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Voutouri C, Hardin CC, Naranbhai V, Nikmaneshi MR, Khandekar MJ, Gainor JF, Munn LL, Jain RK, Stylianopoulos T. Dynamic heterogeneity in COVID-19: Insights from a mathematical model. PLoS One 2024; 19:e0301780. [PMID: 38820409 PMCID: PMC11142552 DOI: 10.1371/journal.pone.0301780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/20/2024] [Indexed: 06/02/2024] Open
Abstract
Critical illness, such as severe COVID-19, is heterogenous in presentation and treatment response. However, it remains possible that clinical course may be influenced by dynamic and/or random events such that similar patients subject to similar injuries may yet follow different trajectories. We deployed a mechanistic mathematical model of COVID-19 to determine the range of possible clinical courses after SARS-CoV-2 infection, which may follow from specific changes in viral properties, immune properties, treatment modality and random external factors such as initial viral load. We find that treatment efficacy and baseline patient or viral features are not the sole determinant of outcome. We found patients with enhanced innate or adaptive immune responses can experience poor viral control, resolution of infection or non-infectious inflammatory injury depending on treatment efficacy and initial viral load. Hypoxemia may result from poor viral control or ongoing inflammation despite effective viral control. Adaptive immune responses may be inhibited by very early effective therapy, resulting in viral load rebound after cessation of therapy. Our model suggests individual disease course may be influenced by the interaction between external and patient-intrinsic factors. These data have implications for the reproducibility of clinical trial cohorts and timing of optimal treatment.
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Affiliation(s)
- Chrysovalantis Voutouri
- Department of Radiation Oncology, Edwin L Steele Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
- Department of Mechanical and Manufacturing Engineering, Cancer Biophysics Laboratory, University of Cyprus, Nicosia, Cyprus
| | - C. Corey Hardin
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Vivek Naranbhai
- Department of Medicine, Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Dana-Farber Cancer Institute, Boston, MA, United States of America
- Center for the AIDS Programme of Research in South Africa, Durban, South Africa
| | - Mohammad R. Nikmaneshi
- Department of Radiation Oncology, Edwin L Steele Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Melin J. Khandekar
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Justin F. Gainor
- Department of Medicine, Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lance L. Munn
- Department of Radiation Oncology, Edwin L Steele Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Rakesh K. Jain
- Department of Radiation Oncology, Edwin L Steele Laboratories, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Triantafyllos Stylianopoulos
- Department of Mechanical and Manufacturing Engineering, Cancer Biophysics Laboratory, University of Cyprus, Nicosia, Cyprus
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2
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Abuyousef S, Alnaimi S, Omar NE, Elajez R, Elmekaty E, Abdelfattah-Arafa E, Barazi R, Ghasoub R, Rahhal A, Hamou F, Al-Amri M, Karawia A, Ajaj F, Alkhawaja R, Kardousha A, Awaisu A, Abou-Ali A, Khatib M, Aboukamar M, Al-Hail M. Early predictors of intensive care unit admission among COVID-19 patients in Qatar. Front Public Health 2024; 12:1278046. [PMID: 38572008 PMCID: PMC10987715 DOI: 10.3389/fpubh.2024.1278046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/19/2024] [Indexed: 04/05/2024] Open
Abstract
Background COVID-19 is associated with significant morbidity and mortality. This study aimed to explore the early predictors of intensive care unit (ICU) admission among patients with COVID-19. Methods This was a case-control study of adult patients with confirmed COVID-19. Cases were defined as patients admitted to ICU during the period February 29-May 29, 2020. For each case enrolled, one control was matched by age and gender. Results A total of 1,560 patients with confirmed COVID-19 were included. Each group included 780 patients with a predominant male gender (89.7%) and a median age of 49 years (interquartile range = 18). Predictors independently associated with ICU admission were cardiovascular disease (adjusted odds ratio (aOR) = 1.64, 95% confidence interval (CI): 1.16-2.32, p = 0.005), diabetes (aOR = 1.52, 95% CI: 1.08-2.13, p = 0.016), obesity (aOR = 1.46, 95% CI: 1.03-2.08, p = 0.034), lymphopenia (aOR = 2.69, 95% CI: 1.80-4.02, p < 0.001), high AST (aOR = 2.59, 95% CI: 1.53-4.36, p < 0.001), high ferritin (aOR = 1.96, 95% CI: 1.40-2.74, p < 0.001), high CRP (aOR = 4.09, 95% CI: 2.81-5.96, p < 0.001), and dyspnea (aOR = 2.50, 95% CI: 1.77-3.54, p < 0.001). Conclusion Having cardiovascular disease, diabetes, obesity, lymphopenia, dyspnea, and increased AST, ferritin, and CRP were independent predictors for ICU admission in patients with COVID-19.
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Affiliation(s)
- Safae Abuyousef
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shaikha Alnaimi
- Department of Pharmacy, Hamad Bin Khalifa Medical City, Hamad Medical Corporation, Doha, Qatar
| | - Nabil E. Omar
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
- Health Sciences Program, Clinical and Population Health Research, College of Pharmacy, Qatar University, Doha, Qatar
| | - Reem Elajez
- Department of Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Eman Elmekaty
- Department of Pharmacy, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Raja Barazi
- Department of Pharmacy, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rola Ghasoub
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ala Rahhal
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Hamou
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maha Al-Amri
- Department of Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Karawia
- Department of Pharmacy, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Ajaj
- Department of Pharmacy, Home Health Care, Hamad Medical Corporation, Doha, Qatar
| | - Raja Alkhawaja
- Department of Pharmacy, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Kardousha
- Department of Pharmacy, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Adel Abou-Ali
- Astellas Pharma Global Development, Inc., Northbrook, IL, United States
| | - Mohamad Khatib
- Department of Critical Care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Aboukamar
- Department of Infectious Disease, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Moza Al-Hail
- Department of Pharmacy, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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3
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Khan Raja S, Rafique Shiekh R, Arshad Abbasi MA, Tariq S, Saleem H, Tariq M, Akbar A, Jadoon SK, Tasneem S, Saleem Khan M. Exploring the Relationship of Comorbidities, Smoking Status, HRCT Findings With COVID-19 Disease Severity and Outcomes. Cureus 2024; 16:e52937. [PMID: 38406150 PMCID: PMC10893976 DOI: 10.7759/cureus.52937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is a serious illness that can affect multiple organs including the lungs. The COVID-mortality risk is attributed to the quick transmission of the virus, the severity of disease, and preclinical risk factors, such as the presence of comorbidities. High-resolution computed tomography (HRCT) can predict disease severity in COVID-19 patients. METHODOLOGY This was a retrospective cohort study in which data were obtained from COVID centers at tertiary care hospitals in Azad Jammu and Kashmir. Details of clinical characteristics and HRCT findings along with details of smoking and comorbid history were obtained. RESULTS Fever at hospital admission, HRCT findings, and having a partner predicted disease severity showed a significant p-value of <0.05. Old age and living in a combined household were associated with severe outcomes (p<0.05). Symptoms of shortness of breath (SOB) on hospital admission could predict the need for ICU admission in COVID-19 patients. CONCLUSION HRCT has a good predictive value for disease severity in patients with COVID-19, and old age is a risk factor. Although, limited associations were established in the analysis, in this study hyperlipidemia and hypertension significantly affected the course of disease. Further studies should be done to explore the relationship.
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Affiliation(s)
- Sohail Khan Raja
- Pulmonology, Azad Jammu Kashmir Medical College, Muzaffarabad, PAK
| | | | | | - Samia Tariq
- Medicine, Women Medical and Dental College Abbottabad, Abbottabad, PAK
| | | | - Maham Tariq
- Radiology, Gujranwala Teaching Hospital, Gujranwala, PAK
| | - Amna Akbar
- Emergency and Accident, District Headquarters Hospital (DHQ), Jhelum, PAK
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4
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Finnerty JP, Hussain ABMA, Ponnuswamy A, Kamil HG, Abdelaziz A. Asthma and COPD as co-morbidities in patients hospitalised with Covid-19 disease: a global systematic review and meta-analysis. BMC Pulm Med 2023; 23:462. [PMID: 37993829 PMCID: PMC10664669 DOI: 10.1186/s12890-023-02761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Factors predisposing to increased mortality with COVID-19 infection have been identified as male sex, hypertension, obesity, and increasing age. Early studies looking at airway diseases gave some contradictory results. The purpose of our study was to determine global variation in studies in patients hospitalized with COVID-19 in the prevalence of COPD and asthma; and to determine whether the presence of asthma or COPD affected mortality in the same hospital population. METHODS A systematic review and meta-analysis of the published literature of COPD and asthma as co-morbidities in patients hospitalized with COVID-19 was performed, looking firstly at the prevalence of these diseases in patients hospitalized with COVID-19, and secondly at the relative risk of death from any cause for patients with asthma or COPD. RESULTS Prevalence of both airway diseases varied markedly by region, making meaningful pooled global estimates of prevalence invalid and not of clinical utility. For individual studies, the interquartile range for asthma prevalence was 4.21 to 12.39%, and for COPD, 3.82 to 11.85%. The relative risk of death with COPD for patients hospitalized with COVID-19 was 1.863 (95% CI 1.640-2.115), while the risk with asthma was 0.918 (95% CI 0.767 to 1.098) with no evidence of increased mortality. CONCLUSIONS For asthma and COPD, prevalence in patients hospitalized with COVID-19 varies markedly by region. We found no evidence that asthma predisposed to increased mortality in COVID-19 disease. For COPD, there was clear evidence of an association with increased mortality. TRIAL REGISTRATION The trial was registered with PROSPERO: registration number CRD42021289886.
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Affiliation(s)
- James Patrick Finnerty
- Countess of Chester Hospital NHS Trust, Chester, UK.
- Department of Respiratory Medicine, Countess of Chester Hospital, Liverpool Road, Chester, CH2 1UL, UK.
| | - A B M Arad Hussain
- Alexandra Hospital, Worcestershire Acute Hospital NHS Trust, Worcester, UK
| | - Aravind Ponnuswamy
- Countess of Chester Hospital NHS Trust, Chester, UK
- University of Chester, Chester, UK
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5
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Natanov D, Avihai B, McDonnell E, Lee E, Cook B, Altomare N, Ko T, Chaia A, Munoz C, Ouellette S, Nyalakonda S, Cederbaum V, Parikh PD, Blaser MJ. Predicting COVID-19 prognosis in hospitalized patients based on early status. mBio 2023; 14:e0150823. [PMID: 37681966 PMCID: PMC10653946 DOI: 10.1128/mbio.01508-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/09/2023] Open
Abstract
IMPORTANCE COVID-19 remains the fourth leading cause of death in the United States. Predicting COVID-19 patient prognosis is essential to help efficiently allocate resources, including ventilators and intensive care unit beds, particularly when hospital systems are strained. Our PLABAC and PRABLE models are unique because they accurately assess a COVID-19 patient's risk of death from only age and five commonly ordered laboratory tests. This simple design is important because it allows these models to be used by clinicians to rapidly assess a patient's risk of decompensation and serve as a real-time aid when discussing difficult, life-altering decisions for patients. Our models have also shown generalizability to external populations across the United States. In short, these models are practical, efficient tools to assess and communicate COVID-19 prognosis.
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Affiliation(s)
- David Natanov
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Byron Avihai
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Erin McDonnell
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Eileen Lee
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Brennan Cook
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Nicole Altomare
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Tomohiro Ko
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Angelo Chaia
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Carolayn Munoz
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | | | - Suraj Nyalakonda
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Vanessa Cederbaum
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Payal D. Parikh
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Martin J. Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, New Brunswick, New Jersey, USA
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6
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Vecchio J, Regan J, Jiang Y, Li R, Romain H, Yousuf F, Adel T, Hall K, DaCosta JM, Yu X, Li JZ, Fofana IB. Viral and immunologic evaluation of smokers with severe COVID-19. Sci Rep 2023; 13:17898. [PMID: 37857680 PMCID: PMC10587108 DOI: 10.1038/s41598-023-45195-z] [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: 03/17/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023] Open
Abstract
Smoking negatively affects B cell function and immunoglobulin levels, but it is unclear if this immune dysfunction contributes to the risk of severe COVID-19 in smokers. We evaluated binding IgM, IgA and IgG antibodies to spike and receptor binding domain antigens, and used a pseudovirus assay to quantify neutralization titers in a set of 27 patients with severe COVID-19. We found no significant differences between binding and neutralization antibody responses for people with a smoking history and people who never smoked. High plasma viral load, but not antibody titers, was linked to an increased risk of death. Humoral immune dysfunction was not a major driver of severe COVID-19 in smokers.
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Affiliation(s)
- Joseph Vecchio
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - James Regan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yuting Jiang
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Roy Li
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Hannah Romain
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Fizah Yousuf
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Thomas Adel
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Kevin Hall
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Jeffrey M DaCosta
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Xu Yu
- Ragon Institute of MGH, MIT and Harvard, Harvard Medical School, Cambridge, MA, USA
| | - Jonathan Z Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ismael Ben Fofana
- Biology Department, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, USA.
