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Meggyesy AM, Wilshire CL, Bograd AJ, Chiu ST, Gilbert CR, Rahman NM, Bedawi EO, Vallieres E, Gorden JA. Complicated Pleural Infection is Associated With Prolonged Recovery and Reduced Functional Ability. J Bronchology Interv Pulmonol 2024; 31:e0974. [PMID: 39037060 DOI: 10.1097/lbr.0000000000000974] [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: 01/17/2024] [Accepted: 05/24/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Management of complicated pleural infections (CPIs) had historically been surgical; however, following the publication of the second multicenter intrapleural sepsis trial (MIST-2), combination tissue plasminogen (tPA) and dornase (DNase) offers a less invasive and effective treatment. Our aim was to assess the quality of life (QOL) and functional ability of patients' recovery from a CPI managed with either intrapleural fibrinolytic therapy (IPFT) or surgery. METHODS We identified 565 patients managed for a CPI between January 1, 2013 and March 31, 2018. There were 460 patients eligible for contact, attempted through 2 phone calls and one mailer. Two questionnaires were administered: the Short Form 36-Item Health Survey (SF-36) and a functional ability questionnaire. RESULTS Contact was made in 35% (159/460) of patients, and 57% (90/159) completed the survey. Patients had lower QOL scores compared to average US citizens; those managed with surgery had higher scores in physical functioning (surgery: 80, IPFT: 70, P=0.040) but lower pain scores (surgery: 58, IPFT: 68, P=0.045). Of 52 patients who returned to work, 48% (25) reported an impact on their work effectiveness during recovery, similarly between management strategies (IPFT: 50%, 13/26 vs. surgery: 46%, 12/26; P=0.781). CONCLUSION Patients with a CPI had a lower QOL compared with average US citizens. Surgically managed patients reported improved physical functioning but worse pain compared with patients managed with IPFT. Patients returned to work within 4 weeks of discharge, and nearly half reported their ability to work effectively was impacted by their recovery. With further research into recovery timelines, patients may be appropriately counselled for expectations.
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Affiliation(s)
- Austin M Meggyesy
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Candice L Wilshire
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Adam J Bograd
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Shih Ting Chiu
- Medical Data Research Center, Providence Health and Services, Portland, OR
| | - Christopher R Gilbert
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Najib M Rahman
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Eihab O Bedawi
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Eric Vallieres
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
| | - Jed A Gorden
- Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA
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Wagner KKL, Corda D, Steinmayr A, Burkert F, Fuchs D, Gostner J, Hofer S, Parrakova L, Gasslitter I, Weiss G, Irsara C, Maier S, Griesmacher A, Bellmann-Weiler R, Kurz K. CRP/Neopterin Ratio and Neuropsychiatric Symptoms in Patients with Different Forms of Pneumonia: Results of a Pilot Study. Microorganisms 2024; 12:1099. [PMID: 38930481 PMCID: PMC11205953 DOI: 10.3390/microorganisms12061099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Pneumonia is one of the most common infectious diseases, mostly caused by viruses or bacteria. In response to bacteria or viruses which are different but which also are partly overlapping, innate and adaptive immune responses are induced, which can be quantified using the determination of specific biomarkers. Among these, C-reactive protein (CRP) has been established as a marker of innate immune function, whereas Neopterin, which is mainly produced upon stimulation with interferon-gamma, reflects cellular immune activation. AIM We investigated inflammation markers in patients with microbiologically confirmed viral or bacterial pneumonia, and studied the potential of CRP, Neopterin, and the CRP/Neopterin ratio to distinguish between viral and bacterial pathogenesis. Furthermore, we examined, how often neuropsychiatric symptoms occur in patients suffering from different kinds of pneumonia. PATIENTS AND METHOD A total of 194 patients diagnosed with either coronavirus disease 2019 (COVID-19) (n = 63), bacterial pneumonia (n = 58), Influenza infection (n = 10), Influenza and a bacterial superinfection (n = 9), and COVID-19 patients with a bacterial superinfection (n = 54) were included in our pilot study. Clinical as well as laboratory parameters were determined shortly after admission. RESULTS We found significantly higher CRP/Neopterin ratios in patients with bacterial pneumonia (median: 0.34) and lower CRP/Neopterin ratios in patients hospitalized with COVID-19 infection (median: 0.03; p < 0.001). Both in men and in women, the CRP/Neopterin ratio was able to distinguish between viral and bacterial pathogens, but also was able to detect bacterial super-infection (BSI) in subjects with initial viral pneumonia (p < 0.001). Patients with BSI presented with significantly lower CRP/Neopterin ratios (median 0.08) than patients with bacterial infection only (median 0.34; p < 0.001). Interestingly, COVID-19 patients had a decreased physical functioning (as reflected in the ECOG score) and a higher frequency of fatigue (84.1%) and neurological symptoms (54.8%) than patients with pneumonia, due to other underlying pathogens. Patients that reported fatigue during viral and bacterial pneumonia presented with lower CRP concentrations than patients without it. CONCLUSIONS The CRP/Neopterin ratio is useful to differentiate between viral and bacterial pathogenesis. The occurrence of neuropsychiatric symptoms in pneumonia appears to depend on the kind of pathogen causing the infection. Lower CRP concentrations at admission appear to be related to fatigue during acute viral and bacterial infection.
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Affiliation(s)
- Katharina Konstanze Lilly Wagner
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
| | - Daniele Corda
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
| | - Andreas Steinmayr
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
| | - Francesco Burkert
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
| | - Dietmar Fuchs
- Institute of Biological Chemistry, Biocenter, CCB, Innsbruck Medical University, 6020 Innsbruck, Austria;
| | - Johanna Gostner
- Institute of Medical Biochemistry, Biocenter, CCB, Innsbruck Medical University, 6020 Innsbruck, Austria; (J.G.); (S.H.); (L.P.)
| | - Stefanie Hofer
- Institute of Medical Biochemistry, Biocenter, CCB, Innsbruck Medical University, 6020 Innsbruck, Austria; (J.G.); (S.H.); (L.P.)
| | - Lucia Parrakova
- Institute of Medical Biochemistry, Biocenter, CCB, Innsbruck Medical University, 6020 Innsbruck, Austria; (J.G.); (S.H.); (L.P.)
| | - Irina Gasslitter
- Department of Dermatology, Innsbruck Medical University, 6020 Innsbruck, Austria;
| | - Günter Weiss
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
| | - Christian Irsara
- Central Institute for Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, 6020 Innsbruck, Austria; (C.I.); (A.G.)
| | - Sarah Maier
- Institute of Medical Statistics and Informatics, Innsbruck Medical University, 6020 Innsbruck, Austria;
| | - Andrea Griesmacher
- Central Institute for Medical and Chemical Laboratory Diagnostics, University Hospital of Innsbruck, 6020 Innsbruck, Austria; (C.I.); (A.G.)
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
| | - Katharina Kurz
- Department of Internal Medicine II, Innsbruck Medical University, 6020 Innsbruck, Austria; (K.K.L.W.); (D.C.); (A.S.); (F.B.); (G.W.)
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van der Feltz-Cornelis C, Turk F, Sweetman J, Khunti K, Gabbay M, Shepherd J, Montgomery H, Strain WD, Lip GYH, Wootton D, Watkins CL, Cuthbertson DJ, Williams N, Banerjee A. Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis. Gen Hosp Psychiatry 2024; 88:10-22. [PMID: 38447388 DOI: 10.1016/j.genhosppsych.2024.02.009] [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: 01/10/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions. METHODS Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection. FINDINGS 17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000). CONCLUSIONS Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.
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Affiliation(s)
- Christina van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, United Kingdom; Hull York Medical School, (HYMS), University of York, York, United Kingdom; Institute of Health Informatics, University College London, London, United Kingdom.
| | - Fidan Turk
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jennifer Sweetman
- Department of Health Sciences, University of York, York, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health University of Liverpool, Liverpool, United Kingdom
| | - Jessie Shepherd
- Department of Health Sciences, University of York, York, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, University College London, London, United Kingdom
| | - W David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Clinical and Biomedical Science and College of Medicine and Health, University of Exeter, Exeter, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Wootton
- Institute of Infection Veterinary and Ecological Sciences and NIHR HPRU in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Caroline Leigh Watkins
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom; School of Nursing and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Daniel J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Nefyn Williams
- Department of Primary Care and Mental Health University of Liverpool, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom; Department of Cardiology, University College London Hospitals NHS Trust, London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom
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Quarton S, McGee K, Cumley N, Behruznia M, Jeff C, Belchamber K, Cox M, Thickett D, Scott A, Parekh D, McNally A, Sapey E. Towards personalised anti-microbial and immune approaches to infections in acute care. Can real-time genomic-informed diagnosis of pathogens, and immune-focused therapies improve outcomes for patients? An observational, experimental study protocol. PLoS One 2024; 19:e0298425. [PMID: 38551904 PMCID: PMC10980213 DOI: 10.1371/journal.pone.0298425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/24/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION Infection causes a vast burden of disease, with significant mortality, morbidity and costs to health-care systems. However, identifying the pathogen causative infection can be challenging, resulting in high use of broad-spectrum antibiotics, much of which may be inappropriate. Novel metagenomic methods have potential to rapidly identify pathogens, however their clinical utility for many infections is currently unclear. Outcome from infection is also impacted by the effectiveness of immune responses, which can be impaired by age, co-morbidity and the infection itself. The aims of this study are twofold: To compare diversity of organisms identified and time-to-result using metagenomic methods versus traditional culture -based techniques, to explore the potential clinical role of metagenomic approaches to pathogen identification in a range of infections.To characterise the ex vivo function of immune cells from patients with acute infection, exploring host and pathogen-specific factors which may affect immune function and overall outcomes. METHODS This is a prospective observational study of patients with acute infection. Patients with symptoms suggestive of an acute infection will be recruited, and blood and bodily fluid relevant to the site of infection collected (for example, sputum and naso-oropharyngeal swabs for respiratory tract infections, or urine for a suspected urinary tract infection). Metagenomic analysis of samples will be compared to traditional microbiology, alongside the antimicrobials received. Blood and respiratory samples such as bronchoalveolar lavage will be used to isolate immune cells and interrogate immune cell function. Where possible, similar samples will be collected from matched participants without a suspected infection to determine the impact of infection on both microbiome and immune cell function.
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Affiliation(s)
- Samuel Quarton
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Kirsty McGee
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicola Cumley
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Microbiology & Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Mahboobeh Behruznia
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Microbiology & Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Charlotte Jeff
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Kylie Belchamber
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Michael Cox
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Microbiology & Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - David Thickett
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Aaron Scott
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alan McNally
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Microbiology & Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth Sapey
- Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Director of PIONEER: Health Data Research UK (HDRUK) Health Data Research Hub for Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Patient Safety Research Collaborative, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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5
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Grant RA, Poor TA, Sichizya L, Diaz E, Bailey JI, Soni S, Senkow KJ, Pérez-Leonor XG, Abdala-Valencia H, Lu Z, Donnelly HK, Simons LM, Ozer EA, Tighe RM, Lomasney JW, Wunderink RG, Singer BD, Misharin AV, Budinger GS. Prolonged exposure to lung-derived cytokines is associated with activation of microglia in patients with COVID-19. JCI Insight 2024; 9:e178859. [PMID: 38502186 PMCID: PMC11141878 DOI: 10.1172/jci.insight.178859] [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: 12/27/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUNDSurvivors of pneumonia, including SARS-CoV-2 pneumonia, are at increased risk for cognitive dysfunction and dementia. In rodent models, cognitive dysfunction following pneumonia has been linked to the systemic release of lung-derived pro-inflammatory cytokines. Microglia are poised to respond to inflammatory signals from the circulation, and their dysfunction has been linked to cognitive impairment in murine models of dementia and in humans.METHODSWe measured levels of 55 cytokines and chemokines in bronchoalveolar lavage fluid and plasma from 341 patients with respiratory failure and 13 healthy controls, including 93 unvaccinated patients with COVID-19 and 203 patients with other causes of pneumonia. We used flow cytometry to sort neuroimmune cells from postmortem brain tissue from 5 patients who died from COVID-19 and 3 patients who died from other causes for single-cell RNA-sequencing.RESULTSMicroglia from patients with COVID-19 exhibited a transcriptomic signature suggestive of their activation by circulating pro-inflammatory cytokines. Peak levels of pro-inflammatory cytokines were similar in patients with pneumonia irrespective of etiology, but cumulative cytokine exposure was higher in patients with COVID-19. Treatment with corticosteroids reduced expression of COVID-19-specific cytokines.CONCLUSIONProlonged lung inflammation results in sustained elevations in circulating cytokines in patients with SARS-CoV-2 pneumonia compared with those with pneumonia secondary to other pathogens. Microglia from patients with COVID-19 exhibit transcriptional responses to inflammatory cytokines. These findings support data from rodent models causally linking systemic inflammation with cognitive dysfunction in pneumonia and support further investigation into the role of microglia in pneumonia-related cognitive dysfunction.FUNDINGSCRIPT U19AI135964, UL1TR001422, P01AG049665, P01HL154998, R01HL149883, R01LM013337, R01HL153122, R01HL147290, R01HL147575, R01HL158139, R01ES034350, R01ES027574, I01CX001777, U01TR003528, R21AG075423, T32AG020506, F31AG071225, T32HL076139.
