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Su Z, Tian S, Liang W, Wu L. Association between omentin-1 and heart failure with preserved ejection fraction in Chinese elderly patients. Clin Cardiol 2023; 47:e24181. [PMID: 37937708 PMCID: PMC10825884 DOI: 10.1002/clc.24181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/17/2023] [Accepted: 10/20/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Omentin-1 is a novel adipokine and is associated with chronic inflammation and cardiovascular diseases. However, it remains unclear whether omentin-1 levels are associated with diagnostic significance in elderly patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to investigate the correlation between omentin-1 and HFpEF in Chinese elderly patients. HYPOTHESIS Omentin-1 may be invovled in HFpEF and there may be a difference of omentin-1 levels between HFpEF and control. METHODS 217 subjects were selected, including 115 patients with HFpEF and 102 control subjects. Enzyme-linked immuno sorbent assay (ELISA) was used to detect plasma levels of omentin-1, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6). The receiver operating characteristics (ROC) curve was used to examine the diagnostic performance of omentin-1 in HFpEF. RESULTS The levels of omentin-1 decreased significantly in the HFpEF group (14.02 ± 8.35 vs. 19.74 ± 8.45 ng/mL, p < .001), while NT-proBNP, IL-6, and TNF-α levels were significantly increased in the HFpEF group compared with the control group. Spearman correlation analysis showed that omentin-1 levels were negatively correlated with E/e' (r = -.340, p < .001). The multivariate logistic regression analysis indicated that omentin-1 was an independent protective factor for HFpEF (odd ratio = 0.948, 95% confidence interval [CI] 0.905-0.993, p = .025). Omentin-1 levels were negatively correlated with NT-proBNP (r = -.273, p < .001) and TNF-α (r = -.221, p = .001). Diagnostic efficiency by ROC curve analysis in the patients with HFpEF showed that the area under the curve (AUC) for omentin-1 was equivalent to NT-proBNP (AUC: 0.734, 95%CI 0.667-0.802; AUC: 0.800, 95%CI 0.738-0.861). Subgroup analysis showed that in the patients between the age of 70 and 80, the predictive capability of omentin-1 was stronger than NT-proBNP (AUC: 0.809, 95%CI 0.680-0.937; AUC: 0.674, 95%CI 0.514-0.833). CONCLUSIONS Omentin-1 levels which were associated with inflammation, were decreased in the HFpEF patients. It could be regarded as a valuable biomarker for the occurrence and development of HFpEF in elderly patients.
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Affiliation(s)
- Zhengjia Su
- Department of Geriatrics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuya Tian
- Department of Geriatrics, Shandong Provincial Third Hospital, Cheeloo College of MedicineShandong UniversityShandonChina
| | - Wei Liang
- Department of Geriatrics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Sharma R, Kumar A, Majeed J, Thakur AK, Aggarwal G. Drugs acting on the renin-angiotensin-aldosterone system (RAAS) and deaths of COVID-19 patients: a systematic review and meta-analysis of observational studies. Egypt Heart J 2022; 74:64. [PMID: 36068392 PMCID: PMC9448845 DOI: 10.1186/s43044-022-00303-8] [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: 07/05/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are two of the most commonly used antihypertensive drugs acting on the renin-angiotensin-aldosterone system (RAAS). Previous research has shown that RAAS inhibitors increase the expression of angiotensin-converting enzyme, a cellular receptor for the severe acute respiratory syndrome coronavirus 2, raising concerns that the use of ACEi and ARBs in hypertensive patients may increase COVID-19 patient mortality. Therefore, the main aim of the current study was to find out the role of drugs acting on RAAS, particularly ACEi/ARBs in the deaths of COVID-19 patients. RESULTS In total, 68 studies were found to be appropriate, reporting a total of 128,078 subjects. The odds ratio was found to be 1.14 [0.95, 1.36], which indicates the non-significant association of ACEi/ARBs with mortality of COVID-19 patients. Further, the association of individual ACEi/ARBs with mortality of COVID-19 patients was also found non-significant. The sensitivity analysis results have shown no significant effect of outliers on the outcome. CONCLUSIONS Based on available evidence, ACEi/ARB were not significantly associated with deaths of COVID-19 patients.
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Affiliation(s)
- Ruchika Sharma
- Centre for Precision Medicine and Pharmacy, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
| | - Anoop Kumar
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India.
| | - Jaseela Majeed
- Department of Pharmaceutical Management, Delhi Pharmaceutical Sciences and Research University, New Delhi, 110017, India
| | - Ajit K Thakur
- Department of Pharmacology, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India
| | - Geeta Aggarwal
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University (DPSRU), New Delhi, 110017, India.