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7
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Hajikhani B, Safavi M, Bostanshirin N, Sameni F, Ghazi M, Yazdani S, Nasiri MJ, Khosravi-Dehaghi N, Noorisepehr N, Sayyari S, Dadashi M. COVID-19 and coronary artery disease; A systematic review and meta-analysis. New Microbes New Infect 2023; 53:101151. [PMID: 37275509 PMCID: PMC10205132 DOI: 10.1016/j.nmni.2023.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
Background and aim Patients with underlying cardiovascular disorders such as coronary artery disease (CAD) are more prone to severe forms and multiple complications of COVID-19. The present systematic review and meta-analysis aimed to investigate the impact of CAD on patients with COVID-19. Methods Main electronic databases, including Medline (via PubMed), EMBASE, and Web of Science, were carefully searched and reviewed for original research articles published between 2019 and 2021. One hundred nine studies that address CAD in patients with COVID-19 were selected and analyzed. Results Following search and screening processes, 109 relevant publications were selected for analysis. The meta-analysis of prevalence studies indicated that the frequency of CAD among patients with COVID-19 was reported in 10 countries with an overall frequency of 12.4% [(95% CI) 11.1-13.8] among 20079 COVID-19 patients. According to case reports/case series studies, 50.9% of COVID-19 patients suffered from CAD. Fever was the most common symptom in these patients (47%); 36.5% also had hypertension. Conclusion The results obtained during the present study show that the simultaneous presence of COVID-19 and CAD, especially in men and elderly patients, can increase the risks and complications of both diseases. Therefore, careful examination of the condition of this group of patients for timely diagnosis and treatment is strongly recommended.
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Affiliation(s)
- Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Safavi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Nazila Bostanshirin
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Sameni
- Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Mona Ghazi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahrooz Yazdani
- Department of Cardiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafiseh Khosravi-Dehaghi
- Department of Pharmacognosy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran
- Evidence-Based Phytotherapy and Complementary Medicine Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Negin Noorisepehr
- Department of Biotechnology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Saba Sayyari
- Neonatal Health Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Shahid Beheshti University of Medical Sciences, Imam Hussein Hospital, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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8
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Wang H, Zeng W, Kabubei KM, Rasanathan JJK, Kazungu J, Ginindza S, Mtshali S, Salinas LE, McClelland A, Buissonniere M, Lee CT, Chuma J, Veillard J, Matsebula T, Chopra M. Modelling the economic burden of SARS-CoV-2 infection in health care workers in four countries. Nat Commun 2023; 14:2791. [PMID: 37188709 DOI: 10.1038/s41467-023-38477-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Health care workers (HCWs) experienced greater risk of SARS-CoV-2 infection during the COVID-19 pandemic. This study applies a cost-of-illness (COI) approach to model the economic burden associated with SARS-CoV-2 infections among HCWs in five low- and middle-income sites (Kenya, Eswatini, Colombia, KwaZulu-Natal province, and Western Cape province of South Africa) during the first year of the pandemic. We find that not only did HCWs have a higher incidence of COVID-19 than the general population, but in all sites except Colombia, viral transmission from infected HCWs to close contacts resulted in substantial secondary SARS-CoV-2 infection and death. Disruption in health services as a result of HCW illness affected maternal and child deaths dramatically. Total economic losses attributable to SARS-CoV-2 infection among HCWs as a share of total health expenditure ranged from 1.51% in Colombia to 8.38% in Western Cape province, South Africa. This economic burden to society highlights the importance of adequate infection prevention and control measures to minimize the risk of SARS-CoV-2 infection in HCWs.
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Affiliation(s)
| | - Wu Zeng
- Department of Global Health, Georgetown University, Washington, DC, USA.
| | | | | | - Jacob Kazungu
- Health Economics Research Unit, KEMRI Welcome Trust Research Program, Nairobi, Kenya
| | | | - Sifiso Mtshali
- Public Health Medicine Department, University of KwaZulu-Natal, Durban, South Africa
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9
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Murali R, Wanjari UR, Mukherjee AG, Gopalakrishnan AV, Kannampuzha S, Namachivayam A, Madhyastha H, Renu K, Ganesan R. Crosstalk between COVID-19 Infection and Kidney Diseases: A Review on the Metabolomic Approaches. Vaccines (Basel) 2023; 11:vaccines11020489. [PMID: 36851366 PMCID: PMC9959335 DOI: 10.3390/vaccines11020489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a respiratory disorder. Various organ injuries have been reported in response to this virus, including kidney injury and, in particular, kidney tubular injury. It has been discovered that infection with the virus does not only cause new kidney disease but also increases treatment difficulty and mortality rates in people with kidney diseases. In individuals hospitalized with COVID-19, urinary metabolites from several metabolic pathways are used to distinguish between patients with acute kidney injury (AKI) and those without. This review summarizes the pathogenesis, pathophysiology, treatment strategies, and role of metabolomics in relation to AKI in COVID-19 patients. Metabolomics is likely to play a greater role in predicting outcomes for patients with kidney disease and COVID-19 with varying levels of severity in the near future as data on metabolic profiles expand rapidly. Here, we also discuss the correlation between COVID-19 and kidney diseases and the available metabolomics approaches.
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Affiliation(s)
- Reshma Murali
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - Uddesh Ramesh Wanjari
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - Anirban Goutam Mukherjee
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
- Correspondence: (A.V.G.); (R.G.)
| | - Sandra Kannampuzha
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - Arunraj Namachivayam
- Department of Biomedical Sciences, School of Biosciences and Technology, Vellore Institute of Technology (VIT), Vellore 632014, Tamil Nadu, India
| | - Harishkumar Madhyastha
- Department of Cardiovascular Physiology, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
| | - Kaviyarasi Renu
- Center of Molecular Medicine and Diagnostics (COMMAND), Department of Biochemistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
| | - Raja Ganesan
- Institute for Liver and Digestive Diseases, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea
- Correspondence: (A.V.G.); (R.G.)
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10
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Le Bideau M, Pires de Souza GA, Boschi C, Baudoin JP, Penant G, Jardot P, Fenollar F, Colson P, Lenk M, La Scola B. Limited permissibility of ENL-R and Mv-1-Lu mink cell lines to SARS-CoV-2. Front Microbiol 2022; 13:1003824. [PMID: 36312916 PMCID: PMC9597503 DOI: 10.3389/fmicb.2022.1003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
The SARS-CoV-2 pandemic started in the end of 2019 in Wuhan, China, which highlighted the scenario of frequent cross-species transmission events. From the outbreak possibly initiated by viral spill-over into humans from an animal reservoir, now we face the human host moving globally while interacting with domesticated and peridomestic animals. The emergence of a new virus into the ecosystem leads to selecting forces and species-specific adaptations. The adaptation of SARS-CoV-2 to other animals represents a risk to controlling the dissemination of this coronavirus and the emergence of new variants. Since 2020, several mink farms in Europe and the United States have had SARS-CoV-2 outbreaks with human–mink and mink–human transmission, where the mink-selected variants possibly hold evolutionary concerning advantages. Here we investigated the permissibility of mink lung-derived cells using two cell lines, Mv-1-Lu and ENL-R, against several lineages of SARS-CoV-2, including some classified as variants of concern. The viral release rate and the infectious titers indicate that these cells support infections by different SARS-CoV-2 lineages. The viral production occurs in the first few days after infection with the low viral release by these mink cells, which is often absent for the omicron variant for lung cells. The electron microscopy reveals that during the viral replication cycle, the endomembrane system of the mink-host cell undergoes typical changes while the viral particles are produced, especially in the first days of infection. Therefore, even if limited, mink lung cells may represent a selecting source for SARS-CoV-2 variants, impacting their transmissibility and pathogenicity and making it difficult to control this new coronavirus.
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Affiliation(s)
- Marion Le Bideau
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Gabriel Augusto Pires de Souza
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Celine Boschi
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Jean-Pierre Baudoin
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Gwilherm Penant
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Priscilla Jardot
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Florence Fenollar
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
- Vecteurs – Infections Tropicales et Méditerranéennes (VITROME), Aix Marseille Univ, Institut Hospitalo-Universitaire (IHU), AP-HM, Marseille, France
| | - Philippe Colson
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Matthias Lenk
- Collection of Cell Lines in Veterinary Medicine (CCLV), Department of Experimental Animal Facilities and Biorisk Management, Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Bernard La Scola
- Microbes, Evolution, Phylogénie et Infection (MEPHI), Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
- Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, Marseille, France
- *Correspondence: Bernard La Scola,
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11
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Sisay G, Mantefardo B, Beyene A. Time from symptom onset to severe COVID-19 and risk factors among patients in Southern Ethiopia: a survival analysis. J Int Med Res 2022; 50:3000605221119366. [PMID: 36036178 PMCID: PMC9425909 DOI: 10.1177/03000605221119366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to assess the time to severe coronavirus disease 2019 (COVID-19) and risk factors among confirmed COVID-19 cases in Southern Ethiopia. Method This two-center retrospective cohort study involved patients with confirmed COVID-19 from 1 October 2020 to 30 September 2021. Kaplan–Meier graphs and log-rank tests were used to determine the pattern of COVID-19 severity among categories of variables. Bivariable and multivariable Cox proportional regression models were used to identify the risk factors of severe COVID-19. Results Four hundred thirteen patients with COVID-19 with a mean age of 41.9 ± 15.3 years were involved in the study. There were 194 severe cases (46.9.1%), including 77 (39.6%) deaths. The median time from symptom onset to severe COVID-19 was 8 days (interquartile range: 7–12 days). The risk factors for severe COVID-19 were age >65 (adjusted hazard ratio [AHR] = 2.65, 95% confidence interval [95%CI]: 1.02, 3.72), cough (AHR = 1.59, 95%CI: 1.39, 2.84), chest pain (AHR = 1.47, 95%CI: 1.34, 2.66), headache (AHR = 2.04, 95%CI: 1.43, 2.88), comorbidity (AHR = 1.3, 95%CI: 1.01, 2.04), asthma (AHR = 1.6. 95%CI: 1.04, 2.24), and symptom onset to admission more than 5 days (AHR = 0.48, 95%CI: 0.34, 0.68). Conclusion Patients with symptoms and comorbidities should be closely monitored.
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Affiliation(s)
- Gizaw Sisay
- Department of Public Health, College of Medicine and Health Sciences, Dilla University, Ethiopia
| | - Bahru Mantefardo
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Dilla University, Ethiopia
| | - Aster Beyene
- Department of Statistics, College of Natural and Computational Science, Dilla University, Ethiopia
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12
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Jafrin S, Aziz MA, Islam MS. Elevated Levels of Pleiotropic Interleukin-6 (IL-6) and Interleukin-10 (IL-10) are Critically Involved With the Severity and Mortality of COVID-19: An Updated Longitudinal Meta-Analysis and Systematic Review on 147 Studies. Biomark Insights 2022; 17:11772719221106600. [PMID: 35747885 PMCID: PMC9209786 DOI: 10.1177/11772719221106600] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Disruption in the natural immune reaction due to SARS-CoV-2 infection can initiate a potent cytokine storm among COVID-19 patients. An elevated level of IL-6 and IL-10 during a hyperinflammatory state plays a vital role in increasing the risk of severity and mortality. In this study, we aimed to evaluate the potential of circulating IL-6 and IL-10 levels as biomarkers for detecting the severity and mortality of COVID-19. Methods This study was conducted according to the Cochrane Handbook and PRISMA guidelines. Authorized databases were searched to extract suitable studies using specific search terms. RevMan 5.4 was applied for performing the meta-analysis. Mean differences in IL-6 and IL-10 levels were calculated among COVID-19 patients via a random-effects model. NOS scoring, publication bias and sensitivity analyses were checked to ensure study quality. Results A total of 147 studies were selected, with 31 909 COVID-19 patients under investigation. In the severity analysis, the mean concentration of IL-6 was significantly higher in the severe COVID-19 cases than in the non-severe cases (MD: 19.98; P < .001; 95% CI: 17.56, 22.40). Similar result was observed for IL-10 mean concentration in severe COVID-19 cases (MD: 1.35; P < .001; 95% CI: 0.90, 1.80). In terms of mortality analysis, circulating IL-6 showed sharp elevation in the deceased patients (MD: 42.11; P < .001; 95% CI: 36.86, 47.36). IL-10 mean concentration was higher in the dead patients than in the survived patients (MD: 4.79; P < .001; 95% CI: 2.83, 6.75). Publication bias was not found except for comparing IL-6 levels with disease severity. Sensitivity analysis also reported no significant deviation from the pooled outcomes. Conclusions Elevated levels of circulating IL-6 and IL-10 signifies worsening of COVID-19. To monitor the progression of SARS-CoV-2 infection, IL-6 and IL-10 should be considered as potential biomarkers for severity and mortality detection in COVID-19. Systematic review registration INPLASY registration number: INPLASY202240046.
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Affiliation(s)
- Sarah Jafrin
- Laboratory of Pharmacogenomics and Molecular Biology, Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
| | - Md Abdul Aziz
- Department of Pharmacy, Faculty of Pharmacy and Health Sciences, State University of Bangladesh, Dhaka, Bangladesh
| | - Mohammad Safiqul Islam
- Laboratory of Pharmacogenomics and Molecular Biology, Department of Pharmacy, Faculty of Science, Noakhali Science and Technology University, Sonapur, Noakhali, Bangladesh
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13
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Mitsumura T, Okamoto T, Tosaka M, Yamana T, Shimada S, Iijima Y, Sakakibara R, Shibata S, Honda T, Shirai T, Ishizuka M, Aiboshi J, Furusawa H, Tateishi T, Tamaoka M, Shigemitsu H, Arai H, Otomo Y, Tohda S, Anzai T, Takahashi K, Yasuda S, Miyazaki Y. SARS-CoV-2 RNA copy number is a factor associated with the mortality of COVID-19 and improves the predictive performance of mortality in severe cases. Jpn J Infect Dis 2022; 75:504-510. [PMID: 35650037 DOI: 10.7883/yoken.jjid.2022.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Factors associated with mortality are important for the treatment of coronavirus disease 2019 (COVID-19). The polymerase chain reaction (PCR) test is the gold standard for diagnosing COVID-19 and reflects the viral load in the upper respiratory tract. This study enrolled 523 patients. Four hundred forty-one and 75 patients were performed PCR testing in nasopharyngeal swabs and sputum specimens, respectively, within 20 days from the onset. We investigated the association between RNA copy number and the severity and mortality of COVID-19, and its effect on the predictive performance for the severity and mortality. RNA copy numbers in nasopharyngeal swabs were higher in the non-survivor group than in the survivor group. Multivariate logistic regression analysis identified that the high RNA copy number (≥ 9 log10 /swab) in nasopharyngeal swabs was a factor associated with mortality (odds ratio, 4.50; 95% confidence interval, 1.510 - 13.100; p = 0.008). Furthermore, in severe cases, adding RNA copy number (≥ 9 log10 /swab), which was adjusted by duration from onset to PCR, improved mortality predictive performance based on known factors. The RNA copy number is a factor associated with the mortality of COVID-19 and can improve the predictive performance of mortality in severe cases.