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Affiliation(s)
- Rogan A. Grant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Taylor A. Poor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Lango Sichizya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Estefani Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Joseph I. Bailey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Sahil Soni
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Karolina J. Senkow
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | | | | | - Ziyan Lu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Helen K. Donnelly
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
| | - Lacy M. Simons
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Robert J. Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Egon A. Ozer
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Pathogen Genomics and Microbial Evolution, Robert J. Havey, MD Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert M. Tighe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
| | | | | | - Benjamin D. Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
- Department of Biochemistry and Molecular Genetics, and Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - G.R. Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine; and
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Iwashyna TJ, Smith VA, Seelye S, Bohnert ASB, Boyko EJ, Hynes DM, Ioannou GN, Maciejewski ML, O’Hare AM, Viglianti EM, Berkowitz TS, Pura J, Womer J, Kamphuis LA, Monahan ML, Bowling CB. Self-Reported Everyday Functioning After COVID-19 Infection. JAMA Netw Open 2024; 7:e240869. [PMID: 38427352 PMCID: PMC10907923 DOI: 10.1001/jamanetworkopen.2024.0869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
Importance Changes in everyday functioning are crucial to assessing the long-term impact of COVID-19 infection. Objective To examine the impact of COVID-19 infection on everyday functioning 18 months after infection among veterans with and without histories of COVID-19 infection. Design, Setting, and Participants This cohort study used data from the US Veterans Affairs (VA) and included 186 veterans who had COVID-19 between October 2020 and April 2021 (ie, COVID-19 cohort) and 186 matched comparators who did not have documented COVID-19 infections (ie, control cohort). This match balanced the risk of COVID-19 based on 39 variables measured in the 24 months before infection or match, using principles of target trial emulation. Data were analyzed from December 2022 to December 2023. Exposure First documented COVID-19. Main Outcome and Measures The differences in self-reported everyday functioning 18 months after COVID-19 infection were estimated and compared with their matched comparators. Within-matched pair logistic and linear regressions assessed differences in outcomes and were weighted to account for sampling and nonresponse. Results Among the 186 matched pairs of participants, their weighted mean age was 60.4 (95% CI, 57.5 to 63.2) years among veterans in the COVID-19 cohort (weighted sample, 91 459 of 101 133 [90.4%] male; 30 611 [30.3%] Black or African American veterans; 65 196 [64.4%] White veterans) and 61.1 (95% CI, 57.8 to 64.4) years among their comparators in the control cohort (91 459 [90.4%] male; 24 576 [24.3%] Black or African American veterans; 70 157 [69.4%] White veterans). A high proportion of veterans in the COVID-19 cohort (weighted percentage, 44.9% [95% CI, 34.2% to 56.2%]) reported that they could do less than what they felt they could do at the beginning of 2020 compared with the control cohort (weighted percentage, 35.3%; [95% CI, 25.6% to 46.4%]; within-matched pair adjusted odds ratio [OR], 1.52 [95% CI, 0.79 to 2.91]). There was no association of documented COVID-19 infection with fatigue, substantial pain, limitations in either activities of daily living and instrumental activities of daily living, severely curtailed life-space mobility, employment, or mean health-related quality of life on a utility scale. Conclusions and Relevance In this cohort study of veterans with and without documented COVID-19, many reported a substantial loss of everyday functioning during the pandemic regardless of whether or not they had a documented infection with COVID-19. Future work with larger samples is needed to validate the estimated associations.
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Affiliation(s)
- Theodore J. Iwashyna
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
- School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Sarah Seelye
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
| | - Amy S. B. Bohnert
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Departments of Anesthesiology, Epidemiology, and Psychiatry, University of Michigan Medical School, Ann Arbor
| | - Edward J. Boyko
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
- University of Washington, Seattle
| | - Denise M. Hynes
- VA Portland Healthcare System, Center to Improve Veteran Involvement in Care, Portland, Oregon
- College of Health, and Center for Quantitative Life Sciences, Oregon State University, Corvallis
- School of Nursing, Oregon Health and Science University, Portland
| | - George N. Ioannou
- University of Washington, Seattle
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- School of Nursing, Oregon Health and Science University, Portland
| | - Ann M. O’Hare
- University of Washington, Seattle
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
| | - Elizabeth M. Viglianti
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Theodore S. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - John Pura
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - James Womer
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lee A. Kamphuis
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
| | - Max L. Monahan
- VA Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - C. Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
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7
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Fernandez-Cotarelo MJ, Jackson-Akers JY, Nagy-Agren SE, Warren CA. Interaction of Clostridioides difficile infection with frailty and cognition in the elderly: a narrative review. Eur J Med Res 2023; 28:439. [PMID: 37849008 PMCID: PMC10580652 DOI: 10.1186/s40001-023-01432-9] [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: 02/18/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE Clostridioides difficile infection (CDI) is the leading cause of antibiotic-related diarrhea and healthcare-associated infections, affecting in particular elderly patients and their global health. This review updates the understanding of this infection, with focus on cognitive impairment and frailty as both risk factors and consequence of CDI, summarizing recent knowledge and potential mechanisms to this interplay. METHODS A literature search was conducted including terms that would incorporate cognitive and functional impairment, aging, quality of life, morbidity and mortality with CDI, microbiome and the gut-brain axis. RESULTS Advanced age remains a critical risk for severe disease, recurrence, and mortality in CDI. Observational and quality of life studies show evidence of functional loss in older people after acute CDI. In turn, frailty and cognitive impairment are independent predictors of death following CDI. CDI has long-term impact in the elderly, leading to increased risk of readmissions and mortality even months after the acute event. Immune senescence and the aging microbiota are key in susceptibility to CDI, with factors including inflammation and exposure to luminal microbial products playing a role in the gut-brain axis. CONCLUSIONS Frailty and poor health status are risk factors for CDI in the elderly. CDI affects quality of life, cognition and functionality, contributing to a decline in patient health over time and leading to early and late mortality. Narrative synthesis of the evidence suggests a framework for viewing the cycle of functional and cognitive decline in the elderly with CDI, impacting the gut-brain and gut-muscle axes.
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Affiliation(s)
- Maria-Jose Fernandez-Cotarelo
- Department of Internal Medicine, Hospital Universitario de Mostoles, Faculty of Health Sciences, Universidad Rey Juan Carlos, Calle Doctor Luis Montes S/N, Mostoles, 28935, Madrid, Spain.
| | - Jasmine Y Jackson-Akers
- División of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA
| | - Stephanie E Nagy-Agren
- Section of Infectious Diseases, Salem Veterans Affairs Medical Center, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Cirle A Warren
- Division of Infectious Disease and International Health, University of Virginia, Charlottesville, VA, USA
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8
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Iwashyna TJ, Seelye S, Berkowitz TS, Pura J, Bohnert ASB, Bowling CB, Boyko EJ, Hynes DM, Ioannou GN, Maciejewski ML, O’Hare AM, Viglianti EM, Womer J, Prescott HC, Smith VA. Late Mortality After COVID-19 Infection Among US Veterans vs Risk-Matched Comparators: A 2-Year Cohort Analysis. JAMA Intern Med 2023; 183:1111-1119. [PMID: 37603339 PMCID: PMC10442778 DOI: 10.1001/jamainternmed.2023.3587] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/09/2023] [Indexed: 08/22/2023]
Abstract
Importance Despite growing evidence of persistent problems after acute COVID-19, how long the excess mortality risk associated with COVID-19 persists is unknown. Objective To measure the time course of differential mortality among Veterans who had a first-documented COVID-19 infection by separately assessing acute mortality from later mortality among matched groups with infected and uninfected individuals who survived and were uncensored at the start of each period. Design, Settings, and Participants This retrospective cohort study used prospectively collected health record data from Veterans Affairs hospitals across the US on Veterans who had COVID-19 between March 2020 and April 2021. Each individual was matched with up to 5 comparators who had not been infected with COVID-19 at the time of matching. This match balanced, on a month-by-month basis, the risk of developing COVID-19 using 37 variables measured in the 24 months before the date of the infection or match. A primary analysis censored comparators when they developed COVID-19 with inverse probability of censoring weighting in Cox regression. A secondary analysis did not censor. Data analyses were performed from April 2021 through June 2023. Exposure First-documented case of COVID-19 (SARS-CoV-2) infection. Main Outcome Measures Hazard ratios for all-cause mortality at clinically meaningful intervals after infection: 0 to 90, 91 to 180, 181 to 365, and 366 to 730 days. Results The study sample comprised 208 061 Veterans with first-documented COVID-19 infection (mean [SD] age, 60.5 (16.2) years; 21 936 (10.5) women; 47 645 [22.9] Black and 139 604 [67.1] White individuals) and 1 037 423 matched uninfected comparators with similar characteristics. Veterans with COVID-19 had an unadjusted mortality rate of 8.7% during the 2-year period after the initial infection compared with 4.1% among uninfected comparators, with censoring if the comparator later developed COVID-19-an adjusted hazard ratio (aHR) of 2.01 (95% CI, 1.98-2.04). The risk of excess death varied, being highest during days 0 to 90 after infection (aHR, 6.36; 95% CI, 6.20-6.51) and still elevated during days 91 to 180 (aHR, 1.18; 95% CI, 1.12-1.23). Those who survived COVID-19 had decreased mortality on days 181 to 365 (aHR, 0.92; 95% CI, 0.89-0.95) and 366 to 730 (aHR, 0.89; 95% CI, 0.85-0.92). These patterns were consistent across sensitivity analyses. Conclusion and Relevance The findings of this retrospective cohort study indicate that although overall 2-year mortality risk was worse among those infected with COVID-19, by day 180 after infection they had no excess mortality during the next 1.5 years.
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Affiliation(s)
- Theodore J. Iwashyna
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
- School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Seelye
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
| | - Theodore S. Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - John Pura
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Amy S. B. Bohnert
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Departments of Anesthesiology and Psychiatry, University of Michigan Medical School, Ann Arbor
| | - C. Barrett Bowling
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Durham VA Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Edward J. Boyko
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Denise M. Hynes
- VA Center to Improve Veteran Involvement in Care, Portland, Oregon
- College of Public Health and Human Sciences and Center for Quantitative Life Sciences, Oregon State University, Corvallis
- School of Nursing, Oregon Health and Science University, Portland
| | - George N. Ioannou
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Matthew L. Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Ann M. O’Hare
- VA Puget Sound Health Care System Hospital and Specialty Medicine Service and Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, Washington
- Department of Medicine, University of Washington, Seattle
| | - Elizabeth M. Viglianti
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - James Womer
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hallie C. Prescott
- Veterans Affairs (VA) Center for Clinical Management Research, Ann Arbor VA, Ann Arbor, Michigan
- Department of Medicine, University of Michigan Medical School, Ann Arbor
| | - Valerie A. Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
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9
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Hendel MK, Rizzuto D, Grande G, Calderón-Larrañaga A, Laukka EJ, Fratiglioni L, Vetrano DL. Impact of Pneumonia on Cognitive Aging: A Longitudinal Propensity-Matched Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:1453-1460. [PMID: 36526613 PMCID: PMC10395566 DOI: 10.1093/gerona/glac253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Acute clinical events, such as pneumonia, may impact physical functionality but their effect on cognition and the possible duration of this effect remains to be quantified. This study investigated the impact of pneumonia on cognitive trajectories and dementia development in older people. METHODS Data were obtained from 60+ years old individuals, who were assessed from 2001 to 2018 in the population-based SNAC-K study (Sweden). Participants were eligible if they were not institutionalized, had no dementia, and did not experience pneumonia 5 years prior to baseline (N = 2 063). A propensity score was derived to match 1:3 participants hospitalized with a diagnosis of pneumonia (N = 178), to nonexposed participants (N = 534). Mixed linear models were used to model cognitive decline. The hazard of dementia, clinically diagnosed by physicians following Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, was estimated using Cox regression models. RESULTS We found a transient impact of pneumonia on cognitive decline in the first 2.5 years (B = -0.94, 95% confidence interval [CI] -1.75, -0.15). The hazard ratio (HR) for dementia was not statistically significantly increased in pneumonia participants (HR = 1.17, 95%CI 0.82, 1.66). CONCLUSIONS The transient impact of pneumonia on cognitive function suggests an increased need of health care for patients after a pneumonia-related hospitalization and reinforces the relevance of pneumonia prevention.
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Affiliation(s)
- Merle K Hendel
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Debora Rizzuto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Gerontology Research Center, Stockholm, Sweden
| | - Giulia Grande
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Gerontology Research Center, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Gerontology Research Center, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Gerontology Research Center, Stockholm, Sweden
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Gerontology Research Center, Stockholm, Sweden
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10
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Gwin MS, Alexeyev MF, Geurts AM, Lee JY, Zhou C, Yang XM, Cohen MV, Downey JM, Barrington RA, Spadafora D, Audia JP, Frank DW, Voth S, Pastukh VV, Bell J, Ayers L, Tambe DT, Nelson AR, Balczon R, Lin MT, Stevens T. Gamma secretase activating protein promotes end-organ dysfunction after bacterial pneumonia. Am J Physiol Lung Cell Mol Physiol 2023; 325:L174-L189. [PMID: 37366533 PMCID: PMC10396227 DOI: 10.1152/ajplung.00018.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023] Open
Abstract
Pneumonia elicits the production of cytotoxic beta amyloid (Aβ) that contributes to end-organ dysfunction, yet the mechanism(s) linking infection to activation of the amyloidogenic pathway that produces cytotoxic Aβ is unknown. Here, we tested the hypothesis that gamma-secretase activating protein (GSAP), which contributes to the amyloidogenic pathway in the brain, promotes end-organ dysfunction following bacterial pneumonia. First-in-kind Gsap knockout rats were generated. Wild-type and knockout rats possessed similar body weights, organ weights, circulating blood cell counts, arterial blood gases, and cardiac indices at baseline. Intratracheal Pseudomonas aeruginosa infection caused acute lung injury and a hyperdynamic circulatory state. Whereas infection led to arterial hypoxemia in wild-type rats, the alveolar-capillary barrier integrity was preserved in Gsap knockout rats. Infection potentiated myocardial infarction following ischemia-reperfusion injury, and this potentiation was abolished in knockout rats. In the hippocampus, GSAP contributed to both pre- and postsynaptic neurotransmission, increasing the presynaptic action potential recruitment, decreasing neurotransmitter release probability, decreasing the postsynaptic response, and preventing postsynaptic hyperexcitability, resulting in greater early long-term potentiation but reduced late long-term potentiation. Infection abolished early and late long-term potentiation in wild-type rats, whereas the late long-term potentiation was partially preserved in Gsap knockout rats. Furthermore, hippocampi from knockout rats, and both the wild-type and knockout rats following infection, exhibited a GSAP-dependent increase in neurotransmitter release probability and postsynaptic hyperexcitability. These results elucidate an unappreciated role for GSAP in innate immunity and highlight the contribution of GSAP to end-organ dysfunction during infection.NEW & NOTEWORTHY Pneumonia is a common cause of end-organ dysfunction, both during and in the aftermath of infection. In particular, pneumonia is a common cause of lung injury, increased risk of myocardial infarction, and neurocognitive dysfunction, although the mechanisms responsible for such increased risk are unknown. Here, we reveal that gamma-secretase activating protein, which contributes to the amyloidogenic pathway, is important for end-organ dysfunction following infection.