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3
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Loader J, Taylor FC, Lampa E, Sundström J. Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research. J Am Heart Assoc 2022; 11:e025289. [PMID: 35624081 PMCID: PMC9238740 DOI: 10.1161/jaha.122.025289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Renin‐angiotensin aldosterone system (RAAS) inhibitor—COVID‐19 studies, observational in design, appear to use biased methods that can distort the interaction between RAAS inhibitor use and COVID‐19 risk. This study assessed the extent of bias in that research and reevaluated RAAS inhibitor—COVID‐19 associations in studies without critical risk of bias. Methods and Results Searches were performed in MEDLINE, EMBASE, and CINAHL databases (December 1, 2019 to October 21, 2021) identifying studies that compared the risk of infection and/or severe COVID‐19 outcomes between those using or not using RAAS inhibitors (ie, angiotensin‐converting enzyme inhibitors or angiotensin II type‐I receptor blockers). Weighted hazard ratios (HR) and 95% CIs were extracted and pooled in fixed‐effects meta‐analyses, only from studies without critical risk of bias that assessed severe COVID‐19 outcomes. Of 169 relevant studies, 164 had critical risks of bias and were excluded. Ultimately, only two studies presented data relevant to the meta‐analysis. In 1 351 633 people with uncomplicated hypertension using a RAAS inhibitor, calcium channel blocker, or thiazide diuretic in monotherapy, the risk of hospitalization (angiotensin‐converting enzyme inhibitor: HR, 0.76; 95% CI, 0.66–0.87; P<0.001; angiotensin II type‐I receptor blockers: HR, 0.86; 95% CI, 0.77–0.97; P=0.015) and intubation or death (angiotensin‐converting enzyme inhibitor: HR, 0.64; 95% CI, 0.48–0.85; P=0.002; angiotensin II type‐I receptor blockers: HR, 0.74; 95% CI, 0.58–0.95; P=0.019) with COVID‐19 was lower in those using a RAAS inhibitor. However, these protective effects are probably not clinically relevant. Conclusions This study reveals the critical risk of bias that exists across almost an entire body of COVID‐19 research, raising an important question: Were research methods and/or peer‐review processes temporarily weakened during the surge of COVID‐19 research or is this lack of rigor a systemic problem that also exists outside pandemic‐based research? Registration URL: www.crd.york.ac.uk/prospero/; Unique identifier: CRD42021237859.
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Affiliation(s)
- Jordan Loader
- Department of Medical Sciences Uppsala University Uppsala Sweden.,Inserm U1300 - HP2 CHU Grenoble Alpes Grenoble France
| | - Frances C Taylor
- Baker Heart and Diabetes Institute Melbourne Victoria Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University Melbourne Victoria Australia
| | - Erik Lampa
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Johan Sundström
- Department of Medical Sciences Uppsala University Uppsala Sweden.,The George Institute for Global Health University of New South Wales Sydney Australia
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Nozari F, Hamidizadeh N. The Effects of Different Classes of Antihypertensive Drugs on Patients with COVID-19 and Hypertension: A Mini-Review. Int J Hypertens 2022; 2022:5937802. [PMID: 35075396 PMCID: PMC8783136 DOI: 10.1155/2022/5937802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/04/2021] [Accepted: 01/06/2022] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a major risk factor for cardiovascular disease. Previous studies showed that patients with hypertension are at an increased risk of developing severe COVID-19 infection. Therefore, proper blood pressure control in hypertensive patients with COVID-19 is of great importance. In this review, we discussed the effects of different classes of antihypertensive drugs on patients with hypertension and COVID-19.