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Affiliation(s)
- Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan.,Department of Pulmonary Immunotherapeutics, Tokyo Medical and Dental University, Japan
| | - Mizuho Tosaka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takashi Yamana
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sho Shimada
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Masahiro Ishizuka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Japan
| | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Japan
| | - Shuji Tohda
- Department of Laboratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Tokyo Medical and Dental University, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
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14
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Kibar Akilli I, Bilge M, Uslu Guz A, Korkusuz R, Canbolat Unlu E, Kart Yasar K. Comparison of Pneumonia Severity Indices, qCSI, 4C-Mortality Score and qSOFA in Predicting Mortality in Hospitalized Patients with COVID-19 Pneumonia. J Pers Med 2022; 12:801. [PMID: 35629223 PMCID: PMC9144423 DOI: 10.3390/jpm12050801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 02/04/2023] Open
Abstract
This is a retrospective and observational study on 1511 patients with SARS-CoV-2, who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. 1511 patients, 879 male (58.17%) and 632 female (41.83%) with a mean age of 60.1 ± 14.7 were included in the study. Survivors and non-survivors groups were statistically compared with respect to survival, discharge, ICU admission and in-hospital death. Although gender was not statistically significant different between two groups, 80 (60.15%) of the patients who died were male. Mean age was 72.8 ± 11.8 in non-survivors vs. 59.9 ± 14.7 in survivors (p < 0.001). Overall in-hospital mortality was found to be 8.8% (133/1511 cases), and overall ICU admission was 10.85% (164/1511 cases). The PSI/PORT score of the non-survivors group was higher than that of the survivors group (144.38 ± 28.64 versus 67.17 ± 25.63, p < 0.001). The PSI/PORT yielding the highest performance was the best predictor for in-hospital mortality, since it incorporates the factors as advanced age and comorbidity (AUROC 0.971; % 95 CI 0.961−0.981). The use of A-DROP may also be preferred as an easier alternative to PSI/PORT, which is a time-consuming evaluation although it is more comprehensive.
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Affiliation(s)
- Isil Kibar Akilli
- Department of Pulmonary Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey
| | - Muge Bilge
- Department of Internal Medicine, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey;
| | - Arife Uslu Guz
- Department of Pulmonary Disease, Mehmet Akif Ersoy Training and Research Hospital, University of Health Sciences, Turgut Ozal Boulevard, No. 11, Kucukcekmece, Istanbul 34303, Turkey;
| | - Ramazan Korkusuz
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
| | - Esra Canbolat Unlu
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
| | - Kadriye Kart Yasar
- Department of Infectious Disease, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Dr. Tevfik Saglam Street, No. 11, Bakirkoy, Istanbul 34147, Turkey; (R.K.); (E.C.U.); (K.K.Y.)
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15
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Yemata GA, Tesfaw A, Mihret G, Tiruneh M, Walle Z, Molla E, Sisay E, Admassu FT, Habtie E, Desalagn T, Shimels H, Teshome F. Survival Time to COVID-19 Severity and Its Predictors in South Gondar Zone, North-West Ethiopia: A Prospective Cohort Study. J Multidiscip Healthc 2022; 15:1187-1201. [PMID: 35634568 PMCID: PMC9139343 DOI: 10.2147/jmdh.s361061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion and Recommendation
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Affiliation(s)
- Getaneh Atikilt Yemata
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
- Correspondence: Getaneh Atikilt Yemata, Email
| | - Aragaw Tesfaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Gashaw Mihret
- Department of Pediatrics, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Mulu Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Zebader Walle
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Eshetie Molla
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Ermias Sisay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Fitalew Tadele Admassu
- Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Eyaya Habtie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Tsion Desalagn
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Habtamu Shimels
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
| | - Fentaw Teshome
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Amhara Region, Ethiopia
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16
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Almarashda AMJ, Rabbani SA, Kurian MT, Cherian A. Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates. J Clin Med 2022; 11:jcm11092439. [PMID: 35566563 PMCID: PMC9100822 DOI: 10.3390/jcm11092439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39−59); 66% male). Age > 45 years (OR = 2.07, 95% CI: 1.04−4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52−6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34−10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69−10.67, p < 0.001), Hb < 13 g/dL (OR = 3.17, 95% CI: 1.51−6.65, p = 0.002), neutrophils > 7 × 103/mcL (OR = 4.89, 95% CI: 1.66−14.37, p=0.004), lymphocytes < 1 × 103/mcL (OR = 7.78, 95% CI: 1.01−60.19, p = 0.049), sodium < 135 mmol/L (OR = 5.42, 95% CI: 1.05−27.95, p = 0.044), potassium < 3.6 mmol/L (OR = 3.36, 95% CI: 1.03−11.01, p = 0.045), urea > 6.5 mmol/L (OR = 3.37, 95% CI: 1.69−6.73, p = 0.001) and LDH > 227 IU/L (OR = 6.26, 95% CI: 1.61−24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients.
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Affiliation(s)
| | - Syed Arman Rabbani
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates
- Correspondence:
| | - Martin Thomas Kurian
- Department of Nephrology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah P.O. Box 4727, United Arab Emirates;
| | - Ajith Cherian
- Department of Internal Medicine, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah P.O. Box 4727, United Arab Emirates;
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17
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A look back at the first wave of COVID-19 in China: A systematic review and meta-analysis of mortality and health care resource use among severe or critical patients. PLoS One 2022; 17:e0265117. [PMID: 35275943 PMCID: PMC8916647 DOI: 10.1371/journal.pone.0265117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background To investigate the mortality and health care resource use among patients with severe or critical coronavirus disease of 2019 (COVID-19) in the first wave of pandemic in China. Methods We performed a systematic review and meta-analysis to investigate the mortality, discharge rate, length of hospital stay, and use of invasive ventilation in severe or critical COVID-19 cases in China. We searched electronic databases for studies from China with no restrictions on language or interventions patients received. We screened records, extracted data and assessed the quality of included studies in duplicate. We performed the meta-analysis using random-effect models through a Bayesian framework. Subgroup analyses were conducted to examine studies by disease severity, study location and patient enrolment start date. We also performed sensitivity analysis using various priors, and assessed between-study heterogeneity and publication bias for the primary outcomes. Results Out of 6,205 titles and abstracts screened, 500 were reviewed in full text. A total of 42 studies were included in the review, of which 95% were observational studies (n = 40). The pooled 28-day and 14-day mortalities among severe or critical patients were 20.48% (7,136 patients, 95% credible interval (CrI), 13.11 to 30.70) and 10.83% (95% CrI, 6.78 to 16.75), respectively. The mortality declined over time and was higher in patients with critical disease than severe cases (1,235 patients, 45.73%, 95% CrI, 22.79 to 73.52 vs. 3,969 patients, 14.90%, 95% CrI, 4.70 to 39.57) and patients in Hubei compared to those outside Hubei (6,719 patients, 26.62%, 95% CrI, 13.11 to 30.70 vs. 244 patients, 5.88%, 95% CrI 2.03 to 14.11). The length of hospital stay was estimated at 18.48 days (6,847 patients, 95% CrI, 17.59 to 21.21), the 28-day discharge rate was 50.48% (3,645 patients, 95% CrI, 26.47 to 79.53), and the use of invasive ventilation rate was 13.46% (4,108 patients, 95% CrI, 7.61 to 22.31). Conclusions Our systematic review and meta-analysis found high mortality among severe and critical COVID-19 cases. Severe or critical COVID-19 cases consumed a large amount of hospital resources during the outbreak.
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18
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Lu LY, Feng PH, Yu MS, Chen MC, Lin AJH, Chen JL, Yu LHL. Current utilization of interferon alpha for the treatment of coronavirus disease 2019: A comprehensive review. Cytokine Growth Factor Rev 2022; 63:34-43. [PMID: 35115233 PMCID: PMC8755267 DOI: 10.1016/j.cytogfr.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Recent studies have identified an association between perturbed type I interferon (IFN) responses and the severity of coronavirus disease 2019 (COVID-19). IFNα intervention may normalize the dysregulated innate immunity of COVID-19. However, details regarding its utilization and therapeutic evidence have yet to be systematically evaluated. The aim of this comprehensive review was to summarize the current utilization of IFNα for COVID-19 treatment and to explore the evidence on safety and efficacy. A comprehensive review of clinical studies in the literature prior to December 1st, 2021, was performed to identify the current utilization of IFNα, which included details on the route of administration, the number of patients who received the treatment, the severity at the initiation of treatment, age range, the time from the onset of symptoms to treatment, dose, frequency, and duration as well as safety and efficacy. Encouragingly, no evidence was found against the safety of IFNα treatment for COVID-19. Early intervention, either within five days from the onset of symptoms or at hospital admission, confers better clinical outcomes, whereas late intervention may result in prolonged hospitalization.
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Affiliation(s)
- Ling-Ying Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying District, Kaohsiung City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, Taiwan
| | - Ming-Sun Yu
- Division of Hematology, Conde S. Januário Hospital, Estrada do Visconde de São Januário, Macau, China
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City, Taiwan
| | - Alex Jia-Hong Lin
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Justin L. Chen
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Lennex Hsueh-Lin Yu
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan,Corresponding author
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19
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McGonagle D, Kearney MF, O'Regan A, O'Donnell JS, Quartuccio L, Watad A, Bridgewood C. Therapeutic implications of ongoing alveolar viral replication in COVID-19. THE LANCET. RHEUMATOLOGY 2022; 4:e135-e144. [PMID: 34873587 PMCID: PMC8635460 DOI: 10.1016/s2665-9913(21)00322-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In patients with moderate-to-severe COVID-19 pneumonia, an aberrant post-viral alveolitis with excessive inflammatory responses and immunothrombosis underpins use of immunomodulatory therapy (eg, corticosteroids and interleukin-6 receptor antagonism). By contrast, immunosuppression in individuals with mild COVID-19 who do not require oxygen therapy or in those with critical disease undergoing prolonged ventilation is of no proven benefit. Furthermore, a window of opportunity is thought to exist for timely immunosuppression in patients with moderate-to-severe COVID-19 pneumonia shortly after clinical presentation. In this Viewpoint, we explore the shortcomings of a universal immunosuppression approach in patients with moderate-to-severe COVID-19 due to disease heterogeneity related to ongoing SARS-CoV-2 replication, which can manifest as RNAaemia in some patients treated with immunotherapy. By contrast, immunomodulatory therapy has overall benefits in patients with rapid SARS-CoV-2 clearance, via blunting of multifaceted, excessive innate immune responses in the lungs, potentially uncontrolled T-cell responses, possible autoimmune responses, and immunothrombosis. We highlight this therapeutic dichotomy to better understand the immunopathology of moderate-to-severe COVID-19, particularly the role of RNAaemia, and to refine therapy choices.
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Affiliation(s)
- Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals, Leeds, UK,Correspondence to: Prof Dennis McGonagle, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK
| | - Mary F Kearney
- HIV Dynamics and Replication Program, National Cancer Institute National Institutes of Health, Bethesda, MD, USA
| | - Anthony O'Regan
- Department of Respiratory Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - James S O'Donnell
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luca Quartuccio
- Department of Medicine, Clinic of Rheumatology, University of Udine, Udine, Italy
| | - Abdulla Watad
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,Department of Medicine B, Rhumatology Unit and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Charles Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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20
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Steinegger B, Arola-Fernández L, Granell C, Gómez-Gardeñes J, Arenas A. Behavioural response to heterogeneous severity of COVID-19 explains temporal variation of cases among different age groups. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2022; 380:20210119. [PMID: 34802272 PMCID: PMC8607153 DOI: 10.1098/rsta.2021.0119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Together with seasonal effects inducing outdoor or indoor activities, the gradual easing of prophylaxis caused second and third waves of SARS-CoV-2 to emerge in various countries. Interestingly, data indicate that the proportion of infections belonging to the elderly is particularly small during periods of low prevalence and continuously increases as case numbers increase. This effect leads to additional stress on the health care system during periods of high prevalence. Furthermore, infections peak with a slight delay of about a week among the elderly compared to the younger age groups. Here, we provide a mechanistic explanation for this phenomenology attributable to a heterogeneous prophylaxis induced by the age-specific severity of the disease. We model the dynamical adoption of prophylaxis through a two-strategy game and couple it with an SIR spreading model. Our results also indicate that the mixing of contacts among the age groups strongly determines the delay between their peaks in prevalence and the temporal variation in the distribution of cases. This article is part of the theme issue 'Data science approaches to infectious disease surveillance'.