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Affiliation(s)
- Meredith S Gwin
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Mikhail F Alexeyev
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Aron M Geurts
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Ji Young Lee
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Chun Zhou
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Xi-Ming Yang
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Michael V Cohen
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - James M Downey
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Robert A Barrington
- Department of Microbiology and Immunology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Domenico Spadafora
- Department of Microbiology and Immunology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Jonathon P Audia
- Department of Microbiology and Immunology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Dara W Frank
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Sarah Voth
- Department of Cell Biology and Physiology, Edward Via College of Osteopathic Medicine, Monroe, Louisiana, United States
| | - Viktoriya V Pastukh
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Jessica Bell
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Linn Ayers
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Dhananjay T Tambe
- Department of Mechanical, Aerospace, and Biomedical Engineering, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Amy R Nelson
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Ron Balczon
- Department of Biochemistry and Molecular Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Mike T Lin
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
| | - Troy Stevens
- Department of Physiology and Cell Biology, Center for Lung Biology, University of South Alabama, Mobile, Alabama, United States
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11
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Grant RA, Poor TA, Sichizya L, Diaz E, Bailey JI, Soni S, Senkow KJ, Pérez-Leonor XG, Abdala-Valencia H, Lu Z, Donnelly HK, Tighe RM, Lomasney JW, Wunderink RG, Singer BD, Misharin AV, Budinger GS. Prolonged exposure to lung-derived cytokines is associated with inflammatory activation of microglia in patients with COVID-19. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.28.550765. [PMID: 37546860 PMCID: PMC10402123 DOI: 10.1101/2023.07.28.550765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Neurological impairment is the most common finding in patients with post-acute sequelae of COVID-19. Furthermore, survivors of pneumonia from any cause have an elevated risk of dementia1-4. Dysfunction in microglia, the primary immune cell in the brain, has been linked to cognitive impairment in murine models of dementia and in humans5. Here, we report a transcriptional response in human microglia collected from patients who died following COVID-19 suggestive of their activation by TNF-α and other circulating pro-inflammatory cytokines. Consistent with these findings, the levels of 55 alveolar and plasma cytokines were elevated in a cohort of 341 patients with respiratory failure, including 93 unvaccinated patients with COVID-19 and 203 patients with other causes of pneumonia. While peak levels of pro-inflammatory cytokines were similar in patients with pneumonia irrespective of etiology, cumulative cytokine exposure was higher in patients with COVID-19. Corticosteroid treatment, which has been shown to be beneficial in patients with COVID-196, was associated with lower levels of CXCL10, CCL8, and CCL2-molecules that sustain inflammatory circuits between alveolar macrophages harboring SARS-CoV-2 and activated T cells7. These findings suggest that corticosteroids may break this cycle and decrease systemic exposure to lung-derived cytokines and inflammatory activation of microglia in patients with COVID-19.
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Affiliation(s)
- Rogan A Grant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Taylor A Poor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lango Sichizya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Estefani Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph I Bailey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sahil Soni
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karolina J Senkow
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xochítl G Pérez-Leonor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hiam Abdala-Valencia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ziyan Lu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Helen K Donnelly
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert M Tighe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jon W Lomasney
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benjamin D Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biochemistry and Molecular Genetics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alexander V Misharin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gr Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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12
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Di Pentima C, Cecchini S, Spannella F, Giulietti F, Allevi M, Schiavi P, Carnevali F, Zoppi L, Ciociola MC, Ventura F, Dragano G, Giordano P, Paci E, Sarzani R. Radiological lung sequelae, functional status and symptoms in older patients 3 and 6 months after hospitalization for COVID-19 pneumonia. Intern Emerg Med 2023; 18:1075-1085. [PMID: 37022640 PMCID: PMC10078021 DOI: 10.1007/s11739-023-03259-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023]
Abstract
The aim of our study was to assess the lung sequelae and clinical consequences 3 and 6 months after hospitalization for COVID-19 pneumonia in older patients. An observational study was conducted on 55 patients aged 65 years and older. Activities of daily living (ADL) and clinical frailty scale (CFS) were assessed at baseline and after 3 months. Both quantitative assessment at chest high-resolution computed tomography (CT) and semi-quantitative severity score (CTSS) were performed at baseline and after 3 and 6 months. Mean age: 82.3 ± 7.1 years. Male prevalence: 56.4%. After 6 months, ground-glass opacities (GGO) were still detectable in 22% of subjects, while consolidations were no longer appreciable. During follow-up, CTSS reached an overall median score of zero after 6 months. Fibrotic-like changes were found in 40% of subjects with an overall median score of 0 (0-5) points, being more prevalent in males. Patients reporting worsening ADL and CFS were 10.9% and 45.5%, respectively. They were associated with the burden of comorbidities, especially history of heart failure and chronic obstructive pulmonary disease at baseline. Amnesic disorders, exertional dyspnea, and fatigue were the most relevant symptoms reported. No association emerged between persistent or new-onset symptoms and evidence of fibrotic-like changes. The typical chest CT abnormalities of the COVID-19 pneumonia acute phase resolved in most of our older patients. Mild fibrotic-like changes persisted in less than half of the patients, especially males, without significantly affecting the functional status and frailty condition, which instead were more likely associated with pre-existing comorbidities.
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Affiliation(s)
- Chiara Di Pentima
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", via Tronto 10/a, Ancona, Italy
| | - Sara Cecchini
- Department of Radiology, IRCCS INRCA, via Della Montagnola 81, Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy.
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", via Tronto 10/a, Ancona, Italy.
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", via Tronto 10/a, Ancona, Italy
| | - Massimiliano Allevi
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", via Tronto 10/a, Ancona, Italy
| | - Paola Schiavi
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", via Tronto 10/a, Ancona, Italy
| | - Francesca Carnevali
- Department of Radiology, IRCCS INRCA, via Della Montagnola 81, Ancona, Italy
| | - Lorenzo Zoppi
- Department of Radiology, IRCCS INRCA, via Della Montagnola 81, Ancona, Italy
| | | | - Fiammetta Ventura
- Department of Radiology, IRCCS INRCA, via Della Montagnola 81, Ancona, Italy
| | - Gina Dragano
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
| | - Piero Giordano
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
| | - Enrico Paci
- Department of Radiology, IRCCS INRCA, via Della Montagnola 81, Ancona, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, via Della Montagnola n. 81, 60127, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica Delle Marche", via Tronto 10/a, Ancona, Italy
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13
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Corrales-Medina VF, van Walraven C. Guideline-Concordant Antibiotic Therapy for the Hospital Treatment of Community-Acquired Pneumonia and 1-Year All-Cause and Cardiovascular Mortality in Older Adult Patients Surviving to Discharge. Chest 2023; 163:1380-1389. [PMID: 36621760 DOI: 10.1016/j.chest.2022.12.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Selection of empiric antibiotic treatment for community-acquired pneumonia (CAP) that is concordant with clinical practice guidelines has been associated with improved short-term outcomes of this infection, but whether it is also associated with longer-term outcomes is unknown. RESEARCH QUESTION Is guideline-concordance of the initial antibiotic treatment given to older adult patients hospitalized with CAP associated with the 1-year all-cause and cardiovascular mortality risk of those patients who survive hospitalization for this infection? STUDY DESIGN AND METHODS A total of 1,909 older (> 65 years of age) patients were identified who survived hospitalization for CAP at The Ottawa Hospital (Ontario, Canada) between 2004 and 2015. Linking patients' information to hospital and provincial data sets, this study analyzed whether the selection of the initial antibiotic therapy for their CAP was concordant with current clinical practice guidelines, and whether guideline-concordance was associated with 1-year all-cause and cardiovascular mortality following their index CAP hospitalization. Adjustments were made for the patients' overall 1-year expected death risk; CAP severity; and history of previous pneumonia admissions, myocardial infarction, heart failure, or cerebrovascular disease. RESULTS Selection of guideline-concordant antibiotic therapy was associated with a trend towards lower all-cause mortality at 1 year post-CAP (hazard ratio, 0.82; 95% CI, 0.65-1.04; P = .099). Furthermore, the use of guideline-concordant antibiotic therapy was associated with a significant almost 50% reduction in cardiovascular death risk 1 year following CAP admission (hazard ratio, 0.53; 95% CI, 0.34-0.80; P = .003). INTERPRETATION Use of guideline-concordant antibiotic therapy for CAP treatment in older hospitalized patients is associated with a significant reduction in the risk of cardiovascular death at 1 year post-CAP. This finding further supports current clinical practice guideline recommendations for CAP treatment.
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Affiliation(s)
- Vicente F Corrales-Medina
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Carl van Walraven
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada; ICES uOttawa, Ottawa, ON, Canada
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Iwai-Saito K, Sato K, Aida J, Kondo K. Association of frailty with influenza and hospitalization due to influenza among independent older adults: a longitudinal study of Japan Gerontological Evaluation Study (JAGES). BMC Geriatr 2023; 23:249. [PMID: 37101153 PMCID: PMC10131426 DOI: 10.1186/s12877-023-03979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND It is unknown that whether frailty is a risk factor of influenza and the hospitalization among older adults, although it has been shown that frailty was associated with poor recovery from the hospitalization among those. We examined the association of frailty with influenza and the hospitalization and the effect by sex among independent older adults. METHODS We used the longitudinal data from the Japan Gerontological Evaluation Study (JAGES), performed in 2016 and 2019 and conducted in 28 municipalities in Japan. The target population comprised 77,103 persons aged ≥ 65 years who did not need assistance from the public long-term care insurance. Primary outcome measures were influenza and hospitalization due to influenza. Frailty was evaluated with the Kihon check list. We estimated the risk of influenza, the hospitalization, those risks by sex, and the interaction for frailty and sex using Poisson regression adjusting for covariates. RESULTS Frailty was associated with both influenza and the hospitalization among the older adults compared with nonfrail individuals after adjusting for covariates (influenza, frail: risk ratio {RR}: 1.36, 95% confidence interval {95% CI}: 1.20 - 1.53, and prefrail: RR: 1.16, 95% CI: 1.09 - 1.23; the hospitalization, frail: RR: 3.18, 95% CI: 1.84 - 5.57, and prefrail: RR: 2.13, 95% CI: 1.44 - 3.16). Male was associated with the hospitalization, but not associated with influenza compared to female (the hospitalization: RR: 1.70, 95% CI: 1.15 - 2.52 and influenza: RR: 1.01, 95% CI: 0.95 - 1.08). The interaction for frailty and sex was significant neither in influenza nor in the hospitalization. CONCLUSION These results suggest that frailty is a risk of influenza and the hospitalization, that risks of the hospitalization are different by sex, but that the sex difference does not cause the effect heterogeneity of frailty on the susceptibility and severity among independent older adults.
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Affiliation(s)
- Kousuke Iwai-Saito
- Division of International Health, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Koryu Sato
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University, Kyoto, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo, 113-8549, Japan
- Liaison Center for Innovative Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba Ward, 980-8574, Sendai City, Miyagi, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chuo-Ku, Chiba, 260-8670, Japan
- Department of Gerontology and Evaluation Study, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, 7-430 Morioka-Cho, Obu, 474-8511, Japan
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Kruckow KL, Zhao K, Bowdish DME, Orihuela CJ. Acute organ injury and long-term sequelae of severe pneumococcal infections. Pneumonia (Nathan) 2023; 15:5. [PMID: 36870980 PMCID: PMC9985869 DOI: 10.1186/s41479-023-00110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/31/2023] [Indexed: 03/06/2023] Open
Abstract
Streptococcus pneumoniae (Spn) is a major public health problem, as it is a main cause of otitis media, community-acquired pneumonia, bacteremia, sepsis, and meningitis. Acute episodes of pneumococcal disease have been demonstrated to cause organ damage with lingering negative consequences. Cytotoxic products released by the bacterium, biomechanical and physiological stress resulting from infection, and the corresponding inflammatory response together contribute to organ damage accrued during infection. The collective result of this damage can be acutely life-threatening, but among survivors, it also contributes to the long-lasting sequelae of pneumococcal disease. These include the development of new morbidities or exacerbation of pre-existing conditions such as COPD, heart disease, and neurological impairments. Currently, pneumonia is ranked as the 9th leading cause of death, but this estimate only considers short-term mortality and likely underestimates the true long-term impact of disease. Herein, we review the data that indicates damage incurred during acute pneumococcal infection can result in long-term sequelae which reduces quality of life and life expectancy among pneumococcal disease survivors.
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Affiliation(s)
- Katherine L Kruckow
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin Zhao
- McMaster Immunology Research Centre and the Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada
| | - Dawn M E Bowdish
- McMaster Immunology Research Centre and the Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada
| | - Carlos J Orihuela
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Wu C, Ye J, Li S, Wu J, Wang C, Yuan L, Wang H, Pan Y, Huang X, Zhong X, Huang M, Guo J, Ning Y, Xiao A. Predictors of everyday functional impairment in older patients with schizophrenia: A cross-sectional study. Front Psychiatry 2023; 13:1081620. [PMID: 36741560 PMCID: PMC9889971 DOI: 10.3389/fpsyt.2022.1081620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Objective This study investigates the prevalence of everyday functional impairment among older adults with schizophrenia and builds a predictive model of functional decline. Methods A total of 113 hospitalized older patients enrolled in this study. Functional impairment is defined according to the Functional Activities Questionnaire (FAQ). Patients who scored <9 could function independently daily, while those who scored ≥9 had problems in everyday functional activities. Data collected include sociodemographic characteristics, depressive symptoms, social support, and physical comorbidities, which were classified according to the eight anatomical systems of the human body. Results The sample comprised 75% female participants with a mean age of 63.74 ± 7.42 years old. A total of 33.6% had a functional impairment, while cognitive impairment was present in 63.7%. Independent participants had better urinary system and respiratory system health (P < 0.05). After adjusting for the potential confounders of age, disease course, physical comorbidities, psychiatric symptoms, the ability to independently carry out daily activities, and cognitive function, we found that impaired everyday function is associated with poor cognition, depressive symptoms, first admission, psychiatric symptoms (especially positive symptoms), ADL, and respiratory and urinary system diseases. Conclusion Everyday functional capacity is predicted by disease course, admission time, cognition, depressive symptoms, severity of psychosis, ability to carry out daily activities, and respiratory and urinary system health status. Urinary system diseases contribute significantly to the prediction of impaired function. Future studies should focus on health status, drug use, and everyday functional recovery in older patients with schizophrenia.