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Affiliation(s)
- Farnoosh Nozari
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Hamidizadeh
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Singh R, Rathore SS, Khan H, Bhurwal A, Sheraton M, Ghosh P, Anand S, Makadia J, Ayesha F, Mahapure KS, Mehra I, Tekin A, Kashyap R, Bansal V. Mortality and Severity in COVID-19 Patients on ACEIs and ARBs-A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Front Med (Lausanne) 2022; 8:703661. [PMID: 35083229 PMCID: PMC8784609 DOI: 10.3389/fmed.2021.703661] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: The primary objective of this systematic review is to assess association of mortality in COVID-19 patients on Angiotensin-converting-enzyme inhibitors (ACEIs) and Angiotensin-II receptor blockers (ARBs). A secondary objective is to assess associations with higher severity of the disease in COVID-19 patients. Materials and Methods: We searched multiple COVID-19 databases (WHO, CDC, LIT-COVID) for longitudinal studies globally reporting mortality and severity published before January 18th, 2021. Meta-analyses were performed using 53 studies for mortality outcome and 43 for the severity outcome. Mantel-Haenszel odds ratios were generated to describe overall effect size using random effect models. To account for between study results variations, multivariate meta-regression was performed with preselected covariates using maximum likelihood method for both the mortality and severity models. Result: Our findings showed that the use of ACEIs/ARBs did not significantly influence either mortality (OR = 1.16 95% CI 0.94-1.44, p = 0.15, I 2 = 93.2%) or severity (OR = 1.18, 95% CI 0.94-1.48, p = 0.15, I 2 = 91.1%) in comparison to not being on ACEIs/ARBs in COVID-19 positive patients. Multivariate meta-regression for the mortality model demonstrated that 36% of between study variations could be explained by differences in age, gender, and proportion of heart diseases in the study samples. Multivariate meta-regression for the severity model demonstrated that 8% of between study variations could be explained by differences in age, proportion of diabetes, heart disease and study country in the study samples. Conclusion: We found no association of mortality or severity in COVID-19 patients taking ACEIs/ARBs.
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Affiliation(s)
- Romil Singh
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Hira Khan
- Department of Internal Medicine, Islamic International Medical College, Rawalpindi, Pakistan
| | - Abhishek Bhurwal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States
| | - Mack Sheraton
- Department of Emergency Medicine, Trinity West Medical Center, Steubenville, OH, United States
| | - Prithwish Ghosh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Sohini Anand
- Patliputra Medical College and Hospital, Dhanbad, India
| | | | - Fnu Ayesha
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Kiran S. Mahapure
- Department of Plastic Surgery, KAHER J. N. Medical College, Belgaum, India
| | - Ishita Mehra
- Department of Internal Medicine, North Alabama Medical Center, Florence, AL, United States
| | - Aysun Tekin
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Rahul Kashyap
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Vikas Bansal
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
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Prognostic implication of uncontrolled hypertension in hospitalized patients with COVID-19. COR ET VASA 2021. [DOI: 10.33678/cor.2021.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Bassetti M, Giacobbe DR, Bruzzi P, Barisione E, Centanni S, Castaldo N, Corcione S, De Rosa FG, Di Marco F, Gori A, Gramegna A, Granata G, Gratarola A, Maraolo AE, Mikulska M, Lombardi A, Pea F, Petrosillo N, Radovanovic D, Santus P, Signori A, Sozio E, Tagliabue E, Tascini C, Vancheri C, Vena A, Viale P, Blasi F. Clinical Management of Adult Patients with COVID-19 Outside Intensive Care Units: Guidelines from the Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP). Infect Dis Ther 2021; 10:1837-1885. [PMID: 34328629 PMCID: PMC8323092 DOI: 10.1007/s40121-021-00487-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The Italian Society of Anti-Infective Therapy (SITA) and the Italian Society of Pulmonology (SIP) constituted an expert panel for developing evidence-based guidance for the clinical management of adult patients with coronavirus disease 2019 (COVID-19) outside intensive care units. METHODS Ten systematic literature searches were performed to answer ten different key questions. The retrieved evidence was graded according to the Grading of Recommendations Assessment, Development, and Evaluation methodology (GRADE). RESULTS AND CONCLUSION The literature searches mostly assessed the available evidence on the management of COVID-19 patients in terms of antiviral, anticoagulant, anti-inflammatory, immunomodulatory, and continuous positive airway pressure (CPAP)/non-invasive ventilation (NIV) treatment. Most evidence was deemed as of low certainty, and in some cases, recommendations could not be developed according to the GRADE system (best practice recommendations were provided in similar situations). The use of neutralizing monoclonal antibodies may be considered for outpatients at risk of disease progression. For inpatients, favorable recommendations were provided for anticoagulant prophylaxis and systemic steroids administration, although with low certainty of evidence. Favorable recommendations, with very low/low certainty of evidence, were also provided for, in specific situations, remdesivir, alone or in combination with baricitinib, and tocilizumab. The presence of many best practice recommendations testified to the need for further investigations by means of randomized controlled trials, whenever possible, with some possible future research directions stemming from the results of the ten systematic reviews.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Paolo Bruzzi