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Affiliation(s)
- Benjamin Steinegger
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona 43007, Spain
| | - Lluís Arola-Fernández
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona 43007, Spain
| | - Clara Granell
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona 43007, Spain
| | - Jesús Gómez-Gardeñes
- Department of Condensed Matter Physics, University of Zaragoza, Zaragoza E-50009, Spain
- GOTHAM Lab—BIFI, University of Zaragoza, Zaragoza E-50018, Spain
| | - Alex Arenas
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona 43007, Spain
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21
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Jdiaa SS, Mansour R, El Alayli A, Gautam A, Thomas P, Mustafa RA. COVID-19 and chronic kidney disease: an updated overview of reviews. J Nephrol 2022; 35:69-85. [PMID: 35013985 PMCID: PMC8747880 DOI: 10.1007/s40620-021-01206-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronavirus disease (COVID-19) has resulted in the death of more than 3.5 million people worldwide. While COVID-19 mostly affects the lungs, different comorbidities can have an impact on its outcomes. We performed an overview of reviews to assess the effect of Chronic Kidney Disease (CKD) on contracting COVID-19, hospitalization, mortality, and disease severity. METHODS We searched published and preprint databases. We updated the reviews by searching for primary studies published after August 2020, and prioritized reviews that are most updated and of higher quality using the AMSTAR tool. RESULTS We included 69 systematic reviews and 66 primary studies. Twenty-eight reviews reported on the prevalence of CKD among patients with COVID-19, which ranged from 0.4 to 49.0%. One systematic review showed an increased risk of hospitalization in patients with CKD and COVID-19 (RR = 1.63, 95% CI 1.03-2.58) (Moderate certainty). Primary studies also showed a statistically significant increase of hospitalization in such patients. Thirty-seven systematic reviews assessed mortality risk in patients with CKD and COVID-19. The pooled estimates from primary studies for mortality in patients with CKD and COVID-19 showed a HR of 1.48 (95% CI 1.33-1.65) (Moderate certainty), an OR of 1.77 (95% CI 1.54-2.02) (Moderate certainty) and a RR of 1.6 (95% CI 0.88-2.92) (Low certainty). CONCLUSIONS Our review highlights the impact of CKD on the poor outcomes of COVID-19, underscoring the importance of identifying strategies to prevent COVID-19 infection among patients with CKD.
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Affiliation(s)
- Sara S Jdiaa
- Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Razan Mansour
- Division of Nephrology and Hypertension, Department of Internal Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Abdallah El Alayli
- Division of Nephrology and Hypertension, Department of Internal Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Archana Gautam
- Division of Nephrology and Hypertension, Department of Internal Medicine, Medical Center, University of Kansas, Kansas City, KS, USA
| | - Preston Thomas
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, Medical Center, University of Kansas, Kansas City, KS, USA.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
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22
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Hosseini SF, Behnam-Roudsari S, Alavinia G, Emami A, Toghyani A, Moradi S, Zadeh MM, Mohseni S, Shafiee MA. Diagnostic and prognostic value of Sepsis-Induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:102. [PMID: 34899940 PMCID: PMC8607173 DOI: 10.4103/jrms.jrms_1295_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/30/2020] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) presents various phenotypes from asymptomatic involvement to death. Disseminated intravascular coagulopathy (DIC) is among the poor prognostic complications frequently observed in critical illness. To improve mortality, a timely diagnosis of DIC is essential. The International Society on Thrombosis and Hemostasis (ISTH) introduced a scoring system to detect overt DIC (score ≥5) and another category called sepsis-induced coagulopathy (SIC) to identify the initial stages of DIC (score ≥4). This study aimed to determine whether clinicians used these scoring systems while assessing COVID-19 patients and the role of relevant biomarkers in disease severity and outcome. MATERIALS AND METHODS An exhaustive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Cochrane, CINAHL, and PubMed until August 2020. Studies considering disease severity or outcome with at least two relevant biomarkers were included. For all studies, the definite, maximum, and minimum ISTH/SIC scores were calculated. RESULTS A total of 37 papers and 12,463 cases were reviewed. Studies considering ISTH/SIC criteria to detect DIC suggested a higher rate of ISTH ≥5 and SIC ≥4 in severe cases and nonsurvivors compared with nonsevere cases and survivors. The calculated ISTH scores were dominantly higher in severe infections and nonsurvivors. Elevated D-dimer was the most consistent abnormality on admission. CONCLUSION Higher ISTH and SIC scores positively correlate with disease severity and death. In addition, more patients with severe disease and nonsurvivors met the ISTH and SIC scores for DIC. Given the high prevalence of coagulopathy in COVID-19 infection, dynamic monitoring of relevant biomarkers in the form of ISTH and SIC scoring systems is of great importance to timely detect DIC in suspicious patients.
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Affiliation(s)
- Sayyideh Forough Hosseini
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Sahar Behnam-Roudsari
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Ghazal Alavinia
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Anahita Emami
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Arash Toghyani
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Moradi
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mahtab Mojtahed Zadeh
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Sana Mohseni
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mohammad Ali Shafiee
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
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23
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Kairu A, Were V, Isaaka L, Agweyu A, Aketch S, Barasa E. Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya. BMJ Glob Health 2021; 6:e007168. [PMID: 34876459 PMCID: PMC8655343 DOI: 10.1136/bmjgh-2021-007168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions. METHODS We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results. RESULTS The status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya's cost-effectiveness threshold (US$908). CONCLUSION When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.
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Affiliation(s)
- Angela Kairu
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Vincent Were
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lynda Isaaka
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Ambrose Agweyu
- Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Samuel Aketch
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Edwine Barasa
- Health Economics Research Unit (HERU), KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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24
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An C, Oh HC, Chang JH, Oh SJ, Lee JM, Han CH, Kim SW. Development and validation of a prognostic model for early triage of patients diagnosed with COVID-19. Sci Rep 2021; 11:21923. [PMID: 34754036 PMCID: PMC8578640 DOI: 10.1038/s41598-021-01452-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/21/2021] [Indexed: 01/10/2023] Open
Abstract
We developed a tool to guide decision-making for early triage of COVID-19 patients based on a predicted prognosis, using a Korean national cohort of 5,596 patients, and validated the developed tool with an external cohort of 445 patients treated in a single institution. Predictors chosen for our model were older age, male sex, subjective fever, dyspnea, altered consciousness, temperature ≥ 37.5 °C, heart rate ≥ 100 bpm, systolic blood pressure ≥ 160 mmHg, diabetes mellitus, heart disease, chronic kidney disease, cancer, dementia, anemia, leukocytosis, lymphocytopenia, and thrombocytopenia. In the external validation, when age, sex, symptoms, and underlying disease were used as predictors, the AUC used as an evaluation metric for our model's performance was 0.850 in predicting whether a patient will require at least oxygen therapy and 0.833 in predicting whether a patient will need critical care or die from COVID-19. The AUCs improved to 0.871 and 0.864, respectively, when additional information on vital signs and blood test results were also used. In contrast, the protocols currently recommended in Korea showed AUCs less than 0.75. An application for calculating the prognostic score in COVID-19 patients based on the results of this study is presented on our website ( https://nhimc.shinyapps.io/ih-psc/ ), where the results of the validation ongoing in our institution are periodically updated.
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Affiliation(s)
- Chansik An
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Jung Hyun Chang
- Department of Otolaryngology-Head and Neck Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seung-Jin Oh
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jung Mo Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Seong Woo Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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25
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Sahni S, Gupta G, Sarda R, Pandey S, Pandey RM, Sinha S. Impact of metabolic and cardiovascular disease on COVID-19 mortality: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102308. [PMID: 34673359 PMCID: PMC8492383 DOI: 10.1016/j.dsx.2021.102308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS This meta-analysis aims to highlight the impact of cardio-metabolic comorbidities on COVID-19 severity and mortality. METHODS A thorough search on major online databases was done for studies describing the clinical outcomes of COVID-19 patients. We used random-effects model to compute pooled estimates for critical or fatal disease. RESULTS A total of 20,475 patients from 33 eligible studies were included. Maximum risk of development of critical or fatal COVID-19 disease was seen in patients with underlying cardiovascular disease [OR: 3.44, 95% CI: 2.65-4.48] followed by chronic lung disease, hypertension and diabetes mellitus. Of the total cases, 64% had one of the four comorbidities with the most prevalent being hypertension with a pooled prevalence of 27%. CONCLUSIONS Presence of comorbidities like cardiovascular disease, chronic lung disease, hypertension and diabetes mellitus led to a higher risk of development of critical or fatal COVID-19 disease, with maximum risk seen with underlying cardiovascular disease.
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Affiliation(s)
- Shubham Sahni
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Radhika Sarda
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India.
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26
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Geng J, Yu X, Bao H, Feng Z, Yuan X, Zhang J, Chen X, Chen Y, Li C, Yu H. Chronic Diseases as a Predictor for Severity and Mortality of COVID-19: A Systematic Review With Cumulative Meta-Analysis. Front Med (Lausanne) 2021; 8:588013. [PMID: 34540855 PMCID: PMC8440884 DOI: 10.3389/fmed.2021.588013] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/05/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Given the ongoing coronavirus disease 2019 (COVID-19) pandemic and the consequent global healthcare crisis, there is an urgent need to better understand risk factors for symptom deterioration and mortality among patients with COVID-19. This systematic review aimed to meet the need by determining the predictive value of chronic diseases for COVID-19 severity and mortality. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Complete to identify studies published between December 1, 2019, and December 31, 2020. Two hundred and seventeen observational studies from 26 countries involving 624,986 patients were included. We assessed the risk of bias of the included studies and performed a cumulative meta-analysis. Results: We found that among COVID-19 patients, hypertension was a very common condition and was associated with higher severity, intensive care unit (ICU) admission, acute respiratory distress syndrome, and mortality. Chronic obstructive pulmonary disease was the strongest predictor for COVID-19 severity, admission to ICU, and mortality, while asthma was associated with a reduced risk of COVID-19 mortality. Patients with obesity were at a higher risk of experiencing severe symptoms of COVID-19 rather than mortality. Patients with cerebrovascular disease, chronic liver disease, chronic renal disease, or cancer were more likely to become severe COVID-19 cases and had a greater probability of mortality. Conclusions: COVID-19 patients with chronic diseases were more likely to experience severe symptoms and ICU admission and faced a higher risk of mortality. Aggressive strategies to combat the COVID-19 pandemic should target patients with chronic diseases as a priority.
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Affiliation(s)
- JinSong Geng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoLan Yu
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - HaiNi Bao
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Zhe Feng
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoYu Yuan
- Department of Emergency Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - JiaYing Zhang
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - XiaoWei Chen
- Library and Reference Department, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - YaLan Chen
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - ChengLong Li
- Department of Medical Informatics, Medical School of Nantong University, Nantong, China
| | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
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27
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Sutiningsih D, Azzahra NA, Prabowo Y, Sugiharto A, Wibowo MA, Lestari ES, Aurorina E. COVID-19 deaths and associated demographic factors in Central Java, Indonesia. Germs 2021; 11:255-265. [PMID: 34422697 DOI: 10.18683/germs.2021.1262] [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: 02/08/2021] [Revised: 05/01/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
Introduction To date, the total number of COVID-19 deaths is still increasing, including in Central Java, with the third-highest total number of deaths in Indonesia. There are still limited studies related to the cases of COVID-19. Thus, this study's objective was to provide an overview of the characteristics of 4359 COVID-19 death cases in Central Java. Methods This research used a cross-sectional descriptive design with univariate, bivariate, and multivariate analysis involving secondary data acquired from a report by the Provincial Health Office of Central Java, recorded up to 13 December 2020. Results The results showed that the highest frequencies of death cases were contributed from ≥60 years group (n=1897 patients; 43.52%) and the male (n=2497 patients; 57.28%) group. The case fatality rate (CFR) rose with age, and the highest CFR was recorded in the elderly (17.95%), males (7.60%), in Pati District (17.45%), while entrepreneur (14.64%) was the highest reported job. Furthermore, the eldest group (≥60 years) and males were more susceptible to die, with ORs 5.49 (95%CI: 5.15-5.86) and 1.61 (95%CI: 1.51-1.71), sequentially. The majority of death cases had comorbidities (65.79%), while the most prevalent reported comorbidities were diabetes (n=1387, 31.82%) and hypertension (n=817, 18.74%). Meanwhile, patients of old age were more likely to associate comorbidity, p<0.001, OR 1.664 (95%CI: 1.425-1.944). Conclusions This study concludes that patients of older age and males may become more vulnerable than younger and females to experience death. Further study is required to measure the relationship between other characteristics of demographics, underlying medical conditions, and fatality.