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Affiliation(s)
- Chenxin Wu
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Junrong Ye
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Shaohua Li
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jialan Wu
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chen Wang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Lexin Yuan
- Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Haoyun Wang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yuanxin Pan
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Xingxiao Huang
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xiaomei Zhong
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Meilian Huang
- Department of Nursing, The Third People’s Hospital of North Guangdong, Guangdong, China
| | - Jianxiong Guo
- Department of Chronic Diseases, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuping Ning
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- Department of Office, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Aixiang Xiao
- Department of Geriatric Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
- Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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17
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Sánchez-Sánchez JL, Rolland Y, Cesari M, de Souto Barreto P. Impact of nursing home-acquired pneumonia on the domains of the novel construct of intrinsic capacity: The INCUR study. J Am Geriatr Soc 2022; 70:3436-3446. [PMID: 36054223 PMCID: PMC10087686 DOI: 10.1111/jgs.17991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nursing home-acquired pneumonia (NHAP) and related hospitalizations might lead to abrupt functional declines, especially among nursing home residents. Intrinsic capacity is a novel construct proposed by the World Health Organization specifically designed to capture the physical and cognitive capacities of the aging individual to design personalized interventions. This study aimed to investigate the associations of NHAP and related hospitalizations with several intrinsic capacity domains among nursing home residents. METHODS We used data from the INCUR study (n = 754; mean age = 86.1 ± 7.4; 75.2% female). Four intrinsic capacity domains were assessed through the Short Physical Performance Battery (SPPB, locomotion), Abbreviated Mental Test (cognition), 10-items Geriatric Depression scale (GDS-10, mood), the Mini-Nutritional Assessment Short-Form (vitality) at three time-points along 1-year. Linear mixed models were used to analyze longitudinal evolution in the intrinsic capacity domains according to NHAP diagnosis and hospitalization. RESULTS A total of 161 (21.4%) were diagnosed with NHAP, and 46 of them (28.6%) required hospitalization. NHAP was significantly associated with declines in the intrinsic capacity vitality domain (β = -0.51; 95% CI -0.84; -0.18). The association was also found for NHAP-related hospitalization (β = -0.97; 95% CI -1.46; -0.48). NHAP-related hospitalization was also associated with worsening in the psychological domain (β = 0.56; 95% CI 0.08; 1.04). No other significant associations were found. CONCLUSIONS NHAP and related hospitalization are associated with the deterioration of intrinsic capacity vitality and psychology domains. Prevention of pneumonia may result in better functional evolution in very old and vulnerable nursing home residents.
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Affiliation(s)
- Juan Luis Sánchez-Sánchez
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France
| | - Yves Rolland
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,CERPOP UMR1295, Université de Toulouse, Toulouse, France
| | - Matteo Cesari
- IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Milan, Italy
| | - Philipe de Souto Barreto
- Gerontopole of Toulouse, Institute of Ageing, Toulouse University Hospital (CHU Toulouse), Toulouse, France.,CERPOP UMR1295, Université de Toulouse, Toulouse, France
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18
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Hartley P, Keating JL, Jeffs KJ, Raymond MJ, Smith TO. Exercise for acutely hospitalised older medical patients. Cochrane Database Syst Rev 2022; 11:CD005955. [PMID: 36355032 PMCID: PMC9648425 DOI: 10.1002/14651858.cd005955.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Approximately 30% of hospitalised older adults experience hospital-associated functional decline. Exercise interventions that promote in-hospital activity may prevent deconditioning and thereby maintain physical function during hospitalisation. This is an update of a Cochrane Review first published in 2007. OBJECTIVES To evaluate the benefits and harms of exercise interventions for acutely hospitalised older medical inpatients on functional ability, quality of life (QoL), participant global assessment of success and adverse events compared to usual care or a sham-control intervention. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was May 2021. SELECTION CRITERIA We included randomised or quasi-randomised controlled trials evaluating an in-hospital exercise intervention in people aged 65 years or older admitted to hospital with a general medical condition. We excluded people admitted for elective reasons or surgery. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our major outcomes were 1. independence with activities of daily living; 2. functional mobility; 3. new incidence of delirium during hospitalisation; 4. QoL; 5. number of falls during hospitalisation; 6. medical deterioration during hospitalisation and 7. participant global assessment of success. Our minor outcomes were 8. death during hospitalisation; 9. musculoskeletal injuries during hospitalisation; 10. hospital length of stay; 11. new institutionalisation at hospital discharge; 12. hospital readmission and 13. walking performance. We used GRADE to assess certainty of evidence for each major outcome. We categorised exercise interventions as: rehabilitation-related activities (interventions designed to increase physical activity or functional recovery, but did not follow a specified exercise protocol); structured exercise (interventions that included an exercise intervention protocol but did not include progressive resistance training); and progressive resistance exercise (interventions that included an element of progressive resistance training). MAIN RESULTS We included 24 studies (nine rehabilitation-related activity interventions, six structured exercise interventions and nine progressive resistance exercise interventions) with 7511 participants. All studies compared exercise interventions to usual care; two studies, in addition to usual care, used sham interventions. Mean ages ranged from 73 to 88 years, and 58% of participants were women. Several studies were at high risk of bias. The most common domain assessed at high risk of bias was measurement of the outcome, and five studies (21%) were at high risk of bias arising from the randomisation process. Exercise may have no clinically important effect on independence in activities of daily living at discharge from hospital compared to controls (16 studies, 5174 participants; low-certainty evidence). Five studies used the Barthel Index (scale: 0 to 100, higher scores representing greater independence). Mean scores at discharge in the control groups ranged from 42 to 96 points, and independence in activities of daily living was 1.8 points better (0.43 worse to 4.12 better) with exercise compared to controls. The minimally clinical important difference (MCID) is estimated to be 11 points. We are uncertain regarding the effect of exercise on functional mobility at discharge from the hospital compared to controls (8 studies, 2369 participants; very low-certainty evidence). Three studies used the Short Physical Performance Battery (SPPB) (scale: 0 to 12, higher scores representing better function) to measure functional mobility. Mean scores at discharge in the control groups ranged from 3.7 to 4.9 points on the SPPB, and the estimated effect of the exercise interventions was 0.78 points better (0.02 worse to 1.57 better). A change of 1 point on the SPPB represents an MCID. We are uncertain regarding the effect of exercise on the incidence of delirium during hospitalisation compared to controls (7 trials, 2088 participants; very low-certainty evidence). The incidence of delirium during hospitalisation was 88/1091 (81 per 1000) in the control group compared with 70/997 (73 per 1000; range 47 to 114) in the exercise group (RR 0.90, 95% CI 0.58 to 1.41). Exercise interventions may result in a small clinically unimportant improvement in QoL at discharge from the hospital compared to controls (4 studies, 875 participants; low-certainty evidence). Mean QoL on the EuroQol 5 Dimensions (EQ-5D) visual analogue scale (VAS) (scale: 0 to 100, higher scores representing better QoL) ranged between 48.9 and 64.7 in the control group at discharge from the hospital, and QoL was 6.04 points better (0.9 better to 11.18 better) with exercise. A change of 10 points on the EQ-5D VAS represents an MCID. No studies measured participant global assessment of success. Exercise interventions did not affect the risk of falls during hospitalisation (moderate-certainty evidence). The incidence of falls was 31/899 (34 per 1000) in the control group compared with 31/888 (34 per 1000; range 20 to 57) in the exercise group (RR 0.99, 95% CI 0.59 to 1.65). We are uncertain regarding the effect of exercise on the incidence of medical deterioration during hospitalisation (very low-certainty evidence). The incidence of medical deterioration in the control group was 101/1417 (71 per 1000) compared with 96/1313 (73 per 1000; range 44 to 120) in the exercise group (RR 1.02, 95% CI 0.62 to 1.68). Subgroup analyses by different intervention categories and by the use of a sham intervention were not meaningfully different from the main analyses. AUTHORS' CONCLUSIONS Exercise may make little difference to independence in activities of daily living or QoL, but probably does not result in more falls in older medical inpatients. We are uncertain about the effect of exercise on functional mobility, incidence of delirium and medical deterioration. Certainty of evidence was limited by risk of bias and inconsistency. Future primary research on the effect of exercise on acute hospitalisation could focus on more consistent and uniform reporting of participant's characteristics including their baseline level of functional ability, as well as exercise dose, intensity and adherence that may provide an insight into the reasons for the observed inconsistencies in findings.
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Affiliation(s)
- Peter Hartley
- Department of Physiotherapy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Kimberley J Jeffs
- Department of Aged Care, Northern Health, Epping, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Melissa Jm Raymond
- Physiotherapy Department, Caulfield Hospital, Alfred Health, Melbourne, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Toby O Smith
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Abstract
OBJECTIVES Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD). METHODS We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle-Ottawa Scale. RESULTS The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen's d = -0.25, 95% CI [-0.02, -0.49] I2 35%). CONCLUSIONS There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.
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Are infections associated with cognitive decline and neuroimaging outcomes? A historical cohort study using data from the UK Biobank study linked to electronic health records. Transl Psychiatry 2022; 12:385. [PMID: 36109502 PMCID: PMC9478085 DOI: 10.1038/s41398-022-02145-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/23/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022] Open
Abstract
While there is growing evidence of associations between infections and dementia risk, associations with cognitive impairment and potential structural correlates of cognitive decline remain underexplored. Here we aimed to investigate the presence and nature of any associations between common infections, cognitive decline and neuroimaging parameters. The UK Biobank is a large volunteer cohort (over 500,000 participants recruited aged 40-69) with linkage to primary and secondary care records. Using linear mixed effects models, we compared participants with and without a history of infections for changes in cognitive function during follow-up. Linear regression models were used to investigate the association of infections with hippocampal and white matter hyperintensity (WMH) volume. 16,728 participants (median age 56.0 years [IQR 50.0-61.0]; 51.3% women) had baseline and follow-up cognitive measures. We found no evidence of an association between the presence of infection diagnoses and cognitive decline for mean correct response time (slope difference [infections versus no infections] = 0.40 ms, 95% CI: -0.17-0.96 per year), visual memory (slope difference 0.0004 log errors per year, 95% CI: -0.003-0.004, fluid intelligence (slope difference 0.007, 95% CI: -0.010-0.023) and prospective memory (OR 0.88, 95% CI: 0.68-1.14). No evidence of an association was found between infection site, setting or frequency and cognitive decline except for small associations on the visual memory test. We found no association between infections and hippocampal or WMH volume. Limitations of our study include selection bias, potential practice effects and the relatively young age of our cohort. Our findings do not support a major role for common midlife infections in contributing to cognitive decline for this cohort. Further research is warranted in individuals with more severe infections, for infections occurring later in life.
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Oishi K, Nishioka S, Okazaki Y, Hirakawa K, Nakamura M, Ichinose A, Kurihara M. Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2022; 13:17-25. [PMID: 37859844 PMCID: PMC10545040 DOI: 10.11336/jjcrs.13.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 10/21/2023]
Abstract
Oishi K, Nishioka S, Okazaki Y, Hirakawa K, Nakamura M, Ichinose A, Kurihara M. Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke. Jpn J Compr Rehabil Sci 2022; 13: 17-25. Objective This study was designed to examine the relationship between improvement in oral hygiene and function and activities of daily living (ADLs) at discharge in patients admitted to convalescent rehabilitation wards. Methods Eligible criteria were patients with stroke with a score of 13 or higher (i.e., severe oral problems) on the Revised Oral Assessment Guide (ROAG) at admission. Age, gender, primary diseases, rehabilitation dose, dentist visits and denture status, Eichner classification, eating status at admission and discharge, and body mass index at admission were collected. The patients were classified into two groups: those with ROAG scores of less than 9 points at discharge (good ROAG group) and those with scores of 9 points or more (poor ROAG group), and Functional Independence Measure (FIM) gain and total FIM discharge scores were compared using univariate and multivariate analyses. Results The good and poor ROAG groups comprised 126 and 366 patients, respectively. The good ROAG group had significantly higher total FIM score, FIM efficiency, and FIM gain at discharge than the poor ROAG group (112 vs. 82; P < 0.001). The ROAG scores at discharge were independently associated with FIM gain (partial regression coefficient = -9.889, 95% confidence interval = -13.499 to -6.279) and total FIM score at discharge. Conclusion Improvement in oral hygiene and function in convalescent patients with stroke was associated with ADLs at hospital discharge.
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Affiliation(s)
- Kana Oishi
- Clinical Department, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Shinta Nishioka
- Nutrition Management Office, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Yuka Okazaki
- Clinical Department, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Kozue Hirakawa
- Clinical Department, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Mimoka Nakamura
- Clinical Department, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Ai Ichinose
- Clinical Department, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
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ŞIK N, ÖZDEMİR D, DUMAN M. Return visit characteristics of SARS-CoV-2 PCR-positive cases in a pediatric emergency department. Turk J Med Sci 2022; 52:21-31. [PMID: 36161597 PMCID: PMC10734818 DOI: 10.3906/sag-2102-281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 02/22/2022] [Accepted: 01/25/2022] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate return visits to the pediatric emergency department (ED) for children who were detected to be positive for SARS-CoV-2 by polymerase chain reaction (PCR). METHODS Between April 2, 2020, and January 20, 2021, children aged 0 to 18 years who were detected to be SARS-CoV-2 PCR-positive and discharged from the ED were evaluated. Among them, patients who returned to the ED within 14 days of quarantine were included in the study. For the first presentation and return visit, demographics, clinical findings, laboratory and radiologic investigations, and ward/pediatric intensive care unit (PICU) admissions were recorded. Patients were divided into 5 groups according to clinical severity. RESULTS Among 575 children who were confirmed to be SARS-CoV-2 PCR-positive, 50 (8.6%) of them [median age: 10.4 years (IQR: 4.8-15.2); 26 females] had returned. There was no difference for age, sex, underlying diseases, or symptoms for patients who returned or did not for the first presentation, but the percentage of those from whom laboratory tests were obtained was higher in cases of return visits. For symptomatic cases on the first presentation, the most common reason for return was having additional symptoms. The most common symptoms at the return visit were fever, cough, and sore throat. There was no severe/critical case in terms of clinical severity. Among all cases, 36 (72.0%) patients were discharged from the ED, 13 (26.0%) were observed for 6-8 h and then discharged, and 1 (2.0%) was admitted to the ward; there was no PICU admission or death, respectively.
