) patients with known chronic kidney disease (CKD) history. Methods Clinical information of 20 COVID-19 pneumonia patients with CKD history diagnosed between January 20th and March 1st, 2020 were collected in Tongji Hospital, Wuhan. We listed the clinical baseline data, laboratory findings, chest computed tomography (CT) changes and processed a short period of follow-up of these 20 patients. Results Based on the estimated glomerular filtration rate (eGFR) on admission, 6 patients were classified as stage 2 of CKD, 5 were as 3a, 2 were as 3b, 3 were as 4 and 4 were as 5, respectively. COVID-19 patients with CKD history were elder and hypertension was the most common comorbidity. Cough and fever accounted for more than 80% of the infectious cases. Lymphopenia, increased d-dimer and elevated infectious indications such as hypersensitive C response protein (hsCRP), interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) were also common among these patients. Ground-glass opacity (GGO) and consolidation were the major manifestations in CT scans. 4 patients died and 7 patients underwent acute kidney injury (AKI) during observation. Among 16 discharged patients, 12 were with stable renal function and 4 had deteriorating renal function compared with that of admission. Conclusion Compared to general population infected with SARS-CoV-2, COVID-19 patients with CKD history had a preference to develop to severity with higher fatality rate.
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Affiliation(s)
- Chuou Xu
- Department of Radiology, Tongji Hospital Affiliated To Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianjing Zhang
- Department of Nephrology, Tongji Hospital Affiliated To Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Na Zhu
- Department of Nephrology, Tongji Hospital Affiliated To Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Min Han
- Department of Nephrology, Tongji Hospital Affiliated To Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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49
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Wang X, Jehi L, Ji X, Mazzone PJ. Phenotypes and Subphenotypes of Patients With COVID-19: A Latent Class Modeling Analysis. Chest 2021; 159:2191-2204. [PMID: 33640378 PMCID: PMC7907753 DOI: 10.1016/j.chest.2021.01.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
Background Since COVID-19 was identified, its clinical and biological heterogeneity has been recognized. Identifying COVID-19 phenotypes might help guide basic, clinical, and translational research efforts. Research Question Does the clinical spectrum of patients with COVID-19 contain distinct phenotypes and subphenotypes? Study Design and Methods We included adult patients (≥ 18 years) positive for laboratory-confirmed SARS-CoV-2 infection from a prospective COVID-19 registry database in the Cleveland Clinic Health System in Ohio and Florida. The patients were split into training and testing sets. Using latent class analysis (LCA), we first identified phenotypic clusters of patients with COVID-19 based on demographics, comorbidities, and presenting symptoms. We then identified subphenotypes of hospitalized patients with additional blood biomarker data measured on hospital admission. The associations of phenotypes/subphenotypes and clinical outcomes were investigated. Multivariable prediction models were established to predict assignment to the LCA-defined phenotypes and subphenotypes and then evaluated on an independent testing set. Results We analyzed data for 20,572 patients. Seven phenotypes were identified on the basis of different profiles of presenting COVID-19 symptoms and existing comorbidities, including the following groups: young, no symptoms; young, symptoms; middle-aged, no symptoms; middle-aged, symptoms; middle-aged, comorbidities; old, no symptoms; and old, symptoms. The rates of inpatient hospitalization for the phenotypes were significantly different (P < .001). Five subphenotypes were identified for the subgroup of hospitalized patients, including the following subgroups: young, elevated WBC and platelet counts; middle-aged, lymphopenic with elevated C-reactive protein; middle-aged, hyperinflammatory; old, leukopenic with comorbidities; and old, hyperinflammatory with kidney dysfunction. The hospital mortality and the times from hospitalization to ICU transfer or death were significantly different (P < .001). The models for predicting the LCA-defined phenotypes and subphenotypes showed high discrimination (concordance index, 0.92 and 0.91). Interpretation Hypothesis-free LCA-defined phenotypes and subphenotypes of patients with COVID-19 can be identified. These may help clinical investigators conduct stratified analyses in clinical trials and assist basic science researchers in characterizing the pathobiology of the spectrum of COVID-19 presentations.
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Affiliation(s)
- Xiaofeng Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
| | - Lara Jehi
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Xinge Ji
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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50
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Genebat M, Tarancón-Díez L, de Pablo-Bernal R, Calderón A, Muñoz-Fernández MÁ, Leal M. Coronavirus Disease (COVID-19): A Perspective from Immunosenescence. Aging Dis 2021; 12:3-6. [PMID: 33532121 PMCID: PMC7801288 DOI: 10.14336/ad.2020.0831] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/31/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Miguel Genebat
- 1Internal Medicine Department, Hospital Fátima, Sevilla, Spain.,2Emergency Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | - Laura Tarancón-Díez
- 3Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Rebeca de Pablo-Bernal
- 4Exterior Health Service, Spanish Government Delegation in the Canary Islands, Las Palmas de Gran Canaria, Spain
| | - Alba Calderón
- 1Internal Medicine Department, Hospital Fátima, Sevilla, Spain
| | - Mª Ángeles Muñoz-Fernández
- 3Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
| | - Manuel Leal
- 5Infectious Diseases and Immunology Unit, Internal Medicine Department, Hospital Viamed Santa Ángela de la Cruz, Sevilla, Spain
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