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Affiliation(s)
- Dwi Sutiningsih
- DVM, M.PH, Ph.D., Epidemiology and Tropical Disease Department, Public Health Faculty, Diponegoro University, Prof. Soedarto, S.H., Tembalang Street, Semarang, Central Java, Indonesia, 50275, and Master of Epidemiology, Postgraduate School, Diponegoro University, Imam Bardjo S.H., No.5 Street, Semarang, Central Java, Indonesia, 50241
| | - Nur Azizah Azzahra
- BPH, Master of Epidemiology, Postgraduate School, Diponegoro University, Imam Bardjo S.H., No.5 Street, Semarang, Central Java, Indonesia, 50241
| | - Yulianto Prabowo
- MD, M.PH, Central Java Provincial Health Office, Kapten Piere Tendean No.24 Sekayu Street, Semarang City, Central Java, Indonesia, 50132
| | - Aris Sugiharto
- BPH, M.PH, Ph.D., Central Java Provincial Health Office, Kapten Piere Tendean No.24 Sekayu Street, Semarang City, Central Java, Indonesia, 50132
| | - Mufti Agung Wibowo
- S.Komp, M.IT, Central Java Provincial Health Office, Kapten Piere Tendean No.24 Sekayu Street, Semarang City, Central Java, Indonesia, 50132
| | - Endah Sri Lestari
- BPH, M.PH, Central Java Provincial Health Office, Kapten Piere Tendean No.24 Sekayu Street, Semarang City, Central Java, Indonesia, 50132
| | - Estri Aurorina
- BPH, M.PH, Central Java Provincial Health Office, Kapten Piere Tendean No.24 Sekayu Street, Semarang City, Central Java, Indonesia, 50132
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28
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Xu J, Xiao W, Liang X, Shi L, Zhang P, Wang Y, Wang Y, Yang H. A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity. BMC Public Health 2021; 21:1533. [PMID: 34380456 PMCID: PMC8355578 DOI: 10.1186/s12889-021-11051-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 05/12/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD), one of the most common comorbidities of coronavirus disease 2019 (COVID-19), has been suspected to be associated with adverse outcomes in COVID-19 patients, but their correlation remains controversial. METHOD This is a quantitative meta-analysis on the basis of adjusted effect estimates. PubMed, Web of Science, MedRxiv, Scopus, Elsevier ScienceDirect, Cochrane Library and EMBASE were searched comprehensively to obtain a complete data source up to January 7, 2021. Pooled effects (hazard ratio (HR), odds ratio (OR)) and the 95% confidence intervals (CIs) were estimated to evaluate the risk of the adverse outcomes in COVID-19 patients with CVD. Heterogeneity was assessed by Cochran's Q-statistic, I2test, and meta-regression. In addition, we also provided the prediction interval, which was helpful for assessing whether the variation across studies was clinically significant. The robustness of the results was evaluated by sensitivity analysis. Publication bias was assessed by Begg's test, Egger's test, and trim-and-fill method. RESULT Our results revealed that COVID-19 patients with pre-existing CVD tended more to adverse outcomes on the basis of 203 eligible studies with 24,032,712 cases (pooled ORs = 1.41, 95% CIs: 1.32-1.51, prediction interval: 0.84-2.39; pooled HRs = 1.34, 95% CIs: 1.23-1.46, prediction interval: 0.82-2.21). Further subgroup analyses stratified by age, the proportion of males, study design, disease types, sample size, region and disease outcomes also showed that pre-existing CVD was significantly associated with adverse outcomes among COVID-19 patients. CONCLUSION Our findings demonstrated that pre-existing CVD was an independent risk factor associated with adverse outcomes among COVID-19 patients.
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Affiliation(s)
- Jie Xu
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Wenwei Xiao
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Xuan Liang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Li Shi
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Peihua Zhang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Ying Wang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China
| | - Yadong Wang
- Department of Toxicology, Henan Center for Disease Control and Prevention, Zhengzhou, 450016, China
| | - Haiyan Yang
- Department of Epidemiology, School of Public Health, Zhengzhou University, No. 100 of Science Avenue, Zhengzhou, 450001, China.
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Berber E, Sumbria D, Çanakoğlu N. Meta-analysis and comprehensive study of coronavirus outbreaks: SARS, MERS and COVID-19. J Infect Public Health 2021; 14:1051-1064. [PMID: 34174535 PMCID: PMC8214867 DOI: 10.1016/j.jiph.2021.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/31/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Zoonotic coronaviruses have caused several endemic and pandemic situations around the world. SARS caused the first epidemic alert at the beginning of this century, followed by MERS. COVID-19 appeared to be highly contagious, with human-to-human transmission by aerosol droplets, and reached nearly all countries around the world. A plethora of studies were performed, with reports being published within a short period of time by scientists and medical physicians. It has been difficult to find the relevant data to create an overview of the situation according to studies from accumulated findings and reports. In the present study we aimed to perform a comprehensive study in the context of the case fatality ratios (CFRs) of three major human Coronavirus outbreaks which occurred during the first twenty years of 21st century. METHODS In this study, we performed meta-analyses on SARS, MERS and COVID-19 outbreak events from publicly available records. Study analyses were performed with the help of highly reputable scientific databases such as PubMed, WOS and Scopus to evaluate and present current knowledge on zoonotic coronavirus outbreaks, starting from 2000 to the end of 2020. RESULTS A total of 250,194 research studies and records were identified with specific keywords and synonyms for the three viruses in order to cover all publications. In the end, 41 records were selected and included after applying several exclusion and inclusion criteria on identified datasets. SARS was found to have a nearly 11% case fatality ratio (CFR), which means the estimated number of deaths as a proportion of confirmed positive cases; Taiwan was the country most affected by the SARS outbreak based on the CFR analysis. MERS had CFRs of 35.8 and 26 in Saudi Arabia during the 2012 and 2015 outbreaks, respectively. COVID-19 resulted in a 2.2 CFR globally, and the USA reported the highest mortality ratio in the world in the end of first year of COVID-19 pandemic. CONCLUSION Some members of the Coronaviridae family can cause highly contagious and devastating infections among humans. Within the last two decades, the whole world has witnessed several deadly emerging infectious diseases, which are most commonly zoonotic in nature. We conclude that pre-existing immunity during the early stages of a pandemic might be important, but case control and management strategies should be improved to decrease CFRs. Finally, we have addressed several concerns in relation to outbreak events in this study.
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Affiliation(s)
- Engin Berber
- University of Tennessee, Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, Knoxville, TN, USA; Erciyes University, College of Veterinary Medicine, Department of Virology, Kayseri, Turkey.
| | - Deepak Sumbria
- University of Tennessee, Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, Knoxville, TN, USA; Dr. Yashwant Singh Parmar University of Horticulture and Forestry, Department of Silviculture and Agroforestry, College of Forestry, Solan, Himachal Pradesh, India
| | - Nurettin Çanakoğlu
- Muğla Sıtkı Koçman University, Milas Faculty of Veterinary Science, Department of Virology, Muğla, Turkey
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30
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Cordero-Franco HF, De La Garza-Salinas LH, Gomez-Garcia S, Moreno-Cuevas JE, Vargas-Villarreal J, González-Salazar F. Risk Factors for SARS-CoV-2 Infection, Pneumonia, Intubation, and Death in Northeast Mexico. Front Public Health 2021; 9:645739. [PMID: 34291023 PMCID: PMC8287121 DOI: 10.3389/fpubh.2021.645739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
Despite the social distancing and mobility restriction measures implemented for susceptible people around the world, infections and deaths due to COVID-19 continued to increase, even more so in the first months of 2021 in Mexico. Thus, it is necessary to find risk groups that can benefit from more aggressive preventive measures in a high-density population. This is a case-control study of suspected COVID-19 patients from Nuevo León, Mexico. Cases were: (1) COVID-19-positive patients and COVID-19-positive patients who (2) developed pneumonia, (3) were intubated and (4) died. Controls were: (1) COVID-19-negative patients, (2) COVID-19-positive patients without pneumonia, (3) non-intubated COVID-19-positive patients and (4) surviving COVID-19-positive patients. ≥ 18 years of age, not pregnant, were included. The pre-existing conditions analysed as risk factors were age (years), sex (male), diabetes mellitus, hypertension, chronic obstructive pulmonary disease, asthma, immunosuppression, obesity, cardiovascular disease, chronic kidney disease and smoking. The Mann-Whitney U tests, Chi square and binary logistic regression were used. A total of 56,715 suspected patients were analysed in Nuevo León, México, with 62.6% being positive for COVID-19 and, of those infected, 14% developed pneumonia, 2.9% were intubated and 8.1% died. The mean age of those infected was 44.7 years, while of those complicated it was around 60 years. Older age, male sex, diabetes, hypertension, and obesity were risk factors for infection, complications, and death from COVID-19. This study highlights the importance of timely recognition of the population exposed to pre-existing conditions to prioritise preventive measures against the virus.
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Affiliation(s)
- Hid Felizardo Cordero-Franco
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Delegación Nuevo León, Instituto Mexicano del Seguro Social, Monterrey, Mexico.,Centro de Investigaciones Biomédicas Del Noreste, Instituto Mexicano Del Seguro Social, Monterrey, Mexico
| | | | - Salvador Gomez-Garcia
- Coordinación de Información y Análisis estratégico, Delegación Regional Nuevo León, Instituto Mexicano del Seguro Social, Monterrey, Mexico
| | - Jorge E Moreno-Cuevas
- División de Ciencias de La Salud, Departamento de Ciencias Básicas, Universidad de Monterrey, Monterrey, Mexico
| | - Javier Vargas-Villarreal
- Centro de Investigaciones Biomédicas Del Noreste, Instituto Mexicano Del Seguro Social, Monterrey, Mexico
| | - Francisco González-Salazar
- Centro de Investigaciones Biomédicas Del Noreste, Instituto Mexicano Del Seguro Social, Monterrey, Mexico.,División de Ciencias de La Salud, Departamento de Ciencias Básicas, Universidad de Monterrey, Monterrey, Mexico
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31
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Bennett TD, Moffitt RA, Hajagos JG, Amor B, Anand A, Bissell MM, Bradwell KR, Bremer C, Byrd JB, Denham A, DeWitt PE, Gabriel D, Garibaldi BT, Girvin AT, Guinney J, Hill EL, Hong SS, Jimenez H, Kavuluru R, Kostka K, Lehmann HP, Levitt E, Mallipattu SK, Manna A, McMurry JA, Morris M, Muschelli J, Neumann AJ, Palchuk MB, Pfaff ER, Qian Z, Qureshi N, Russell S, Spratt H, Walden A, Williams AE, Wooldridge JT, Yoo YJ, Zhang XT, Zhu RL, Austin CP, Saltz JH, Gersing KR, Haendel MA, Chute CG. Clinical Characterization and Prediction of Clinical Severity of SARS-CoV-2 Infection Among US Adults Using Data From the US National COVID Cohort Collaborative. JAMA Netw Open 2021; 4:e2116901. [PMID: 34255046 PMCID: PMC8278272 DOI: 10.1001/jamanetworkopen.2021.16901] [Citation(s) in RCA: 160] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022] Open
Abstract
Importance The National COVID Cohort Collaborative (N3C) is a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative COVID-19 cohort to date. This multicenter data set can support robust evidence-based development of predictive and diagnostic tools and inform clinical care and policy. Objectives To evaluate COVID-19 severity and risk factors over time and assess the use of machine learning to predict clinical severity. Design, Setting, and Participants In a retrospective cohort study of 1 926 526 US adults with SARS-CoV-2 infection (polymerase chain reaction >99% or antigen <1%) and adult patients without SARS-CoV-2 infection who served as controls from 34 medical centers nationwide between January 1, 2020, and December 7, 2020, patients were stratified using a World Health Organization COVID-19 severity scale and demographic characteristics. Differences between groups over time were evaluated using multivariable logistic regression. Random forest and XGBoost models were used to predict severe clinical course (death, discharge to hospice, invasive ventilatory support, or extracorporeal membrane oxygenation). Main Outcomes and Measures Patient demographic characteristics and COVID-19 severity using the World Health Organization COVID-19 severity scale and differences between groups over time using multivariable logistic regression. Results The cohort included 174 568 adults who tested positive for SARS-CoV-2 (mean [SD] age, 44.4 [18.6] years; 53.2% female) and 1 133 848 adult controls who tested negative for SARS-CoV-2 (mean [SD] age, 49.5 [19.2] years; 57.1% female). Of the 174 568 adults with SARS-CoV-2, 32 472 (18.6%) were hospitalized, and 6565 (20.2%) of those had a severe clinical course (invasive ventilatory support, extracorporeal membrane oxygenation, death, or discharge to hospice). Of the hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March to April 2020 to 8.6% in September to October 2020 (P = .002 for monthly trend). Using 64 inputs available on the first hospital day, this study predicted a severe clinical course using random forest and XGBoost models (area under the receiver operating curve = 0.87 for both) that were stable over time. The factor most strongly associated with clinical severity was pH; this result was consistent across machine learning methods. In a separate multivariable logistic regression model built for inference, age (odds ratio [OR], 1.03 per year; 95% CI, 1.03-1.04), male sex (OR, 1.60; 95% CI, 1.51-1.69), liver disease (OR, 1.20; 95% CI, 1.08-1.34), dementia (OR, 1.26; 95% CI, 1.13-1.41), African American (OR, 1.12; 95% CI, 1.05-1.20) and Asian (OR, 1.33; 95% CI, 1.12-1.57) race, and obesity (OR, 1.36; 95% CI, 1.27-1.46) were independently associated with higher clinical severity. Conclusions and Relevance This cohort study found that COVID-19 mortality decreased over time during 2020 and that patient demographic characteristics and comorbidities were associated with higher clinical severity. The machine learning models accurately predicted ultimate clinical severity using commonly collected clinical data from the first 24 hours of a hospital admission.