- Clinical Epidemiology Unit, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nadia Castaldo
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Fabiano Di Marco
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Gori
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Andrea Gramegna
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Angelo Gratarola
- Department of Emergency and Urgency, San Martino Policlinico Hospital, IRCCS, Genoa, Italy
| | | | - Malgorzata Mikulska
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Andrea Lombardi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- SSD Clinical Pharmacology Unit, University Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
- Infection Control and Infectious Disease Service, University Hospital "Campus-Biomedico", Rome, Italy
| | - Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Emanuela Sozio
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Elena Tagliabue
- Interventional Pulmonology, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Carlo Tascini
- Infectious Diseases Clinic, Santa Maria Misericordia Hospital, Udine, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Diseases-University Hospital "Policlinico G. Rodolico", Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Vena
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi, 10, 16132, Genoa, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Infectious Diseases Unit, University Hospital IRCCS Policlinico Sant'Orsola, Bologna, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
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Mahamat-Saleh Y, Fiolet T, Rebeaud ME, Mulot M, Guihur A, El Fatouhi D, Laouali N, Peiffer-Smadja N, Aune D, Severi G. Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies. BMJ Open 2021; 11:e052777. [PMID: 34697120 PMCID: PMC8557249 DOI: 10.1136/bmjopen-2021-052777] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/07/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions. METHODS Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework. RESULTS A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I2=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I2=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I2=91%, n=54, high certainty) for patients with BMI ≥30 kg/m2 compared with those with BMI <30 kg/m2 and 1.12 (95% CI 1.07 to 1.17, I2=68%, n=25) per 5 kg/m2 increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I2=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I2=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I2=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively. CONCLUSION Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths. TRIAL REGISTRATION NUMBER CRD42020218115.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Thibault Fiolet
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Mathieu Edouard Rebeaud
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Mulot
- Laboratory of Soil Biodiversity, Faculty of Science, University of Neuchatel, Neuchâtel, Switzerland
| | - Anthony Guihur
- Department of Plant Molecular Biology, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Douae El Fatouhi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nathan Peiffer-Smadja
- Universite de Paris, IAME, INSERM, Paris, France
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
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9
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Giossi R, Menichelli D, Pani A, Tratta E, Romandini A, Roncato R, Nani A, Schenardi P, Diani E, Fittipaldo VA, Farcomeni A, Scaglione F, Pastori D. A Systematic Review and a Meta-Analysis Comparing Prophylactic and Therapeutic Low Molecular Weight Heparins for Mortality Reduction in 32,688 COVID-19 Patients. Front Pharmacol 2021; 12:698008. [PMID: 34539396 PMCID: PMC8443784 DOI: 10.3389/fphar.2021.698008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Antithrombotic treatment, including low molecular weight heparin (LMWH) or unfractionated heparin (UFH), has been proposed as a potential therapy for coronavirus disease 2019 (COVID-19) to lower diffuse intravascular clotting activation. However, it is unclear whether prophylactic or therapeutic doses have similar efficacy in reducing mortality. Methods: We performed a systematic review (PROSPERO registration CRD42020179955) and meta-analysis including observational cohort studies and randomized controlled trials (RCT) evaluating the effectiveness of heparins (either LMWH, UFH, or fondaparinux) in COVID-19 patients. Heparin treatment was compared to no anticoagulation. A subgroup analysis on prophylactic or therapeutic doses compared to no anticoagulation was performed. Prophylactic dose was also compared to full dose anticoagulation. Primary endpoint was all-cause mortality. Secondary endpoints were major bleeding and length of hospital stay (LOS). Results: 33 studies (31 observational, 2 RCT) were included for a total overall population of 32,688 patients. Of these, 21,723 (66.5%) were on heparins. 31 studies reported data on all-cause mortality, showing that both prophylactic and full dose reduced mortality (pooled Hazard Ratio [HR] 0.63, 95% confidence interval [CI] 0.57-0.69 and HR 0.56, 95% CI 0.47-0.66, respectively). However, the full dose was associated with a higher risk of major bleeding (Odds Ratio [OR] 2.01, 95% CI 1.14-3.53) compared to prophylactic dose. Finally, LOS was evaluated in 3 studies; no difference was observed between patients with and without heparins (0.98, -3.87, 5.83 days). Conclusion: Heparin at both full and prophylactic dose is effective in reducing mortality in hospitalized COVID-19 patients, compared to no treatment. However, full dose was associated with an increased risk of bleeding. Systematic Review Registration: https://clinicaltrials.gov/, identifier CRD42020179955.