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Affiliation(s)
- Nihan ŞIK
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir,
Turkey
| | - Durgül ÖZDEMİR
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir,
Turkey
| | - Murat DUMAN
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir,
Turkey
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Le Gentil S, Prampart S, Karakachoff M, Bureau ML, Chapelet G, De Decker L, Rouaud A, Boureau AS. Functional Decline in COVID-19 Older Survivors Compared to Other Pneumonia Patients, a Case Control Study. J Nutr Health Aging 2022; 26:896-903. [PMID: 36156682 PMCID: PMC9470507 DOI: 10.1007/s12603-022-1845-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/15/2022] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Among patients over 75 years, little is known about functional decline due to COVID-19. The aim of this study was to explore this functional decline, compare to other infectious pneumonia. DESIGN AND SETTING This case-control study included all COVID-19 patients hospitalized from March to December 2020 in Acute Geriatric Ward in Nantes University Hospital matched 1/1 with patients with pneumonia hospitalized in geriatric department between March 2017 and March 2019 (controls) on sex, age. Functional decline was assessed at 3 month follow up as it is routinely done after hospitalization in geriatric ward. We performed multivariable analyses to compare clinical outcomes between patients with COVID-19 vs controls. RESULTS 132 pairs were matched on age (mean: 87 y-o), and sex (61% of women). In multivariable logistic regression analysis, there were no statistical significant association between COVID-19 infection and functional decline (OR=0.89 p=0.72). A statistical significant association was found between functional decline and Charlson comorbidity index (OR=1.17, p=0.039); prior fall (OR=2.08, p=0.012); malnutrition (OR=1.97, p=0.018); length of hospital stay (OR=1.05, p=0.002) and preadmission ADL(OR=1.25, p=0.049). CONCLUSION COVID-19 does not seem to be responsible for a more frequent or severe functional decline than other infectious pneumonia in older and comorbid population after 3 month follow up. In this population, pneumonia is associated with functional decline in almost 1 in 2 cases. The individual preadmission frailty seems to be a more important predictor of functional decline, encouraging multidimensional care management for this population.
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Affiliation(s)
- S Le Gentil
- Anne-Sophie Boureau, Department of Geriatrics, University Hospital, 44093 Nantes, France; phone: +33 2-40-16-50-46;
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Coleman B, Casiraghi E, Blau H, Chan L, Haendel M, Laraway B, Callahan TJ, Deer RR, Wilkins K, Reese J, Robinson PN. Increased risk of psychiatric sequelae of COVID-19 is highest early in the clinical course. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.11.30.21267071. [PMID: 34909790 PMCID: PMC8669857 DOI: 10.1101/2021.11.30.21267071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background COVID-19 has been shown to increase the risk of adverse mental health consequences. A recent electronic health record (EHR)-based observational study showed an almost two-fold increased risk of new-onset mental illness in the first 90 days following a diagnosis of acute COVID-19. Methods We used the National COVID Cohort Collaborative, a harmonized EHR repository with 2,965,506 COVID-19 positive patients, and compared cohorts of COVID-19 patients with comparable controls. Patients were propensity score-matched to control for confounding factors. We estimated the hazard ratio (COVID-19:control) for new-onset of mental illness for the first year following diagnosis. We additionally estimated the change in risk for new-onset mental illness between the periods of 21-120 and 121-365 days following infection. Findings We find a significant increase in incidence of new-onset mental disorders in the period of 21-120 days following COVID-19 (3.8%, 3.6-4.0) compared to patients with respiratory tract infections (3%, 2.8-3.2). We further show that the risk for new-onset mental illness decreases over the first year following COVID-19 diagnosis compared to other respiratory tract infections and demonstrate a reduced (non-significant) hazard ratio over the period of 121-365 days following diagnosis. Similar findings are seen for new-onset anxiety disorders but not for mood disorders. Interpretation Patients who have recovered from COVID-19 are at an increased risk for developing new-onset mental illness, especially anxiety disorders. This risk is most prominent in the first 120 days following infection. Funding National Center for Advancing Translational Sciences (NCATS).
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Affiliation(s)
- Ben Coleman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Institute for Systems Genomics, University of Connecticut, Farmington, CT 06032, USA
| | - Elena Casiraghi
- AnacletoLab, Dipartimento di Informatica, Università degli Studi di Milano, Italy
| | - Hannah Blau
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Lauren Chan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Melissa Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan Laraway
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tiffany J Callahan
- University of Colorado Anschutz Medical Campus, Center for Health AI, Aurora 80045, CO, USA
| | - Rachel R Deer
- University of Texas Medical Branch, Galveston, TX, 77550 USA
| | - Ken Wilkins
- Biostatistics Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Justin Reese
- Division of Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Peter N Robinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
- Institute for Systems Genomics, University of Connecticut, Farmington, CT 06032, USA
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Hosoda T, Hamada S. Functional decline in hospitalized older patients with coronavirus disease 2019: a retrospective cohort study. BMC Geriatr 2021; 21:638. [PMID: 34772350 PMCID: PMC8586826 DOI: 10.1186/s12877-021-02597-w] [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: 05/22/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background This study aimed to determine the frequency of functional decline and to identify the factors related to a greater risk of functional decline among hospitalized older patients with coronavirus disease 2019 (COVID-19). Methods We reviewed the medical records of patients aged over 65 years who were admitted to a tertiary care hospital for COVID-19 over 1 year from February 2020. We evaluated the proportion of functional decline, which was defined as a decrease in the Barthel Index score from before the onset of COVID-19 to discharge. Multivariable logistic regression analyses were performed to evaluate the associations between the demographic and clinical characteristics of patients at admission and a greater risk of functional decline. Two sensitivity analyses with different inclusion criteria were performed: one in patients without very severe functional decline before the onset of COVID-19 (i.e., limited to those with Barthel Index score ≥ 25), and the other with a composite outcome of functional decline and death at discharge. Results The study included 132 patients with COVID-19; of these, 72 (54.5%) developed functional decline. The severity of COVID-19 did not differ between patients with functional decline and those without (P = 0.698). Factors associated with a greater risk of functional decline included female sex (adjusted odds ratio [aOR], 3.14; 95% confidence interval [CI], 1.25 to 7.94), Barthel Index score < 100 before the onset of COVID-19 (aOR, 13.73; 95% CI, 3.29 to 57.25), and elevation of plasma D-dimer level on admission (aOR, 3.19; 95% CI, 1.12 to 9.07). The sensitivity analyses yielded similar results to those of the main analysis. Conclusions Over half of the older patients who recovered from COVID-19 developed functional decline at discharge from a tertiary care hospital in Japan. Baseline activities of daily living impairment, female sex, and elevated plasma D-dimer levels at admission were associated with a greater risk of functional decline. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02597-w.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 210-0013, Japan.
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Weiss DJ, Wang C, Suen KY, Basford J, Cheville A. Can Proxy Ratings Supplement Patient Report to Assess Functional Domains Among Hospitalized Patients? Arch Phys Med Rehabil 2021; 103:S34-S42.e4. [PMID: 34678294 PMCID: PMC9018891 DOI: 10.1016/j.apmr.2021.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To (1) characterize the agreement between patient and proxy responses on a multidimensional computerized adaptive testing (MCAT) measure of function, and to (2) determine whether patient, proxy, or MCAT score characteristics identify when a proxy report can be used as a substitute for patient report in clinical decision making. DESIGN A psychometric study of the Functional Assessment in Acute Care MCAT (FAMCAT) and its three scales (Applied Cognition, Daily Activity, and Basic Mobility). SETTING An Upper Midwestern quaternary academic medical center PARTICIPANTS: A total of 300 pairs of patients [average age 60.9 years (range 19 to 89)] hospitalized on general medical services or readmitted to surgical services for postoperative complications and their proxies [average age 60.5 years (range 20-88]. INTERVENTION Not applicable. MAIN OUTCOME MEASURES There were three outcomes:. 1) Agreement between patient and proxy scores on the FAMCAT domains, as well as age and gender, analyzed with univariate and multivariate analysis of variance (MANOVA); 2) Associations of patient-proxy relationship and FAMCAT score characteristics with patient-proxy score agreement; and 3) Presence of psychometrically significant intra-dyad differences in FAMCAT scores. RESULTS The results of the MANOVA and follow-up ANOVAs indicated that there were no statistically significant differences in FAMCAT scale scores between patient and proxy estimates for either the Daily Activity or Basic Mobility scales. There were significant differences for the Applied Cognition scale (p < .005) between mean patient and proxy scores, with proxies rating patients as functioning at a higher level (mean = 0.42) than patients did themselves (mean = 0.00). However, psychometrically significant intra-dyadic Applied Cognition score differences occurred in only 14% of dyads, compared to 25% in the other two scales. Gender and age were associated with patient-proxy agreement, but the patterns were not sufficiently consistent to permit generalizations regarding the likely validity of a proxy's scores. CONCLUSIONS Patient and proxy FAMCAT Daily Activity and Basic Mobility scores did not differ significantly, and proxy reporting offers a credible surrogate for patient report on these domains. Low rates of psychometrically significant intra-dyadic score differences suggest that proxy report may serve as a low resolution screen for functional deficits in all FAMCAT domains. Approximately half the proxies provided multi-domain profile ratings on the three scales that did not differ significantly from these of the associated patients, but more research is needed to identify situations in which proxy profiles could be used in place of those provided by patients.
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Affiliation(s)
| | - Chun Wang
- University of Washington, Seattle, WA
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Vetrano DL, Triolo F, Maggi S, Malley R, Jackson TA, Poscia A, Bernabei R, Ferrucci L, Fratiglioni L. Fostering healthy aging: The interdependency of infections, immunity and frailty. Ageing Res Rev 2021; 69:101351. [PMID: 33971332 PMCID: PMC9588151 DOI: 10.1016/j.arr.2021.101351] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/16/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022]
Abstract
Untangling the interdependency of infections, immunity and frailty may help to clarify their roles in the maintenance of health in aging individuals, and the recent COVID-19 pandemic has further highlighted such priority. In this scoping review we aimed to systematically collect the evidence on 1) the impact of common infections such as influenza, pneumonia and varicella zoster on frailty development, and 2) the role played by frailty in the response to immunization of older adults. Findings are discussed under a unifying framework to identify knowledge gaps and outline their clinical and public health implications to foster a healthier aging. Twenty-nine studies (113,863 participants) selected to answer the first question provided a moderately strong evidence of an association between infections and physical as well as cognitive decline - two essential dimensions of frailty. Thirteen studies (34,520 participants) investigating the second aim, showed that frailty was associated with an impaired immune response in older ages, likely due to immunosenescence. However, the paucity of studies, the absence of tools to predict vaccine efficacy, and the lack of studies investigating the efficacy of newer vaccines in presence of frailty, strongly limit the formulation of more personalized immunization strategies for older adults. The current evidence suggests that infections and frailty repeatedly cross each other pathophysiological paths and accelerate the aging process in a vicious circle. Such evidence opens to several considerations. First, the prevention of both conditions pass through a life course approach, which includes several individual and societal aspects. Second, the maintenance of a well-functioning immune system may be accomplished by preventing frailty, and vice versa. Third, increasing the adherence to immunization may delay the onset of frailty and maintain the immune system homeostasis, beyond preventing infections.
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Affiliation(s)
- Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Italy.
| | - Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Geriatrics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Roberto Bernabei
- Centro Medicina dell'Invecchiamento, Fondazione Policlinico "A- Gemelli" IRCCS and Catholic University of Rome, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
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Green CL, Englund DA, Das S, Herrerias MM, Yousefzadeh MJ, Grant RA, Clark J, Pak HH, Liu P, Bai H, Prahlad V, Lamming DW, Chusyd DE. The Second Annual Symposium of the Midwest Aging Consortium: The Future of Aging Research in the Midwestern United States. J Gerontol A Biol Sci Med Sci 2021; 76:2156-2161. [PMID: 34323268 PMCID: PMC8599030 DOI: 10.1093/gerona/glab210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Indexed: 01/07/2023] Open
Abstract
While the average human life span continues to increase, there is little evidence that this is leading to a contemporaneous increase in "healthy years" experienced by our aging population. Consequently, many scientists focus their research on understanding the process of aging and trialing interventions that can promote healthspan. The 2021 Midwest Aging Consortium consensus statement is to develop and further the understanding of aging and age-related disease using the wealth of expertise across universities in the Midwestern United States. This report summarizes the cutting-edge research covered in a virtual symposium held by a consortium of researchers in the Midwestern United States, spanning topics such as senescence biomarkers, serotonin-induced DNA protection, immune system development, multisystem impacts of aging, neural decline following severe infection, the unique transcriptional impact of calorie restriction of different fat depots, the pivotal role of fasting in calorie restriction, the impact of peroxisome dysfunction, and the influence of early life trauma on health. The symposium speakers presented data from studies conducted in a variety of common laboratory animals as well as less-common species, including Caenorhabditis elegans, Drosophila, mice, rhesus macaques, elephants, and humans. The consensus of the symposium speakers is that this consortium highlights the strength of aging research in the Midwestern United States as well as the benefits of a collaborative and diverse approach to geroscience.
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Affiliation(s)
- Cara L Green
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA,William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Davis A Englund
- Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota, USA
| | - Srijit Das
- Department of Biology, Aging Mind & Brain Initiative, University of Iowa, Iowa City, Iowa, USA
| | - Mariana M Herrerias
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew J Yousefzadeh
- Department of Biochemistry, Molecular Biology and Biophysics and Institute on the Biology of Aging and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rogan A Grant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Josef Clark
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA,William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Heidi H Pak
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA,William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Peiduo Liu
- Department of Genetics, Development, and Cell Biology, Iowa State University, Ames, Iowa, USA
| | - Hua Bai
- Department of Genetics, Development, and Cell Biology, Iowa State University, Ames, Iowa, USA
| | - Veena Prahlad
- Department of Biology, Aging Mind & Brain Initiative, University of Iowa, Iowa City, Iowa, USA
| | - Dudley W Lamming
- Department of Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA,William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Daniella E Chusyd
- Department of Epidemiology and Biostatistics, Indiana University-Bloomington, Bloomington, Indiana, USA,Address correspondence to: Daniella E. Chusyd, PhD, School of Public Health, Indiana University-Bloomington, 701 E. Kirkwood Ave., Bloomington, IN 47405-7100, USA. E-mail:
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Chiu CJ, Li ML, Chang CM, Wu CH, Tan MP. Disability trajectories prior to death for ten leading causes of death among middle-aged and older adults in Taiwan. BMC Geriatr 2021; 21:420. [PMID: 34246236 PMCID: PMC8272348 DOI: 10.1186/s12877-021-02300-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prolonged life expectancy is associated with increased prevalence of chronic diseases. The aim of this study was to determine the different disability trajectories for the top ten leading causes of death in Taiwan . METHODS A total of 2,431 participants aged 50-96 in 1996 from the Taiwan longitudinal study on aging (TLSA) who died from 1996 to 2016 were analyzed. Integration of Cause of Death Data and TLSA helped sort out participants who had died from the ten leading causes of death. The level of physical disability was evaluated with the Activities of Daily Living Scale (ADLs), ranging from 0 to 6 points, in 1996, 1999, 2003, 2007, and 2011. A multilevel model was used to investigate the levels and rates of change in disability development before death. RESULTS The outcome of the research showed that the earliest group to experience physical limitation was individuals living with diabetes. The groups with the highest ADL scores were participants with diabetes, cerebrovascular disease, and hypertension-related diseases. Most groups reach ADL scores ≥ 1 (mild-level) during 4-6 years before death except chronic hepatitis and cirrhosis and injury. CONCLUSIONS People who had died from the ten leading causes of death experienced different disability trajectories before death. The trajectory of the participants who had died from diabetes showed a unique pattern with the earliest occurrence and more severe deterioration in terms of development of disabilities. Disability trajectories provide a prediction of survival status for middle-aged and older adults associated with the ten leading causes of death.