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Affiliation(s)
- Tellen D. Bennett
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
| | - Richard A. Moffitt
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | | | | | - Adit Anand
- Stony Brook University, Stony Brook, New York
| | | | | | | | - James Brian Byrd
- Department of Internal Medicine, The University of Michigan at Ann Arbor, Ann Arbor
| | - Alina Denham
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Peter E. DeWitt
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
| | - Davera Gabriel
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian T. Garibaldi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Elaine L. Hill
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Stephanie S. Hong
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ramakanth Kavuluru
- Division of Biomedical Informatics, Department of Internal Medicine, University of Kentucky, Lexington
| | - Kristin Kostka
- Real World Solutions, IQVIA, Cambridge, Massachusetts
- Observational Health Data Sciences and Informatics, New York, New York
| | - Harold P. Lehmann
- Division of Health Science Informatics, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eli Levitt
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham
| | | | | | - Julie A. McMurry
- Translational and Integrative Sciences Center, Oregon State University, Corvallis
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Muschelli
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew J. Neumann
- Translational and Integrative Sciences Center, Oregon State University, Corvallis
| | | | - Emily R. Pfaff
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Zhenglong Qian
- Department of biomedical informatics, Stony Brook University, Stony Brook, New York
| | | | - Seth Russell
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, University of Colorado, Aurora
| | - Heidi Spratt
- Department of Preventive Medicine and Public Health, University of Texas Medical Branch, Galveston
| | - Anita Walden
- Sage Bionetworks, Seattle, Washington
- Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland
| | - Andrew E. Williams
- Tufts Medical Center Clinical and Translational Science Institute, Tufts Medical Center, Boston, Massachusetts
| | | | - Yun Jae Yoo
- Stony Brook University, Stony Brook, New York
| | - Xiaohan Tanner Zhang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L. Zhu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher P. Austin
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
| | - Joel H. Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Ken R. Gersing
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
| | - Melissa A. Haendel
- TriNetX, Cambridge, Massachusetts
- Center for Health AI, University of Colorado, Aurora
| | - Christopher G. Chute
- Department of Health Policy and Management, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Nursing, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Melo AKG, Milby KM, Caparroz ALMA, Pinto ACPN, Santos RRP, Rocha AP, Ferreira GA, Souza VA, Valadares LDA, Vieira RMRA, Pileggi GS, Trevisani VFM. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis. PLoS One 2021; 16:e0253894. [PMID: 34185801 PMCID: PMC8241122 DOI: 10.1371/journal.pone.0253894] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 06/16/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To describe the laboratory parameters and biomarkers of the cytokine storm syndrome associated with severe and fatal COVID-19 cases. METHODS A search with standardized descriptors and synonyms was performed on November 28th, 2020 of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, LILACS, and IBECS to identify studies of interest. Grey literature searches and snowballing techniques were additionally utilized to identify yet-unpublished works and related citations. Two review authors independently screened the retrieved titles and abstracts, selected eligible studies for inclusion, extracted data from the included studies, and then assessed the risk of bias using the Newcastle-Ottawa Scale. Eligible studies were those including laboratory parameters-including serum interleukin-6 levels-from mild, moderate, or severe COVID-19 cases. Laboratory parameters, such as interleukin-6, ferritin, hematology, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer, were extracted from the studies. Meta-analyses were conducted using the laboratory data to estimate mean differences with associated 95% confidence intervals. DATA SYNTHESIS The database search yielded 9,620 records; 40 studies (containing a total of 9,542 patients) were included in the final analysis. Twenty-one studies (n = 4,313) assessed laboratory data related to severe COVID-19 cases, eighteen studies (n = 4,681) assessed predictors for fatal COVID-19 cases and one study (n = 548) assessed laboratory biomarkers related to severe and fatal COVID-19 cases. Lymphopenia, thrombocytopenia, and elevated levels of interleukin-6, ferritin, D-dimer, aspartate aminotransferase, C-Reactive-Protein, procalcitonin, creatinine, neutrophils and leucocytes were associated with severe and fatal COVID-19 cases. CONCLUSIONS This review points to interleukin-6, ferritin, leukocytes, neutrophils, lymphocytes, platelets, C-Reactive Protein, procalcitonin, lactate dehydrogenase, aspartate aminotransferase, creatinine, and D-dimer as important biomarkers of cytokine storm syndrome. Elevated levels of interleukin-6 and hyperferritinemia should be considered as red flags of systemic inflammation and poor prognosis in COVID-19.
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Affiliation(s)
- Ana Karla G. Melo
- Division of Rheumatology, Department of Clinical Medicine, Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Keilla M. Milby
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Ana Luiza M. A. Caparroz
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Pediatric Rheumatology, Hospital de Base, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brazil
| | - Ana Carolina P. N. Pinto
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Biological and Health Sciences, Universidade Federal do Amapá, Macapá, AP, Brazil
- Fulbright Alumna at University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Rodolfo R. P. Santos
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Data Science, Synova Health, Campinas, SP, Brazil
| | - Aline P. Rocha
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Gilda A. Ferreira
- Department of Lokomotor System, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Viviane A. Souza
- Department of Clinical Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | | | - Rejane M. R. A. Vieira
- Department of Clinical Medicine, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
- Department of Clinical Medicine, Universidade de Fortaleza, Fortaleza, CE, Brazil
| | - Gecilmara S. Pileggi
- Department of Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Virgínia F. M. Trevisani
- Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Department of Rheumatology, Universidade de Santo Amaro, São Paulo, SP, Brazil
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Separated serum was used for the analysisCombined Analysis of Anti SARS-CoV-2 IgG and IgM Responses in COVID19 Patients in India. Indian J Clin Biochem 2021; 36:485-491. [PMID: 34177138 PMCID: PMC8212795 DOI: 10.1007/s12291-021-00986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a global health problem, India being the second most affected country. The kinetics of antibody response to SARS-CoV-2 in Indian population is not studied yet. To understand serological response in relation to age, gender, time period and severity of disease, Roche Elecsys anti-SARS-CoV-2 test was used which analysed both IgM and IgG. One hundred and three COVID-19 patients were enrolled. Seropositivity was seen in 64% of patients, with 33% at ≤ 7 days, 62% between 8 and 15 days and 81% at ≥ 16 days from the time of admission. Men (65%) showed higher antibody response than women (59%), whereas no difference was observed in seropositivity with respect to age of the patients. Dynamics of antibody responses revealed individual variations. Patients in ICU had higher antibody reactivity with 67% positivity as compared to 60% positivity in non-ICU patients. Kinetics of antibody response during COVID-19 disease varied in relation to gender, age, time period and severity and these factors might play an important role in treatment and control of COVID-19.
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Pires de Souza GA, Osman IO, Le Bideau M, Baudoin JP, Jaafar R, Devaux C, La Scola B. Angiotensin II Receptor Blockers (ARBs Antihypertensive Agents) Increase Replication of SARS-CoV-2 in Vero E6 Cells. Front Cell Infect Microbiol 2021; 11:639177. [PMID: 34178717 PMCID: PMC8231006 DOI: 10.3389/fcimb.2021.639177] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
Several comorbidities, including hypertension, have been associated with an increased risk of developing severe disease during SARS-CoV-2 infection. Angiotensin II receptor blockers (ARBs) are currently some of the most widely-used drugs to control blood pressure by acting on the angiotensin II type 1 receptor (AT1R). ARBs have been reported to trigger the modulation of the angiotensin I converting enzyme 2 (ACE2), the receptor used by the virus to penetrate susceptible cells, raising concern that such treatments may promote virus capture and increase their viral load in patients receiving ARBs therapy. In this in vitro study, we reviewed the effect of ARBs on ACE2 and AT1R expression and investigated whether treatment of permissive ACE2+/AT1R+ Vero E6 cells with ARBs alters SARS-CoV-2 replication in vitro in an angiotensin II-free system. After treating the cells with the ARBs, we observed an approximate 50% relative increase in SARS-CoV-2 production in infected Vero E6 cells that correlates with the ARBs-induced up-regulation of ACE2 expression. From this data, we believe that the use of ARBs in hypertensive patients infected by SARS-CoV-2 should be carefully evaluated.
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Affiliation(s)
- Gabriel Augusto Pires de Souza
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France
| | - Ikram Omar Osman
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France
| | - Marion Le Bideau
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France
| | - Jean-Pierre Baudoin
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France
| | - Rita Jaafar
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France
| | - Christian Devaux
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France.,Centre National de La Recherche Scientifique (CNRS), Marseille, France
| | - Bernard La Scola
- Aix-Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique - Hôpitaux de Marseille (AP-HM), MEPHI, Marseille, France.,Microbes, Evolution, Phylogénie et Infection (MEPHI), IHU - Méditerranée Infection, Marseille, France
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Liang C, Zhang W, Li S, Qin G. Coronary heart disease and COVID-19: A meta-analysis. ACTA ACUST UNITED AC 2021; 156:547-554. [PMID: 34109276 PMCID: PMC8178966 DOI: 10.1016/j.medcle.2020.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022]
Abstract
Objective Since the World Health Organization (WHO) announced coronavirus disease 2019 (COVID-19) had become a global pandemic on March 11, 2020, the number of infections has been increasing. The purpose of this meta-analysis was to investigate the prognosis of COVID-19 in patients with coronary heart disease. Method Pubmed, Embase, and Cochrane Library databases were searched to collect the literature concerning coronary heart disease and COVID-19. The retrieval time was from inception to Nov 20, 2020, using Stata version 14.0 for meta-analysis. Results A total of 22,148 patients from 40 studies were included. The meta-analysis revealed that coronary heart disease was associated with poor prognosis of COVID-19 (OR=3.42, 95%CI [2.83, 4.13], P < 0.001). After subgroup analysis, coronary heart disease was found to be related to mortality (OR = 3.75, 95%CI [2.91, 4.82], P < 0.001), severe/critical COVID-19 (OR = 3.23, 95%CI [2.19, 4.77], P < 0.001), ICU admission (OR = 2.25, 95%CI [1.34, 3.79], P = 0.002), disease progression (OR = 3.01, 95%CI [1.46, 6.22], P = 0.003); Meta-regression showed that the association between coronary heart disease and poor prognosis of COVID-19 was affected by hypertension (P = 0.004), and subgroup analysis showed that compared with the proportion of hypertension >30% (OR = 2.85, 95%CI [2.33, 3.49]), the proportion of hypertension <30% (OR = 4.78, 95%CI [3.50, 6.51]) had a higher risk of poor prognosis. Conclusion Coronary heart disease is a risk factor for poor prognosis in patients with COVID-19.
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Affiliation(s)
- Chendi Liang
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - Weijun Zhang
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Shuzhen Li
- Baoan District Center for Disease Control and Prevention, Shenzhen, Guangdong, China
| | - Gang Qin
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Yegorov S, Goremykina M, Ivanova R, Good SV, Babenko D, Shevtsov A, MacDonald KS, Zhunussov Y. Epidemiology, clinical characteristics, and virologic features of COVID-19 patients in Kazakhstan: A nation-wide retrospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 4:100096. [PMID: 33880458 PMCID: PMC8050615 DOI: 10.1016/j.lanepe.2021.100096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The earliest coronavirus disease-2019 (COVID-19) cases in Central Asia were announced in March 2020 by Kazakhstan. Despite the implementation of aggressive measures to curb infection spread, gaps remain in the understanding of the clinical and epidemiologic features of the regional pandemic. METHODS We did a retrospective, observational cohort study of patients with laboratory-confirmed COVID-19 hospitalized in Kazakhstan between February and April 2020. We compared demographic, clinical, laboratory and radiological data of patients with different COVID-19 severities on admission. Logistic regression was used to assess factors associated with disease severity and in-hospital death. Whole-genome SARS-CoV-2 analysis was performed in 53 patients. FINDINGS Of the 1072 patients with laboratory-confirmed COVID-19 in March-April 2020, the median age was 36 years (IQR 24-50) and 484 (45%) were male. On admission, 683 (64%) participants had asymptomatic/mild, 341 (32%) moderate, and 47 (4%) severe-to-critical COVID-19 manifestation; 20 in-hospital deaths (1•87%) were reported by 5 May 2020. Multivariable regression indicated increasing odds of severe disease associated with older age (odds ratio 1•05, 95% CI 1•03-1•07, per year increase; p<0•001), the presence of comorbidities (2•34, 95% CI 1•18-4•85; p=0•017) and elevated white blood cell count (WBC, 1•13, 95% CI 1•00-1•27; p=0•044) on admission, while older age (1•09, 95% CI 1•06-1•13, per year increase; p<0•001) and male sex (5•63, 95% CI 2•06-17•57; p=0•001) were associated with increased odds of in-hospital death. The SARS-CoV-2 isolates grouped into seven phylogenetic lineages, O/B.4.1, S/A.2, S/B.1.1, G/B.1, GH/B.1.255, GH/B.1.3 and GR/B.1.1.10; 87% of the isolates were O and S sub-types descending from early Asian lineages, while the G, GH and GR isolates were related to lineages from Europe and the Americas. INTERPRETATION Older age, comorbidities, increased WBC count, and male sex were risk factors for COVID-19 disease severity and mortality in Kazakhstan. The broad SARS-CoV-2 diversity suggests multiple importations and community-level amplification predating travel restriction. FUNDING Ministry of Education and Science of the Republic of Kazakhstan.