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Affiliation(s)
- Ching-Ju Chiu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, 701, Tainan, Taiwan.
| | - Meng-Ling Li
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chia-Ming Chang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan City, Taiwan
| | - Chih-Hsing Wu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1 University Road, 701, Tainan, Taiwan
- Department of Family medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kumar D, Jahan S, Khan A, Siddiqui AJ, Redhu NS, Wahajuddin, Khan J, Banwas S, Alshehri B, Alaidarous M. Neurological Manifestation of SARS-CoV-2 Induced Inflammation and Possible Therapeutic Strategies Against COVID-19. Mol Neurobiol 2021; 58:3417-3434. [PMID: 33715108 PMCID: PMC7955900 DOI: 10.1007/s12035-021-02318-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023]
Abstract
There are regular reports of extrapulmonary infections and manifestations related to the ongoing COVID-19 pandemic. Coronaviruses are potentially neurotropic, which renders neuronal tissue vulnerable to infection, especially in elderly individuals or in those with neuro-comorbid conditions. Complaints of ageusia, anosmia, myalgia, and headache; reports of diseases such as stroke, encephalopathy, seizure, and encephalitis; and loss of consciousness in patients with COVID-19 confirm the neuropathophysiological aspect of this disease. The brain is linked to pulmonary organs, physiologically through blood circulation, and functionally through the nervous system. The interdependence of these vital organs may further aggravate the pathophysiological aspects of COVID-19. The induction of a cytokine storm in systemic circulation can trigger a neuroinflammatory cascade, which can subsequently compromise the blood-brain barrier and activate microglia- and astrocyte-borne Toll-like receptors, thereby leading to neuronal tissue damage. Hence, a holistic approach should be adopted by healthcare professionals while treating COVID-19 patients with a history of neurodegenerative disorders, neuropsychological complications, or any other neuro-compromised conditions. Imperatively, vaccines are being developed at top priority to contain the spread of the severe acute respiratory syndrome coronavirus 2, and different vaccines are at different stages of development globally. This review discusses the concerns regarding the neuronal complications of COVID-19 and the possible mechanisms of amelioration.
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Affiliation(s)
- Dipak Kumar
- Zoology Department, KKM College, Jamui, Munger University, Munger, India
| | - Sadaf Jahan
- Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Kingdom of Saudi Arabia.
| | - Andleeb Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, 45142, Saudi Arabia
| | - Arif Jamal Siddiqui
- Department of Biology, College of Science, University of Hail, Hail, PO Box 2440, Saudi Arabia
| | - Neeru Singh Redhu
- Department of Molecular Biology, Biotechnology and Bioinformatics, Chaudhary Charan Singh Haryana Agricultural University, Hisar, Haryana 125004, India
| | - Wahajuddin
- Division of Pharmaceutics & Pharmacokinetics, CSIR-Central Drug Research Institute, Lucknow, UP, India
| | - Johra Khan
- Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Kingdom of Saudi Arabia
| | - Saeed Banwas
- Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Kingdom of Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Majmaah, 11952, Saudi Arabia
- Departments of Biomedical Sciences, Oregon State University, Corvallis, OR, 97331, USA
| | - Bader Alshehri
- Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Kingdom of Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Majmaah, 11952, Saudi Arabia
| | - Mohammed Alaidarous
- Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia, Kingdom of Saudi Arabia
- Health and Basic Sciences Research Center, Majmaah University, Majmaah, 11952, Saudi Arabia
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Muzambi R, Bhaskaran K, Smeeth L, Brayne C, Chaturvedi N, Warren-Gash C. Assessment of common infections and incident dementia using UK primary and secondary care data: a historical cohort study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e426-e435. [PMID: 34240064 PMCID: PMC8245326 DOI: 10.1016/s2666-7568(21)00118-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Common infections have been associated with dementia risk; however, evidence is scarce. We aimed to investigate the association between common infections and dementia in adults (≥65 years) in a UK population-based cohort study. METHODS We did a historical cohort study of individuals who were 65 years and older with no history of dementia or cognitive impairment using the Clinical Practice Research Datalink linked to Hospital Episode Statistics between Jan 1, 2004, and Dec 31, 2018. Multivariable Cox proportional hazard regression models were used to estimate the association between time-updated previous common infections (sepsis, pneumonia, other lower respiratory tract infections, urinary tract infections, and skin and soft tissue infections) and incident dementia diagnosis. We also tested for effect modification by diabetes since it is an independent risk factor for dementia and co-occurs with infection. FINDINGS Between Jan 1, 2004, and Dec 31, 2018, our study included 989 800 individuals (median age 68·6 years [IQR 65·0-77·0]; 537 602 [54·3%] women) of whom 402 204 (40·6%) were diagnosed with at least one infection and 56 802 (5·7%) had incident dementia during a median follow-up of 5·2 years (IQR 2·3-9·0). Dementia risk increased in those with any infection (adjusted hazard ratio [HR] 1·53 [95% CI 1·50-1·55]) compared with those without infection. HRs were highest for sepsis (HR 2·08 [1·89-2·29]) and pneumonia (HR 1·88 [1·77-1·99]) and for infections leading to hospital admission (1·99 [1·94-2·04]). HRs were also higher in individuals with diabetes compared with those without diabetes. INTERPRETATION Common infections, particularly those resulting in hospitalisation, were associated with an increased risk of dementia persisting over the long term. Whether reducing infections lowers the risk of subsequent dementia warrants evaluation. FUNDING Alzheimer's Society, Wellcome Trust, and the Royal Society.
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Affiliation(s)
- Rutendo Muzambi
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nish Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at University College London, Institute of Cardiovascular Science, University College London, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Cheville AL, Wang C, Yost KJ, Teresi JA, Ramirez M, Ocepek-Welikson K, Ni P, Marfeo E, Keeney T, Basford JR, Weiss DJ. Improving the Delivery of Function-Directed Care During Acute Hospitalizations: Methods to Develop and Validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT). Arch Rehabil Res Clin Transl 2021; 3:100112. [PMID: 34179750 PMCID: PMC8212002 DOI: 10.1016/j.arrct.2021.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To (1) develop a patient-reported, multidomain functional assessment tool focused on medically ill patients in acute care settings; (2) characterize the measure's psychometric performance; and (3) establish clinically actionable score strata that link to easily implemented mobility preservation plans. DESIGN This article describes the approach that our team pursued to develop and characterize this tool, the Functional Assessment in Acute Care Multidimensional Computer Adaptive Test (FAMCAT). Development involved a multistep process that included (1) expanding and refining existing item banks to optimize their salience for hospitalized patients; (2) administering candidate items to a calibration cohort; (3) estimating multidimensional item response theory models; (4) calibrating the item banks; (5) evaluating potential multidimensional computerized adaptive testing (MCAT) enhancements; (6) parameterizing the MCAT; (7) administering it to patients in a validation cohort; and (8) estimating its predictive and psychometric characteristics. SETTING A large (2000-bed) Midwestern Medical Center. PARTICIPANTS The overall sample included 4495 adults (2341 in a calibration cohort, 2154 in a validation cohort) who were admitted either to medical services with at least 1 chronic condition or to surgical/medical services if they required readmission after a hospitalization for surgery (N=4495). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS The FAMCAT is an instrument designed to permit the efficient, precise, low-burden, multidomain functional assessment of hospitalized patients. We tried to optimize the FAMCAT's efficiency and precision, as well as its ability to perform multiple assessments during a hospital stay, by applying cutting edge methods such as the adaptive measure of change (AMC), differential item functioning computerized adaptive testing, and integration of collateral test-taking information, particularly item response times. Evaluation of these candidate methods suggested that all may enhance MCAT performance, but none were integrated into initial MCAT parameterization. CONCLUSIONS The FAMCAT has the potential to address a longstanding need for structured, frequent, and accurate functional assessment among patients hospitalized with medical diagnoses and complications of surgery.
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Key Words
- AM-PAC, Activity Measure of Post-Acute Care
- AMC, Adaptive Measurement of Change
- Activities of daily living
- CAT, computerized adaptive testing
- Cognition
- DIF, differential item functioning
- EHR, electronic health record
- FAM, Functional Assessment for Acute Care Multidimensional
- FAMCAT, Functional Assessment in Acute Care Multidimensional Computer Adaptive Test
- HIPAA, Health Insurance Portability and Accountability Act of 1996
- IRT, item response theory
- MCAT, multidimensional computerized adaptive testing
- MGRM, multidimensional graded response model
- MIRT, multidimensional item response theory
- PAC, postacute care
- PH, physical function
- PROM, patient-reported outcome measure
- PROMIS, Patient-Reported Outcomes Measurement Information System
- Rehabilitation
- SF, short form
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Affiliation(s)
- Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Chun Wang
- College of Education, University of Washington, Seattle, Washington
| | - Kathleen J. Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jeanne A. Teresi
- Research Division, Hebrew Home at Riverdale, Riverdale, New York
- Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale, Riverdale, New York
| | | | - Pengsheng Ni
- School of Public Health, Boston University, Boston, Massachusetts
| | - Elizabeth Marfeo
- Tufts University, Department of Occupational Therapy, Medford, Massachusetts
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey R. Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - David J. Weiss
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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Persistent Neuroinflammation and Brain-Specific Immune Priming in a Novel Survival Model of Murine Pneumosepsis. Shock 2021; 54:78-86. [PMID: 31415473 DOI: 10.1097/shk.0000000000001435] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pneumonia is the leading cause of sepsis and septic shock. Patients who survive pneumonia are vulnerable to long-term complications including increased risk of neurocognitive dysfunction. This study investigated the immune response and long-term complications of a non-surgical mouse model of Klebsiella pneumoniae pneumosepsis with antibiotic treatment. Pneumosepsis resulted in acutely enhanced expression of inflammatory cytokines, chemokines, and damage-associated molecular patterns in the brain and spleen. Despite resolution of infection, murine pneumosepsis survivors demonstrated a deficit in exploratory locomotor behavior at 2 weeks. This was associated with brain-specific persistent inflammatory gene expression and infiltrating myeloid cells in the brain. The brain inflammatory response was also primed in response to secondary challenge with lipopolysaccharide. The findings of this study demonstrate behavioral and inflammatory outcomes that parallel observations in other models of sepsis, but that have not previously been described in antibiotic-treated pneumonia models, highlighting a common pathway to the development of chronic brain dysfunction in sepsis survival.
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Gracner T, Agarwal M, Murali KP, Stone PW, Larson EL, Furuya EY, Harrison JM, Dick AW. Association of Infection-Related Hospitalization With Cognitive Impairment Among Nursing Home Residents. JAMA Netw Open 2021; 4:e217528. [PMID: 33890988 PMCID: PMC8065379 DOI: 10.1001/jamanetworkopen.2021.7528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Hospitalizations for infections among nursing home (NH) residents remain common despite national initiatives to reduce them. Cognitive impairment, which markedly affects quality of life and caregiving needs, has been associated with hospitalizations, but the association between infection-related hospitalizations and long-term cognitive function among NH residents is unknown. OBJECTIVE To examine whether there are changes in cognitive function before vs after infection-related hospitalizations among NH residents. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Minimum Data Set 3.0 linked to Medicare hospitalization data from 2011 to 2017 for US nursing home residents aged 65 years or older who had experienced an infection-related hospitalization and had at least 2 quarterly Minimum Data Set assessments before and 4 or more after the infection-related hospitalization. Analyses were performed from September 1, 2019, to December 21, 2020. EXPOSURE Infection-related hospitalization lasting 1 to 14 days. MAIN OUTCOMES AND MEASURES Using an event study approach, associations between infection-related hospitalizations and quarterly changes in cognitive function among NH residents were examined overall and by sex, age, Alzheimer disease and related dementias (ADRD) diagnosis, and sepsis vs other infection-related diagnoses. Resident-level cognitive function was measured using the Cognitive Function Scale (CFS), with scores ranging from 1 (intact) to 4 (severe cognitive impairment). RESULTS Of the sample of 20 698 NH residents, 71.0% were women and 82.6% were non-Hispanic White individuals; the mean (SD) age at the time of transfer to the hospital was 82 (8.5) years. The mean CFS score was 2.17, and the prevalence of severe cognitive impairment (CFS score, 4) was 9.0%. During the first quarter after an infection-related hospitalization, residents experienced a mean increase of 0.06 points in CFS score (95% CI, 0.05-0.07 points; P < .001), or 3%. The increase in scores was greatest among residents aged 85 years or older vs younger residents by approximately 0.022 CFS points (95% CI, 0.004-0.040 points; P < .05). The prevalence of severe cognitive impairment increased by 1.6 percentage points (95% CI, 1.2-2.0 percentage points; P < .001), or 18%; the increases were observed among individuals with ADRD but not among those without it. After an infection-related hospitalization, cognition among residents who had experienced sepsis declined more than for residents who had not by about 0.02 CFS points (95% CI, 0.00-0.04 points; P < .05). All observed differences persisted without an accelerated rate of decline for at least 6 quarters after infection-related hospitalization. No differences were observed by sex. CONCLUSIONS AND RELEVANCE In this cohort study, infection-related hospitalization was associated with immediate and persistent cognitive decline among nursing home residents, with the largest increase in CFS scores among older residents, those with ADRD, and those who had experienced sepsis. Identification of NH residents at risk of worsened cognition after an infection-related hospitalization may help to ensure that their care needs are addressed to prevent further cognitive decline.