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Affiliation(s)
- Sergey Yegorov
- School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Ave, Nur-Sultan 010000, Kazakhstan
- Michael G. DeGroote Institute for Infectious Disease Research, Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Maiya Goremykina
- Department of Rheumatology and Non-Infectious Diseases, Semey Medical University 103 Abai street, Semey 071400, Kazakhstan
| | - Raifa Ivanova
- Department of Rheumatology and Non-Infectious Diseases, Semey Medical University 103 Abai street, Semey 071400, Kazakhstan
| | - Sara V. Good
- Department of Biology, University of Winnipeg, 599 Portage Avenue, Winnipeg, Manitoba R3B2E9, Canada
| | - Dmitriy Babenko
- Department of Biology, University of Winnipeg, 599 Portage Avenue, Winnipeg, Manitoba R3B2E9, Canada
- Research Centre, Karaganda Medical University, 40 Gogol St, Karaganda, 100008 Kazakhstan
| | - Alexandr Shevtsov
- National Centre for Biotechnology, 13/5 Kurgalzhynskoye road, Nur-Sultan 010000, Kazakhstan
| | - COVID-19 Genomics Research Group
- School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Ave, Nur-Sultan 010000, Kazakhstan
- Department of Rheumatology and Non-Infectious Diseases, Semey Medical University 103 Abai street, Semey 071400, Kazakhstan
- Department of Biology, University of Winnipeg, 599 Portage Avenue, Winnipeg, Manitoba R3B2E9, Canada
- Research Centre, Karaganda Medical University, 40 Gogol St, Karaganda, 100008 Kazakhstan
- National Centre for Biotechnology, 13/5 Kurgalzhynskoye road, Nur-Sultan 010000, Kazakhstan
- Departments of Medicine, Microbiology & Immunology, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9, Canada
- JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, Manitoba R3E3L5, Canada
- Department of Public Health, Semey Medical University, 103 Abai street, Semey 071400, Kazakhstan
- Michael G. DeGroote Institute for Infectious Disease Research, Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - Kelly S. MacDonald
- Departments of Medicine, Microbiology & Immunology, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9, Canada
- JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, Manitoba R3E3L5, Canada
| | - Yersin Zhunussov
- Department of Public Health, Semey Medical University, 103 Abai street, Semey 071400, Kazakhstan
| | - Semey COVID-19 Epidemiology Research Group
- School of Sciences and Humanities, Nazarbayev University, 53 Kabanbay Batyr Ave, Nur-Sultan 010000, Kazakhstan
- Department of Rheumatology and Non-Infectious Diseases, Semey Medical University 103 Abai street, Semey 071400, Kazakhstan
- Department of Biology, University of Winnipeg, 599 Portage Avenue, Winnipeg, Manitoba R3B2E9, Canada
- Research Centre, Karaganda Medical University, 40 Gogol St, Karaganda, 100008 Kazakhstan
- National Centre for Biotechnology, 13/5 Kurgalzhynskoye road, Nur-Sultan 010000, Kazakhstan
- Departments of Medicine, Microbiology & Immunology, Max Rady College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9, Canada
- JC Wilt Infectious Diseases Research Centre, Public Health Agency of Canada, 745 Logan Avenue, Winnipeg, Manitoba R3E3L5, Canada
- Department of Public Health, Semey Medical University, 103 Abai street, Semey 071400, Kazakhstan
- Michael G. DeGroote Institute for Infectious Disease Research, Faculty of Health Sciences, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
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Ramphul K, Lohana P, Ramphul Y, Park Y, Mejias S, Dhillon BK, Sombans S, Verma R. Hypertension, diabetes mellitus, and cerebrovascular disease predispose to a more severe outcome of COVID-19. Arch Med Sci Atheroscler Dis 2021; 6:e30-e39. [PMID: 34027212 PMCID: PMC8117084 DOI: 10.5114/amsad.2021.105255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The world is currently facing the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The total number of cases of coronavirus disease 2019 (COVID-19) is rising daily and no vaccine has yet been approved. While the pathophysiology behind the virus is still being studied, many possible several risk factors using small sample sizes have been found. MATERIAL AND METHODS We conducted a pooled analysis using several databases such as Medline, Scopus, Wangfang, Web of Science, Research Square, medrxiv, and Google Scholar to identify studies reporting severe and non-severe groups of COVID-19 patients. The odds ratios as well as the 95% confidence intervals for hypertension, diabetes, and cerebrovascular disease leading to severe COVID-19 were calculated using R-software. RESULTS Fifty-three articles were used for our analysis and they involved 30,935 confirmed cases of COVID-19 from several countries across the world. The odds ratio for severe COVID-19 in hypertensive patients, diabetics, and patients with a history of cerebrovascular disease was 2.58 (95% confidence interval (CI): 2.16-3.08, from 53 studies), 2.17 (95% CI: 1.72-2.74, from 44 studies), and 2.63 (95% CI: 1.80-3.85, from 25 studies), respectively. CONCLUSIONS Our analysis confirms that patients with hypertension, diabetes, or cerebrovascular disease are at a higher risk of a severe outcome of COVID-19. It is thus vital for physicians to identify the main risk factors for a severe outcome of this disease.
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Affiliation(s)
- Kamleshun Ramphul
- Department of Pediatrics, Shanghai Xin Hua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Petras Lohana
- Department of Medicine, Liaquat University of Medical and Health Sciences Hospital, Jamshroo, Pakistan
| | - Yogeshwaree Ramphul
- Department of Medicine, Sir Seewoosagur Ramgoolam National Hospital, Pamplemousses, Mauritius
| | - Yun Park
- Department of Orthodontics, Affiliation: Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Stephanie Mejias
- Department of Medicine, University Iberoamericana UNIBE, School of Medicine, Santo Domingo, Dominican Republic
| | | | - Shaheen Sombans
- Department of Medicine, Bharati Vidyapeeth University Medical College and Hospital, Pune, India
| | - Renuka Verma
- Department of Medicine, Guru Gobind Singh Medical College, Punjab, India
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Salem Salamh AB, Salamah AA, Akyüz HI. A Study of a New Technique of the CT Scan View and Disease Classification Protocol Based on Level Challenges in Cases of Coronavirus Disease. Radiol Res Pract 2021; 2021:5554408. [PMID: 33791127 PMCID: PMC7996048 DOI: 10.1155/2021/5554408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/21/2021] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
The chest Computer Tomography (CT scan) is used in the diagnosis of coronavirus disease 2019 (COVID-19) and is an important complement to the Reverse Transcription Polymerase Chain Reaction (RT-PCR) test. The paper aims to improve the radiological diagnosis in the case of coronavirus disease COVID-19 pneumonia on forms of noninvasive approaches with conventional and high-resolution computer tomography (HRCT) scan images upon chest CT images of patients confirmed with mild to severe findings. The preliminary study is to compare the radiological findings of COVID-19 pneumonia in conventional chest CT images with images processed by a new tool and reviewed by expert radiologists. The researchers used a new filter called Golden Key Tool (GK-Tool) which has confirmed the improvement in the quality and diagnostic efficacy of images acquired using our modified images. Further, Convolution Neural Networks (CNNs) architecture called VGG face was used to classify chest CT images. The classification has been performed by using VGG face on various datasets which are considered as a protocol to diagnose COVID-19, Non-COVID-19 (other lung diseases), and normal cases (no findings on chest CT). Accordingly, the performance evaluation of the GK-Tool was fairly good as shown in the first set of results, where 80-95% of participants show a good to excellent assessment of the new images view in the case of COVID-19 patients. The results, in general, illustrate good recognition rates in the diagnosis and, therefore, would be significantly higher in normal cases with COVID-19. These results could reduce the radiologist's workload burden and play a major role in the decision-making process.
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Affiliation(s)
- Ahmed B. Salem Salamh
- Institute of Science, Material Science and Engineering, Kastamonu University, Kuzey Kent /P.O. Box, 37150, Kastamonu, Kastamonu, Turkey
| | | | - Halil Ibrahim Akyüz
- Computer and Teaching Technologies Education, Kastamonu University, Kuzey Kent /P.O. Box, 37150, Kastamonu, Kastamonu, Turkey
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Li Y, Ashcroft T, Chung A, Dighero I, Dozier M, Horne M, McSwiggan E, Shamsuddin A, Nair H. Risk factors for poor outcomes in hospitalised COVID-19 patients: A systematic review and meta-analysis. J Glob Health 2021; 11:10001. [PMID: 33767855 PMCID: PMC7980087 DOI: 10.7189/jogh.11.10001] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Understanding the risk factors for poor outcomes among COVID-19 patients could help identify vulnerable populations who would need prioritisation in prevention and treatment for COVID-19. We aimed to critically appraise and synthesise published evidence on the risk factors for poor outcomes in hospitalised COVID-19 patients. METHODS We searched PubMed, medRxiv and the WHO COVID-19 literature database for studies that reported characteristics of COVID-19 patients who required hospitalisation. We included studies published between January and May 2020 that reported adjusted effect size of any demographic and/or clinical factors for any of the three poor outcomes: mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation. We appraised the quality of the included studies using Joanna Briggs Institute appraisal tools and quantitatively synthesised the evidence through a series of random-effect meta-analyses. To aid data interpretation, we further developed an interpretation framework that indicated strength of the evidence, informed by both quantity and quality of the evidence. RESULTS We included a total of 40 studies in our review. Most of the included studies (29/40, 73%) were assessed as "good quality", with assessment scores of 80 or more. We found that male sex (pooled odds ratio (OR) = 1.32 (95% confidence interval (CI) = 1.18-1.48; 20 studies), older age (OR = 1.05, 95% CI = 1.04-1.07, per one year of age increase; 10 studies), obesity (OR = 1.59, 95% CI = 1.02-2.48; 4 studies), diabetes (OR = 1.25, 95% CI = 1.11-1.40; 11 studies) and chronic kidney diseases (6 studies; OR = 1.57, 95% CI = 1.27-1.93) were associated with increased risks for mortality with the greatest strength of evidence based on our interpretation framework. We did not find increased risk of mortality for several factors including chronic obstructive pulmonary diseases (5 studies), cancer (4 studies), or current smoker (5 studies); however, this does not indicate absence of risk due to limited data on each of these factors. CONCLUSION Male sex, older age, obesity, diabetes and chronic kidney diseases are important risk factors of COVID-19 poor outcomes. Our review provides not only an appraisal and synthesis of evidence on the risk factors of COVID-19 poor outcomes, but also a data interpretation framework that could be adopted by relevant future research.
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Affiliation(s)
- You Li
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Izzie Dighero
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marshall Dozier
- Information Services, University of Edinburgh, Edinburgh, UK
| | - Margaret Horne
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Cho SY, Park SS, Song MK, Bae YY, Lee DG, Kim DW. Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study. J Med Internet Res 2021; 23:e26257. [PMID: 33539312 PMCID: PMC7901599 DOI: 10.2196/26257] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count <1000/mm3. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (P<.001). The length of hospital stay and disease severity were directly associated with overall survival (P<.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.
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Affiliation(s)
- Sung-Yeon Cho
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Kyu Song
- Data Research Institute, YMDtech Inc, Seoul, Republic of Korea
- St. Mary's Gong-Gam Mental Health Clinic, Siheung-si, Gyeonggi-do, Republic of Korea
| | - Young Yi Bae
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Wook Kim
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Mitsumura T, Okamoto T, Shirai T, Iijima Y, Sakakibara R, Honda T, Ishizuka M, Aiboshi J, Tateishi T, Tamaoka M, Shigemitsu H, Arai H, Otomo Y, Tohda S, Anzai T, Takahashi K, Yasuda S, Miyazaki Y. Predictors associated with clinical improvement of SARS-CoV-2 pneumonia. J Infect Chemother 2021; 27:857-863. [PMID: 33676842 PMCID: PMC7885694 DOI: 10.1016/j.jiac.2021.02.012] [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: 12/03/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
Background There are few agents that have been proven effective for COVID-19. Predicting clinical improvement as well as mortality or severity is very important. Objectives This study aimed to investigate the factors associated with the clinical improvement of COVID-19. Methods Overall, 74 patients receiving treatment for COVID-19 at Tokyo Medical and Dental University Hospital from April 6th to May 15th, 2020 were included in this study. Clinical improvement was evaluated, which defined as the decline of two levels on a six-point ordinal scale of clinical status or discharge alive from the hospital within 28 days after admission. The clinical courses were particularly investigated and the factors related to time to clinical improvement were analyzed with the log-rank test and the Cox proportional hazard model. Results Forty-nine patients required oxygen support during hospitalization, 22 patients required invasive mechanical ventilation, and 5 patients required extracorporeal membrane oxygenation. A total of 83% of cases reached clinical improvement. Longer period of time from onset to admission (≥10 days) (HR, 1.057; 95% CI, 1.002–1.114), no hypertension (HR, 2.077; 95% CI, 1.006–4.287), and low D-dimer levels (<1 μg/ml) (HR, 2.372; 95% CI, 1.229–4.576) were confirmed to be significant predictive factors for time to clinical improvement. Furthermore, a lower SARS-CoV-2 RNA copy number was also a predictive factor for clinical improvement. Conclusions Several predictors for the clinical improvement of COVID-19 pneumonia were identified. These results may be important for the management of COVID-19 pneumonia.
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Affiliation(s)
- Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masahiro Ishizuka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shuji Tohda
- Department of Laboratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tatsuhiko Anzai
- M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Kunihiko Takahashi
- M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Li Y, Li J, Ke J, Jiao N, Zhu L, Shen L, Chen L, Jiang Z, Cheng S, Huang Y, Zou Y, Zhu R, Yan G. Adverse Outcomes Associated With Corticosteroid Use in Critical COVID-19: A Retrospective Multicenter Cohort Study. Front Med (Lausanne) 2021; 8:604263. [PMID: 33634148 PMCID: PMC7900536 DOI: 10.3389/fmed.2021.604263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/21/2021] [Indexed: 12/15/2022] Open
Abstract
Corticosteroid is commonly used to reduce damage from inflammatory reactions in coronavirus disease 2019 (COVID-19). We aim to determine the outcomes of corticosteroid use in critically ill COVID-19 patients. Ninety six critically ill patients, hospitalized in 14 hospitals outside Wuhan from January 16 to March 30, 2020 were enrolled in this study. Among 96 critical patients, 68 were treated with corticosteroid (CS group), while 28 were not treated with corticosteroids (non-CS group). Multivariable logistic regression were performed to determine the possible correlation between corticosteroid use and the treatment outcomes. Forty-six (68%) patients in the CS group died compared to six (21%) of the non-CS group. Corticosteroid use was also associated with the development of ARDS, exacerbation of pulmonary fibrosis, longer hospital stay and virus clearance time. On admission, no difference in laboratory findings between the CS and the non-CS group was observed. After corticosteroid treatment, patients treated with corticosteroids were associated with higher counts of white blood cells, neutrophils, neutrophil-to-lymphocyte ratio, alanine aminotransferase level and Sequential Organ Failure Assessment score. In conclusion, corticosteroid use in critically ill COVID-19 patients was associated with a much higher case fatality rate. Frequent incidence of liver injury and multi-organ failure in corticosteroid treated patients may have contributed to the adverse outcomes. The multi-organ failure is likely caused by more persistent SARS-CoV-2 infection and higher viral load, due to the inhibition of immune surveillance by corticosteroid.