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Affiliation(s)
- Tadeja Gracner
- RAND Corporation, Arlington, Virginia
- Now with RAND Corporation, Santa Monica, California
| | - Mansi Agarwal
- Center for Health Policy, Columbia University School of Nursing, New York, New York
- Now with Washington University School of Medicine, St Louis, Missouri
| | - Komal P. Murali
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Patricia W. Stone
- Center for Health Policy, Columbia University School of Nursing, New York, New York
| | - Elaine L. Larson
- Columbia University School of Nursing, New York, New York
- Columbia University Mailman School of Public Health, New York, New York
| | - E. Yoko Furuya
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Edgcomb JB, Shaddox T, Hellemann G, Brooks JO. Predicting suicidal behavior and self-harm after general hospitalization of adults with serious mental illness. J Psychiatr Res 2021; 136:515-521. [PMID: 33218748 PMCID: PMC8009812 DOI: 10.1016/j.jpsychires.2020.10.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/26/2020] [Accepted: 10/16/2020] [Indexed: 12/30/2022]
Abstract
Individuals with psychiatric disorders are vulnerable to adverse mental health outcomes following physical illness. This longitudinal cohort study defined risk profiles for readmission for suicidal behavior and self-harm after general hospitalization of adults with serious mental illness. Structured electronic health record data were analyzed from 15,644 general non-psychiatric index hospitalizations of individuals with depression, bipolar, and psychotic disorders admitted to an urban health system in the southwestern United States between 2006 and 2017. Using data from one-year prior to and including index hospitalization, supervised machine learning was implemented to predict risk of readmission for suicide attempt and self-harm in the following year. The Classification and Regression Tree algorithm produced a classification prediction with an area under the receiver operating curve (AUC) of 0.86 (95% confidence interval (CI) 0.74-0.97). Incidence of suicide-related behavior was highest after general non-psychiatric hospitalizations of individuals with prior suicide attempt or self-harm (18%; 69 cases/389 hospitalizations) and lowest after hospitalizations associated with very high medical morbidity burden (0 cases/3090 hospitalizations). Predictor combinations, rather than single risk factors, explained the majority of risk, including concomitant alcohol use disorder with moderate medical morbidity, and age ≤55-years-old with low medical morbidity. Findings suggest that applying an efficient and highly interpretable machine learning algorithm to electronic health record data may inform general hospital clinical decision support, resource allocation, and preventative interventions for medically ill adults with serious mental illness.
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Affiliation(s)
- Juliet Beni Edgcomb
- University of California, Los Angeles, Department of Psychiatry and Behavioral Sciences, 760 Westwood Plaza, C8-193, Los Angeles, California, USA.
| | - Trevor Shaddox
- University of California, Los Angeles, Department of Psychiatry and Behavioral Sciences, 760 Westwood Plaza, C8-193, Los Angeles, California, USA.
| | - Gerhard Hellemann
- Semel Institute Biostatistics Core, University of California, Los Angeles, Department of Psychiatry and Behavioral Sciences, USA.
| | - John O Brooks
- University of California, Los Angeles, Department of Psychiatry and Behavioral Sciences, 760 Westwood Plaza, C8-193, Los Angeles, California, USA.
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Li J, Feng L, Huang Q, Ren W. An L-Shaped Relationship Between Serum Iron and Stroke-Associated Pneumonia. Clin Interv Aging 2021; 16:505-511. [PMID: 33790545 PMCID: PMC7997604 DOI: 10.2147/cia.s301480] [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] [Received: 01/11/2021] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Pneumonia is a common complication in patients with stroke. There was a close relationship between serum iron and inflammatory response. This study aimed to explore the relationship between serum iron levels and stroke-associated pneumonia (SAP). Methods Patients with acute stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University and divided into SAP group and Non-SAP group. The demographic and clinical data of the patients were collected via the medical records, and the blood samples were collected within 24 hours after admission. The predictive value of serum iron to SAP was evaluated by receiver operating characteristic curve (ROC) and binary Logistic regression models. A restricted cubic spline (RCS) was used to furtherly clarify the relationship between serum iron and the risk of SAP. Results A total of 906 participants were enrolled, including Non-SAP group (n = 755) and SAP group (n = 151). Serum iron levels in the SAP group were significantly lower than those in the Non-SAP group (9.77±5.61 vs 14.01±6.80, P < 0.001). Logistic regression showed that patients with high serum iron levels (≥7.8μmol/L) showed a lower risk of SAP (OR=0.43, 95% CI, 0.27–0.69, P < 0.001). Besides, the RCS model showed that there was an L-shaped relationship between the serum iron and risk of SAP (P for non-linearity: 0.014). Conclusion Low serum iron level was a risk factor for SAP, and there was an L-shaped relationship between them. Stroke patients with low serum iron levels should be alert to the risk of SAP.
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Affiliation(s)
- Jia Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Qiqi Huang
- Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
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Effect of Inpatient and Outpatient Pneumonia on Mobility Disability, Gait Speed, and Physical Activity in Older Adults. J Clin Med 2021; 10:jcm10061236. [PMID: 33809731 PMCID: PMC8002307 DOI: 10.3390/jcm10061236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/07/2021] [Accepted: 03/12/2021] [Indexed: 11/17/2022] Open
Abstract
Pathophysiological changes caused by pneumonia may influence physical functioning in older adults. This study was a secondary analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study. The LIFE Study included 1635 individuals over an average follow-up of 2.6 years at eight clinical sites during 2010–2013. Adults ≥70 years-old with mobility limitations (Short Physical Performance Battery score ≤9) were randomized to a physical activity (exercise) intervention or health education control arm. This analysis evaluated the association between pneumonia events and major mobility disability (MMD), gait speed, and physical activity levels. Pneumonia events, classified as inpatient or outpatient, were assessed by self-report during longitudinal follow-up. MMD was measured by the inability to complete a 400-m walk test, or other proxies, as a binary outcome and separately analyzed as “short-term” and “long-term” MMD. Short-term MMD was defined as MMD occurring in the assessment period immediately following (between 1-day to 6-months after) a pneumonia event and long-term was in the following assessment period (6 to 12 months after the event). Short- and long-term gait speed was similarly recorded during the walk test in meters per second (m/s) and measured on a linear scale. Physical activity levels were captured via accelerometry and shown visually. Mixed-effects repeated measures regression adjusted for intervention assignment, baseline demographics, comorbid conditions, and frailty. Among the 1635 participants, n = 174 (10.7%) had a pneumonia event of which 80 (46% of events) were hospitalized. Those with pneumonia during follow-up had higher baseline medication use, prior hospitalizations, and higher prevalence of lung disorders but similar baseline functioning. Pneumonia hospitalization was associated with a 4-fold increase [OR = 4.1 (3.2–5.0)] and outpatient events were associated with a 2-fold increase [OR = 2.6 (2.1–3.1)] in the odds of short-term MMD. Pneumonia hospitalizations, but not outpatient events, were associated with a nearly 10% decrement in short-term gait speed. Pneumonia events were not associated with either long-term MMD or gait speed outcomes. Physical activity levels decreased from baseline immediately following the pneumonia episode (10–30% reductions) and returned to baseline after 6 months. These results emphasize the importance of managing pneumonia risk factors to prevent disease in order to maintain physical independence and activity in older adults.
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Corrales-Medina VF, deKemp RA, Chirinos JA, Zeng W, Wang J, Waterer G, Beanlands RSB, Dwivedi G. Persistent Lung Inflammation After Clinical Resolution of Community-Acquired Pneumonia as Measured by 18FDG-PET/CT Imaging. Chest 2021; 160:446-453. [PMID: 33667494 DOI: 10.1016/j.chest.2021.02.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Survivors of community-acquired pneumonia (CAP) are at increased risk of cardiovascular disease, cognitive and functional decline, and death, but the mechanisms remain unknown. RESEARCH QUESTION Do CAP survivors have evidence of increased inflammatory activity in their lung parenchyma on 2-deoxy-2-[18F]fluoro-d-glucose (18FDG)-PET/CT imaging after clinical resolution of infection? STUDY DESIGN AND METHODS We obtained 18FDG-PET/CT scans from 22 CAP survivors during their hospitalization with pneumonia (acute CAP) and 30 to 45 days after hospital discharge (post-CAP). In each set of scans, we assessed the lungs for foci of increased 18FDG uptake by visual interpretation and by total pulmonary glycolytic activity (tPGA), a background-corrected measure of total metabolic activity (as measured by 18FDG uptake). We also measured, post-CAP, the glycolytic activity of CAP survivor lung areas with volumes similar to the areas in 28 matched historical control subjects without pneumonia. RESULTS Overall, 68% of CAP survivors (95% CI, 45%-85%) had distinct residual areas of increased 18FDG uptake in their post-CAP studies. tPGA decreased from 821.5 (SD, 1,140.2) in the acute CAP period to 80.0 (SD, 81.4) in the post-CAP period (P = .006). The tPGA post-CAP was significantly higher than that in lung areas of similar volume in control subjects (80.0 [SD, 81.4] vs -19.4 [SD, 5.9]; P < .001). INTERPRETATION An important proportion of CAP survivors have persistent pulmonary foci of increased inflammatory activity beyond resolution of their infection. As inflammation contributes to cardiovascular disease, cognitive decline, functional waning, and mortality risk in the general population, this finding provides a plausible mechanism for the increased morbidity and mortality that have been observed post-CAP.
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Affiliation(s)
- Vicente F Corrales-Medina
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, ON, Canada
| | - Robert A deKemp
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada; Division of Cardiology, Department of Medicine, University of Ottawa, ON, Canada
| | | | - Wanzhen Zeng
- Department of Medicine, University of Ottawa, ON, Canada
| | - Jerry Wang
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada; Division of Cardiology, Department of Medicine, University of Ottawa, ON, Canada
| | - Grant Waterer
- Royal Perth Hospital, Perth, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Rob S B Beanlands
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada; Division of Cardiology, Department of Medicine, University of Ottawa, ON, Canada
| | - Girish Dwivedi
- National Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada; Division of Cardiology, Department of Medicine, University of Ottawa, ON, Canada; School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Murdoch, WA, Australia; Department of Cardiology, Fiona Stanley Hospital, Murdoch, WA, Australia.
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Ye S, Hiura G, Fleck E, Garcia A, Geleris J, Lee P, Liyanage-Don N, Moise N, Schluger N, Singer J, Sobieszczyk M, Sun Y, West H, Kronish IM. Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness. J Gen Intern Med 2021; 36:722-729. [PMID: 33443699 PMCID: PMC7808120 DOI: 10.1007/s11606-020-06340-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. OBJECTIVE To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. DESIGN Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73). LIMITATIONS Single-center study; assignment to remote monitoring was not randomized. CONCLUSIONS During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.
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Affiliation(s)
- Siqin Ye
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA
| | - Grant Hiura
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Elaine Fleck
- New York Presbyterian Hospital, New York, NY, USA
| | - Aury Garcia
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Joshua Geleris
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Lee
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nadia Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Neil Schluger
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Jessica Singer
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY, USA
| | - Yifei Sun
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Harry West
- Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 W. 168th Street, New York, NY, PH9-311, USA.
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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Gonçalves de Andrade E, Šimončičová E, Carrier M, Vecchiarelli HA, Robert MÈ, Tremblay MÈ. Microglia Fighting for Neurological and Mental Health: On the Central Nervous System Frontline of COVID-19 Pandemic. Front Cell Neurosci 2021; 15:647378. [PMID: 33737867 PMCID: PMC7961561 DOI: 10.3389/fncel.2021.647378] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is marked by cardio-respiratory alterations, with increasing reports also indicating neurological and psychiatric symptoms in infected individuals. During COVID-19 pathology, the central nervous system (CNS) is possibly affected by direct severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, exaggerated systemic inflammatory responses, or hypoxia. Psychosocial stress imposed by the pandemic further affects the CNS of COVID-19 patients, but also the non-infected population, potentially contributing to the emergence or exacerbation of various neurological or mental health disorders. Microglia are central players of the CNS homeostasis maintenance and inflammatory response that exert their crucial functions in coordination with other CNS cells. During homeostatic challenges to the brain parenchyma, microglia modify their density, morphology, and molecular signature, resulting in the adjustment of their functions. In this review, we discuss how microglia may be involved in the neuroprotective and neurotoxic responses against CNS insults deriving from COVID-19. We examine how these responses may explain, at least partially, the neurological and psychiatric manifestations reported in COVID-19 patients and the general population. Furthermore, we consider how microglia might contribute to increased CNS vulnerability in certain groups, such as aged individuals and people with pre-existing conditions.
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Affiliation(s)
| | - Eva Šimončičová
- Division of Medical Science, University of Victoria, Victoria, BC, Canada
| | - Micaël Carrier
- Division of Medical Science, University of Victoria, Victoria, BC, Canada.,Axe Neurosciences, Centre de Recherche du CHU de Québec, Université de Laval, Québec City, QC, Canada
| | | | - Marie-Ève Robert
- Axe Neurosciences, Centre de Recherche du CHU de Québec, Université de Laval, Québec City, QC, Canada
| | - Marie-Ève Tremblay
- Division of Medical Science, University of Victoria, Victoria, BC, Canada.,Axe Neurosciences, Centre de Recherche du CHU de Québec, Université de Laval, Québec City, QC, Canada.,Neurology and Neurosurgery Department, McGill University, Montréal, QC, Canada.,Department of Molecular Medicine, Université de Laval, Québec City, QC, Canada.,Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada
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Fritze T, Doblhammer G, Widmann CN, Heneka MT. Time course of dementia following sepsis in German health claims data. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 8:8/1/e911. [PMID: 33293458 PMCID: PMC7803331 DOI: 10.1212/nxi.0000000000000911] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/24/2020] [Indexed: 11/15/2022]
Abstract
Objective We evaluated the short-, medium-, and long-term effects of sepsis on dementia
incidence using German health claims data. Methods A total of 161,567 patients (65 years or older) were followed from 2004 to
2015 at quarterly intervals. Time since sepsis was categorized into 0 (the
effective quarter of sepsis diagnosis), 1–8, and ≥9 quarters
since the latest diagnosis of sepsis, taking into account admission to
intensive care unit and controlling for delirium, surgery, age, sex, and
comorbidities. Incident dementia was defined for all persons who did not
have a validated dementia diagnosis in 2004 and 2005 and who received a
first-time, valid diagnosis between 2006 and 2015. Results During the quarter of sepsis diagnosis, patients not admitted to intensive
care had a 3.14-fold (95% CI 2.83–3.49) increased risk, and those
with intensive care stay had a 2.22-fold (95% CI: 1.83–2.70)
increased risk of receiving an incident dementia diagnosis compared with
patients without sepsis. The impact of sepsis on incident dementia remained
in the following 2 years, remitting only thereafter. Conclusions For sepsis survivors, medium-term dementia risk remains elevated, whereas
long-term risk may reach the level of those without sepsis, even after
controlling for delirium. These findings encourage identifying modifiable
components of hospital and rehabilitation care.
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Affiliation(s)
- Thomas Fritze
- From the German Center for Neurodegenerative Diseases (T.F., G.D., C.N.W., M.T.H.), Bonn; Institute for Sociology and Demography (G.D.), University of Rostock; and Department of Neurodegenerative Disease and Geriatric Psychiatry (C.N.W., M.T.H.), University of Bonn, Germany
| | - Gabriele Doblhammer
- From the German Center for Neurodegenerative Diseases (T.F., G.D., C.N.W., M.T.H.), Bonn; Institute for Sociology and Demography (G.D.), University of Rostock; and Department of Neurodegenerative Disease and Geriatric Psychiatry (C.N.W., M.T.H.), University of Bonn, Germany
| | - Catherine N Widmann
- From the German Center for Neurodegenerative Diseases (T.F., G.D., C.N.W., M.T.H.), Bonn; Institute for Sociology and Demography (G.D.), University of Rostock; and Department of Neurodegenerative Disease and Geriatric Psychiatry (C.N.W., M.T.H.), University of Bonn, Germany
| | - Michael T Heneka
- From the German Center for Neurodegenerative Diseases (T.F., G.D., C.N.W., M.T.H.), Bonn; Institute for Sociology and Demography (G.D.), University of Rostock; and Department of Neurodegenerative Disease and Geriatric Psychiatry (C.N.W., M.T.H.), University of Bonn, Germany.
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Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, Bowie W, Katz K, McGeer A, Semret M, McNeil SA. Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness. J Am Geriatr Soc 2020; 69:696-703. [PMID: 33294986 PMCID: PMC7984066 DOI: 10.1111/jgs.16950] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/23/2023]
Abstract
Background/objectives Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under‐studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI). Design Protective observational cohort study. Setting Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season. Participants A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI. Measurements Influenza was laboratory‐confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100‐point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living. Results Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty‐six (37.4%) had laboratory‐confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI. Conclusion Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.
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Affiliation(s)
- Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada
| | - Sarah MacDonald
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jason LeBlanc
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- Department of Medicine (Infectious Diseases), University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Makeda Semret
- McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
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43
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Jones B, Waterer G. Advances in community-acquired pneumonia. Ther Adv Infect Dis 2020; 7:2049936120969607. [PMID: 33224494 PMCID: PMC7656869 DOI: 10.1177/2049936120969607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Community-acquired pneumonia is one of the commonest and deadliest of the infectious diseases, yet our understanding of it remains relatively poor. The recently published American Thoracic Society and Infectious Diseases Society of America Community-acquired pneumonia guidelines acknowledged that most of what we accept as standard of care is supported only by low quality evidence, highlighting persistent uncertainty and deficiencies in our knowledge. However, progress in diagnostics, translational research, and epidemiology has changed our concept of pneumonia, contributing to a gradual improvement in prevention, diagnosis, treatment, and outcomes for our patients. The emergence of considerable evidence about adverse long-term health outcomes in pneumonia survivors has also challenged our concept of pneumonia as an acute disease and what treatment end points are important. This review focuses on advances in the research and care of community-acquired pneumonia in the past two decades. We summarize the evidence around our understanding of pathogenesis and diagnosis, discuss key contentious management issues including the role of procalcitonin and the use or non-use of corticosteroids, and explore the relationships between pneumonia and long-term outcomes including cardiovascular and cognitive health.
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Affiliation(s)
- Barbara Jones
- Division of Pulmonary and Critical Care, University of Utah and Salt Lake City VA Healthcare System, Salt Lake City, UT, USA
| | - Grant Waterer
- University of Western Australia, Royal Perth Hospital, Perth, WA 6009, Australia
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44
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Tappen RM, Worch SM, Newman DO, Hain D. Evaluation of a Novel Decision Guide "Go to the Hospital or Stay Here?" for Nursing Home Residents and Families: A Randomized Trial. Res Gerontol Nurs 2020; 13:309-319. [PMID: 33034651 DOI: 10.3928/19404921-20201002-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
Initiatives to reduce potentially preventable hospitalizations of nursing home residents have focused on staff response to changes in condition and advance care planning. Yet, resident and family insistence on transfer has been one of the most intractable sources of these hospitalizations, although not the target of active intervention until now. Consented residents and family members in the intervention group received a newly developed decision aid entitled, "Go to the Hospital or Stay Here?," providing information on the risks and benefits of transfer versus remaining in the nursing home. This person-centered decision aid was developed from the results of 271 interviews of residents, families, and providers to identify what they wanted to know and any misunderstandings surrounding the transfer process. Engaging residents in the decision respects their right to participate and provides the information they need to make a deliberative decision. The intervention group showed a gain in knowledge and reduction in decisional conflict but reported decreased decisional preparation. There was no decrease in transfers compared to the control group. Evaluation of the decision guide by residents and families was positive. TARGETS Nursing home residents and their family members. INTERVENTION To provide information regarding the decision to stay in the nursing home or transfer to acute care due to a change in condition. MECHANISMS OF ACTION Decision aid "Go the "Hospital or Stay Here?" to impart knowledge regarding the decision to remain in the nursing home or transfer to acute care. OUTCOMES Use of the Guide was found to increase residents' and family members' knowledge and decrease decisional conflict, but it did not increase decisional preparation. No reduction in transfers was found. Residents and families rated the Guide as very helpful. [Research in Gerontological Nursing, 13(6), 309-319.].
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45
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Zhang N. Multicomponent exercise programmes among very elderly hospitalised patients can be safe and effective in reversing functional decline. Evid Based Nurs 2020; 23:99. [PMID: 31630125 DOI: 10.1136/ebnurs-2019-103107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Nicole Zhang
- Nursing, Hartwick College, Oneonta, New York, USA
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46
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Riordan P, Stika M, Goldberg J, Drzewiecki M. COVID-19 and clinical neuropsychology: A review of neuropsychological literature on acute and chronic pulmonary disease. Clin Neuropsychol 2020; 34:1480-1497. [PMID: 32883155 DOI: 10.1080/13854046.2020.1810325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The illness resulting from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as COVID-19, has quickly escalated to a worldwide pandemic. Although understanding of the short and long-term manifestations of COVID-19 remains incomplete, there is a preponderance of respiratory pathology in COVID-19 and potential for chronic loss of pulmonary function in recovered patients, raising concerns for associated cognitive impacts.Method: We conducted a narrative review of the existing literature on neuropsychological variables in acute/severe respiratory disease and various forms of chronic pulmonary disease to inform expectations about potential cognitive manifestations of COVID-19.Results: Cognitive dysfunction is common but not inevitable in acute and chronic pulmonary disease, although unique predictors and symptom trajectories appear to be associated with each.Conclusions: Although the full scope of neuropathophysiology associated with COVID-19 remains to be established, pulmonary insults associated with the disease are likely to produce cognitive dysfunction in a substantial percentage of patients.
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Affiliation(s)
- Patrick Riordan
- Mental Health Service, Hines VA Medical Center, Hines, IL, USA.,Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Monica Stika
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Joshua Goldberg
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
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47
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Palmer K, Monaco A, Kivipelto M, Onder G, Maggi S, Michel JP, Prieto R, Sykara G, Donde S. The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing. Aging Clin Exp Res 2020; 32:1189-1194. [PMID: 32458356 PMCID: PMC7248450 DOI: 10.1007/s40520-020-01601-4] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022]
Abstract
The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.
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Affiliation(s)
- Katie Palmer
- Oliba, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of NVS, Center for Alzheimer Research, Karolinska Institutet, Karolinska University Hospital, Theme Aging, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Ageing and Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | - Jean-Pierre Michel
- Department of Geriatrics and Rehabilitation, Medical University of Geneva, Geneva, Switzerland
| | | | - Georgia Sykara
- Medical Affairs, Upjohn Hellas Ltd (Division of Pfizer), Athens, Greece
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48
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Sañudo B, Seixas A, Gloeckl R, Rittweger J, Rawer R, Taiar R, van der Zee EA, van Heuvelen MJ, Lacerda AC, Sartorio A, Bemben M, Cochrane D, Furness T, de Sá-Caputo D, Bernardo-Filho M. Potential Application of Whole Body Vibration Exercise For Improving The Clinical Conditions of COVID-19 Infected Individuals: A Narrative Review From the World Association of Vibration Exercise Experts (WAVex) Panel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3650. [PMID: 32455961 PMCID: PMC7277771 DOI: 10.3390/ijerph17103650] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022]
Abstract
COVID-19 is a highly infectious respiratory disease which leads to several clinical conditions related to the dysfunction of the respiratory system along with other physical and psychological complaints. Severely affected patients are referred to intensive care units (ICUs), limiting their possibilities for physical exercise. Whole body vibration (WBV) exercise is a non-invasive, physical therapy, that has been suggested as part of the procedures involved with pulmonary rehabilitation, even in ICU settings. Therefore, in the current review, the World Association of Vibration Exercise Experts (WAVEX) reviewed the potential of WBV exercise as a useful and safe intervention for the management of infected individuals with COVID-19 by mitigating the inactivity-related declines in physical condition and reducing the time in ICU. Recommendations regarding the reduction of fatigue and the risk of dyspnea, the improvement of the inflammatory and redox status favoring cellular homeostasis and the overall improvement in the quality of life are provided. Finally, practical applications for the use of this paradigm leading to a better prognosis in bed bound and ICU-bound subjects is proposed.
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Affiliation(s)
- Borja Sañudo
- Departamento de Educación Física y Deporte, Universidad de Sevilla, 41013 Seville, Spain;
| | - Adérito Seixas
- Escola Superior de Saúde, Universidade Fernando Pessoa, 4200-253 Porto, Portugal
| | - Rainer Gloeckl
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, 83471 Schoenau am Koenigssee, Germany;
- Department of Pulmonary Rehabilitation, Philipps–University of Marburg, German Center for Lung Research (DZL), 35037 Marburg, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), 51147 Cologne, Germany;
- Department of Pediatrics and Adolescent Medicine, University of Cologne, D50931 Cologne, Germany
| | - Rainer Rawer
- Head of Research & Development Department, Novotec Medical GmbH & Galileo Training, 75172 Pforzheim, Germany;
| | - Redha Taiar
- Université de Reims Champagne Ardenne, 51100 Grand Est, France;
| | - Eddy A. van der Zee
- Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, 9747 AG Groningen, The Netherlands;
| | - Marieke J.G. van Heuvelen
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, The Netherlands;
| | - Ana Cristina Lacerda
- Faculdade de Ciências Biológicas e da Saúde, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina 39100-000, MG, Brazil;
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-endocrinological Research & Division of Metabolic Diseases, 20145 Milan, Italy;
| | - Michael Bemben
- Department of Health and Exercise Science, University of Oklahoma, Norman, OK 73019, USA;
| | - Darryl Cochrane
- School of Sport, Exercise and Nutrition, Massey University, Private Bag 11 222, Palmerston North 4442, New Zealand;
| | - Trentham Furness
- Faculty of Health Sciences, Australian Catholic University, Fitzroy, VIC 3065, Australia;
| | - Danúbia de Sá-Caputo
- Laboratório de Vibrações Mecânicas, Policlínica Piquet Carneiro, Instituto de Biología Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil; (D.d.S.-C.); (M.B.-F.)
- Faculdade Bezerra de Araújo, Rio de Janeiro 23052-180, Brazil
| | - Mario Bernardo-Filho
- Laboratório de Vibrações Mecânicas, Policlínica Piquet Carneiro, Instituto de Biología Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil; (D.d.S.-C.); (M.B.-F.)
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49
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Muzambi R, Bhaskaran K, Brayne C, Davidson JA, Smeeth L, Warren-Gash C. Common Bacterial Infections and Risk of Dementia or Cognitive Decline: A Systematic Review. J Alzheimers Dis 2020; 76:1609-1626. [PMID: 32651320 PMCID: PMC7504996 DOI: 10.3233/jad-200303] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bacterial infections may be associated with dementia, but the temporality of any relationship remains unclear. OBJECTIVES To summarize existing literature on the association between common bacterial infections and the risk of dementia and cognitive decline in longitudinal studies. METHODS We performed a comprehensive search of 10 databases of published and grey literature from inception to 18 March 2019 using search terms for common bacterial infections, dementia, cognitive decline, and longitudinal study designs. Two reviewers independently performed the study selection, data extraction, risk of bias and overall quality assessment. Data were summarized through a narrative synthesis as high heterogeneity precluded a meta-analysis. RESULTS We identified 3,488 studies. 9 met the eligibility criteria; 6 were conducted in the United States and 3 in Taiwan. 7 studies reported on dementia and 2 investigated cognitive decline. Multiple infections were assessed in two studies. All studies found sepsis (n = 6), pneumonia (n = 3), urinary tract infection (n = 1), and cellulitis (n = 1) increased dementia risk (HR 1.10; 95% CI 1.02-1.19) to (OR 2.60; 95% CI 1.84-3.66). The range of effect estimates was similar when limited to three studies with no domains at high risk of bias. However, the overall quality of evidence was rated very low. Studies on cognitive decline found no association with infection but had low power. CONCLUSION Our review suggests common bacterial infections may be associated with an increased risk of subsequent dementia, after adjustment for multiple confounders, but further high-quality, large-scale longitudinal studies, across different healthcare settings, are recommended to further explore this association.
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Affiliation(s)
- Rutendo Muzambi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, Cambridge University, Cambridge, UK
| | - Jennifer A. Davidson
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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50
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Cross-Sectional and Longitudinal Associations between Peak Expiratory Flow and Frailty in Older Adults. J Clin Med 2019; 8:jcm8111901. [PMID: 31703301 PMCID: PMC6912606 DOI: 10.3390/jcm8111901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/30/2019] [Accepted: 11/05/2019] [Indexed: 01/20/2023] Open
Abstract
Peak expiratory flow (PEF) has been linked to several health-related outcomes in older people, but its association with frailty is still unclear. This study investigates the association between PEF and prevalent and incident frailty in older adults. Data come from 2559 community-dwelling participants (age ≥ 60 years) of the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Baseline PEF was expressed as standardized residual (SR) percentiles. Frailty was assessed at baseline and over six years, according to the Fried criteria. Associations between PEF and frailty were estimated cross-sectionally through logistic regressions, and longitudinally by multinomial logistic regression, considering death as alternative outcome. Obstructive respiratory diseases and smoking habits were treated as potential effect modifiers. Our cross-sectional results showed that the 10th–49th and <10th PEF SR percentile categories were associated with three- and five-fold higher likelihood of being frail than the 80th–100th category. Similar estimates were confirmed longitudinally, i.e., adjusted OR = 3.11 (95% CI: 1.61–6.01) for PEF SR percentiles < 10th, compared with 80th–100th percentiles. Associations were enounced in participants without physical deficits, and tended to be stronger among those with baseline obstructive respiratory diseases, and, longitudinally, also among former/current smokers. These findings suggest that PEF is a marker of general robustness in older adults, and its reduction exceeding that expected by age is associated with frailty development.
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