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Affiliation(s)
- Yichen Li
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Li
- The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, China
| | - Jia Ke
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Na Jiao
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Putuo People's Hospital, Department of Bioinformatics, Tongji University, Shanghai, China
| | - Lixin Zhu
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lihan Shen
- Department of Critical Care Medicine, Dongguan People's Hospital, Southern Medical University, Dongguan, China
| | - Lei Chen
- Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Jiang
- School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Sijing Cheng
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,School of Medicine, Sun Yat-sen University, Shenzhen, China
| | - Yibo Huang
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yifeng Zou
- The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruixin Zhu
- Putuo People's Hospital, Department of Bioinformatics, Tongji University, Shanghai, China
| | - Guangjun Yan
- The Third Clinical Medical College of Yangtze University, Jingzhou Hospital of Traditional Chinese Medicine, Jingzhou, China
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Liu S, Cao Y, Du T, Zhi Y. Prevalence of Comorbid Asthma and Related Outcomes in COVID-19: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:693-701. [PMID: 33309934 PMCID: PMC7725230 DOI: 10.1016/j.jaip.2020.11.054] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/07/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The impact of asthma on coronavirus disease 2019 (COVID-19) remains largely unknown. OBJECTIVE To investigate the asthma prevalence among patients with COVID-19 and compare outcomes between patients with and without asthma. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, bioRxiv, and medRxiv for studies reporting asthma prevalence in general patients with COVID-19 or comparing outcomes between patients with and without asthma, and excluded duplicate publications, reviews, editorials, comments, single case reports, or small case series (<10 cases). We determined the pooled estimates of effect using random-effect model. RESULTS On the basis of 131 studies (410,382 patients), we found great variability in the prevalence of comorbid asthma among patients with COVID-19 in different countries or regions ranging from 1.1% to 16.9%. No significant difference in asthma prevalence was found between hospitalized and nonhospitalized (risk ratio [RR], 1.15; 95% CI, 0.92-1.43), severe and nonsevere (RR, 1.21; 95% CI, 0.92-1.57), intensive care unit and non-intensive care unit (RR, 1.19; 95% CI, 0.92-1.54), dead and survived (RR, 0.90; 95% CI, 0.73-1.11), intubated/mechanically ventilated and nonintubated/mechanically ventilated (RR, 0.91; 95% CI, 0.71-1.17) patients with COVID-19. Patients with asthma have a lower risk of death compared with patients without asthma (RR, 0.65; 95% CI, 0.43-0.98). Asthma is not associated with a higher risk of intubation or mechanical ventilation (RR, 1.03; 95% CI, 0.72-1.46). CONCLUSIONS There is great variability in asthma prevalence among patients with COVID-19 in different countries or regions. Asthma is not associated with higher COVID-19 severity or worse prognosis, and patients with asthma are found to have a lower risk of death compared with patients without asthma.
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Affiliation(s)
- Shuang Liu
- Department of Allergy & Clinical Immunology, National Clinical Research Center for Immunologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China; School of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yang Cao
- Department of Allergy & Clinical Immunology, National Clinical Research Center for Immunologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China; School of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tian Du
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China; Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuxiang Zhi
- Department of Allergy & Clinical Immunology, National Clinical Research Center for Immunologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
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Richardson TG, Fang S, Mitchell RE, Holmes MV, Davey Smith G. Evaluating the effects of cardiometabolic exposures on circulating proteins which may contribute to severe SARS-CoV-2. EBioMedicine 2021; 64:103228. [PMID: 33548839 PMCID: PMC7857697 DOI: 10.1016/j.ebiom.2021.103228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/14/2020] [Accepted: 01/13/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Developing insight into the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of critical importance to overcome the global pandemic caused by coronavirus disease 2019 (covid-19). In this study, we have applied Mendelian randomization (MR) to systematically evaluate the effect of 10 cardiometabolic risk factors and genetic liability to lifetime smoking on 97 circulating host proteins postulated to either interact or contribute to the maladaptive host response of SARS-CoV-2. METHODS We applied the inverse variance weighted (IVW) approach and several robust MR methods in a two-sample setting to systemically estimate the genetically predicted effect of each risk factor in turn on levels of each circulating protein. Multivariable MR was conducted to simultaneously evaluate the effects of multiple risk factors on the same protein. We also applied MR using cis-regulatory variants at the genomic location responsible for encoding these proteins to estimate whether their circulating levels may influence severe SARS-CoV-2. FINDINGS In total, we identified evidence supporting 105 effects between risk factors and circulating proteins which were robust to multiple testing corrections and sensitivity analyzes. For example, body mass index provided evidence of an effect on 23 circulating proteins with a variety of functions, such as inflammatory markers c-reactive protein (IVW Beta=0.34 per standard deviation change, 95% CI=0.26 to 0.41, P = 2.19 × 10-16) and interleukin-1 receptor antagonist (IVW Beta=0.23, 95% CI=0.17 to 0.30, P = 9.04 × 10-12). Further analyzes using multivariable MR provided evidence that the effect of BMI on lowering immunoglobulin G, an antibody class involved in protection from infection, is substantially mediated by raised triglycerides levels (IVW Beta=-0.18, 95% CI=-0.25 to -0.12, P = 2.32 × 10-08, proportion mediated=44.1%). The strongest evidence that any of the circulating proteins highlighted by our initial analysis influence severe SARS-CoV-2 was identified for soluble glycoprotein 130 (odds ratio=1.81, 95% CI=1.25 to 2.62, P = 0.002), a signal transductor for interleukin-6 type cytokines which are involved in inflammatory response. However, based on current case samples for severe SARS-CoV-2 we were unable to replicate findings in independent samples. INTERPRETATION Our findings highlight several key proteins which are influenced by established exposures for disease. Future research to determine whether these circulating proteins mediate environmental effects onto risk of SARS-CoV-2 infection or covid-19 progression are warranted to help elucidate therapeutic strategies for severe covid-19 disease. FUNDING The Medical Research Council, the Wellcome Trust, the British Heart Foundation and UK Research and Innovation.
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Affiliation(s)
- Tom G Richardson
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom.
| | - Si Fang
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom
| | - Ruth E Mitchell
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom
| | - Michael V Holmes
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom; Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit (MRC IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom
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Bennett TD, Moffitt RA, Hajagos JG, Amor B, Anand A, Bissell MM, Bradwell KR, Bremer C, Byrd JB, Denham A, DeWitt PE, Gabriel D, Garibaldi BT, Girvin AT, Guinney J, Hill EL, Hong SS, Jimenez H, Kavuluru R, Kostka K, Lehmann HP, Levitt E, Mallipattu SK, Manna A, McMurry JA, Morris M, Muschelli J, Neumann AJ, Palchuk MB, Pfaff ER, Qian Z, Qureshi N, Russell S, Spratt H, Walden A, Williams AE, Wooldridge JT, Yoo YJ, Zhang XT, Zhu RL, Austin CP, Saltz JH, Gersing KR, Haendel MA, Chute CG. The National COVID Cohort Collaborative: Clinical Characterization and Early Severity Prediction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33469592 PMCID: PMC7814838 DOI: 10.1101/2021.01.12.21249511] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The majority of U.S. reports of COVID-19 clinical characteristics, disease course, and treatments are from single health systems or focused on one domain. Here we report the creation of the National COVID Cohort Collaborative (N3C), a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative U.S. cohort of COVID-19 cases and controls to date. This multi-center dataset supports robust evidence-based development of predictive and diagnostic tools and informs critical care and policy. Methods and Findings: In a retrospective cohort study of 1,926,526 patients from 34 medical centers nationwide, we stratified patients using a World Health Organization COVID-19 severity scale and demographics; we then evaluated differences between groups over time using multivariable logistic regression. We established vital signs and laboratory values among COVID-19 patients with different severities, providing the foundation for predictive analytics. The cohort included 174,568 adults with severe acute respiratory syndrome associated with SARS-CoV-2 (PCR >99% or antigen <1%) as well as 1,133,848 adult patients that served as lab-negative controls. Among 32,472 hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March/April 2020 to 8.6% in September/October 2020 (p = 0.002 monthly trend). In a multivariable logistic regression model, age, male sex, liver disease, dementia, African-American and Asian race, and obesity were independently associated with higher clinical severity. To demonstrate the utility of the N3C cohort for analytics, we used machine learning (ML) to predict clinical severity and risk factors over time. Using 64 inputs available on the first hospital day, we predicted a severe clinical course (death, discharge to hospice, invasive ventilation, or extracorporeal membrane oxygenation) using random forest and XGBoost models (AUROC 0.86 and 0.87 respectively) that were stable over time. The most powerful predictors in these models are patient age and widely available vital sign and laboratory values. The established expected trajectories for many vital signs and laboratory values among patients with different clinical severities validates observations from smaller studies, and provides comprehensive insight into COVID-19 characterization in U.S. patients. Conclusions: This is the first description of an ongoing longitudinal observational study of patients seen in diverse clinical settings and geographical regions and is the largest COVID-19 cohort in the United States. Such data are the foundation for ML models that can be the basis for generalizable clinical decision support tools. The N3C Data Enclave is unique in providing transparent, reproducible, easily shared, versioned, and fully auditable data and analytic provenance for national-scale patient-level EHR data. The N3C is built for intensive ML analyses by academic, industry, and citizen scientists internationally. Many observational correlations can inform trial designs and care guidelines for this new disease.
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Aggarwal A, Agarwal R, Dhooria S, Prasad K, Sehgal I, Muthu V. Impact of chronic obstructive pulmonary disease on severity and outcomes in COVID-19 patients: A systematic review. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2021. [DOI: 10.4103/jncd.jncd_7_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Del Giorno R, Quarenghi M, Stefanelli K, Capelli S, Giagulli A, Quarleri L, Stehrenberger D, Ossola N, Monotti R, Gabutti L. Nutritional Risk Screening and Body Composition in COVID-19 Patients Hospitalized in an Internal Medicine Ward. Int J Gen Med 2020; 13:1643-1651. [PMID: 33380822 PMCID: PMC7767704 DOI: 10.2147/ijgm.s286484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malnutrition in patients hospitalized in internal medicine wards is highly prevalent and represents a prognostic factor of worse outcomes. Previous evidence suggested the prognostic role of the nutritional status in patients affected by the coronavirus disease 2019 (COVID-19). We aim to investigate the nutritional risk in patients with COVID-19 hospitalized in an internal medicine ward and their clinical outcomes using the Nutritional Risk Screening 2002 (NRS-2002) and parameters derived from bioelectrical impedance analysis (BIA). METHODS Retrospective analysis of patients with COVID-19 aimed at exploring: 1) the prevalence of nutritional risk with NRS-2002 and BIA; 2) the relationship between NRS-2002, BIA parameters and selected outcomes: length of hospital stay (LOS); death and need of intensive care unit (ICU); prolonged LOS; and loss of appetite. RESULTS Data of 90 patients were analyzed. Patients at nutritional risk were 92% with NRS-2002, with BIA-derived parameters: 88% by phase angle; 86% by body cell mass; 84% by fat-free mass and 84% by fat mass (p-value ≤0.001). In ROC analysis, NRS had the maximum sensitivity in predicting the risk of death and need of ICU and a prolonged hospitalization showing moderate-low specificity; phase angle showed a good predictive power in terms of AUC. NRS-2002 was significantly associated with LOS (β 12.62, SE 5.79). In a multivariate analysis, blood glucose level and the early warning score are independent predictors of death and need of ICU (OR 2.79, p ≤0.001; 1.59, p-0.029, respectively). CONCLUSION Present findings confirm the clinical utility of NRS-2002 to assess nutritional risk in patients with COVID-19 at hospital admission and in predicting LOS, and that bioimpedance does not seem to add further predictive value. An early detection of nutritional risk has to be systematically included in the management of COVID-19 patients hospitalized in internal medicine wards.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
| | - Massimo Quarenghi
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Kevyn Stefanelli
- Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy
| | - Silvia Capelli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Antonella Giagulli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Lara Quarleri
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Daniela Stehrenberger
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Nicola Ossola
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | - Rita Monotti
- Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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Monteonofrio L, Florio MC, AlGhatrif M, Lakatta EG, Capogrossi MC. Aging- and gender-related modulation of RAAS: potential implications in COVID-19 disease. VASCULAR BIOLOGY 2020; 3:R1-R14. [PMID: 33537555 PMCID: PMC7849461 DOI: 10.1530/vb-20-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a new infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is frequently characterized by a marked inflammatory response with severe pneumonia and respiratory failure associated with multiorgan involvement. Some risk factors predispose patients to develop a more severe infection and to an increased mortality; among them, advanced age and male gender have been identified as major and independent risk factors for COVID-19 poor outcome. The renin-angiotensin-aldosterone system (RAAS) is strictly involved in COVID-19 because angiotensin converting enzyme 2 (ACE2) is the host receptor for SARS-CoV-2 and also converts pro-inflammatory angiotensin (Ang) II into anti-inflammatory Ang(1–7). In this review, we have addressed the effect of aging and gender on RAAS with emphasis on ACE2, pro-inflammatory Ang II/Ang II receptor 1 axis and anti-inflammatory Ang(1–7)/Mas receptor axis.
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Affiliation(s)
- Laura Monteonofrio
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Maria Cristina Florio
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Majd AlGhatrif
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.,Longitudinal Study Section, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.,Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward G Lakatta
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Maurizio C Capogrossi
- Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA.,Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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