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Affiliation(s)
- Riccardo Giossi
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Danilo Menichelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Arianna Pani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Elena Tratta
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Central Pharmacy, ASST Spedali Civili, Brescia, Italy
| | - Alessandra Romandini
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Rossana Roncato
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Alessandro Nani
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Paolo Schenardi
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Erika Diani
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Pharmacy Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessio Farcomeni
- Department of Economics and Finance, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesco Scaglione
- Postgraduate School of Clinical Pharmacology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Department of Laboratory Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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10
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Denegri A, Pezzuto G, D'Arienzo M, Morelli M, Savorani F, Cappello CG, Luciani A, Boriani G. Clinical and electrocardiographic characteristics at admission of COVID-19/SARS-CoV2 pneumonia infection. Intern Emerg Med 2021; 16:1451-1456. [PMID: 33398608 PMCID: PMC7781180 DOI: 10.1007/s11739-020-02578-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The aim of the present study was to compare clinical and electrocardiographic characteristics of patients with COVID-19 pneumonia in Modena, Emilia Romagna, Italy. METHODS Patients admitted to the emergency department for suspected COVID-19 pneumonia from March the 16th to April the 15th were enrolled in the study. COVID-19 pneumonia was confirmed by positive nasopharyngeal swab. Primary endpoint was 30-day mortality. RESULTS 201 patients were diagnosed with COVID-19 pneumonia. Compared to survivors, patients who died were older (79.7 ± 10.8 vs 65.6 ± 14.1, p < 0.001), with a more complex cardiovascular history, including coronary artery disease (CAD, 33.3% vs 13.3%, p = 0.004), atrial fibrillation (23.8 vs 8.8, p = 0.011) and chronic kidney disease (CKD 35.7% vs 7.0%, p < 0.001). 30-day mortality was 20,9% in these patients; atrial fibrillation (OR 12.74, 95% CI 3.65-44.48, p < 0.001), ST-segment depression (OR 5.30, 95% CI 1.50-18.81, p = 0.010) and QTc-interval prolongation (OR 3.17, 95% CI 1.24-8.10, p = 0.016) at ECG admission were associated to an increased mortality risk. On the contrary, sinus rhythm (OR 0.08, 95% CI 0.02-0.27, p < 0.001) and low-molecular weight heparin (LMWH) administration (OR 0.08, 95% CI 0.02-0.29, p < 0.001) were related to reduced mortality. At multivariate analysis, after adjustment for age, sex, diabetes, CAD, and MCA admission, sinus rhythm (HR 2.7, CI 95% 1.1-7.0, p = 0.038) and LMWH (HR 8.5, 95% CI 2.0-36.6, p = 0.004) were confirmed to be independent predictors of increased survival. CONCLUSION Sinus rhythm at ECG admission in COVID-19 pneumonia patients was associated with greater survival as well as LMWH administration, which conferred an overall better outcome.
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Affiliation(s)
- Andrea Denegri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
| | - Giuseppe Pezzuto
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Matteo D'Arienzo
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Marianna Morelli
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Fulvio Savorani
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Carlo G Cappello
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Antonio Luciani
- Emergency Department, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Largo del Pozzo, 71, 41125, Modena, Italy
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11
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Lean-ing Method in an Emergency Department of the Italian Epicenter of the COVID-19 Outbreak: When the Algorithm Makes Difference. APPLIED SYSTEM INNOVATION 2021. [DOI: 10.3390/asi4030055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The Lean method entails a set of standardized processes intending to optimize resources, reduce waste, and improve results. Lean has been proposed as an operative model for the COVID-19 outbreak. Herein, we summarized data resulted from the Lean model adoption in an Emergency Department of the Lombardy region, the Italian epicenter of the pandemic, to critically appraise its effectiveness and feasibility. The Lean algorithm was applied in the Humanitas Clinical and Research Hospital, Milan, north of Italy. At admission, patients underwent outdoor pre-triage for fever, respiratory, and gastrointestinal symptoms, with a focus on SpO2. Based on these data, they were directed to the most appropriate area for the COVID-19 first-level screening. High-risk patients were assisted by trained staff for second-level screening and planning of treatment. Out of 7.778 patients, 21.9% were suspected of SARS-CoV-2 infection. Mortality was 21.9% and the infection rate in health workers was 4.8%. The lean model has proved to be effective in optimizing the overall management of COVID-19 patients in an emergency setting. It allowed for screening of a large volume of patients, while also limiting the health workers’ infection rate. Further studies are necessary to validate the suggested approach.
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12
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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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13
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Almutlaq M, Alamro AA, Alroqi F, Barhoumi T. Classical and Counter-Regulatory Renin-Angiotensin System: Potential Key Roles in COVID-19 Pathophysiology. CJC Open 2021; 3:1060-1074. [PMID: 33875979 PMCID: PMC8046706 DOI: 10.1016/j.cjco.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/08/2021] [Indexed: 02/08/2023] Open
Abstract
In the current COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 uses angiotensin-converting enzyme-2 (ACE-2) receptors for cell entry, leading to ACE-2 dysfunction and downregulation, which disturb the balance between the classical and counter-regulatory renin-angiotensin system (RAS) in favor of the classical RAS. RAS dysregulation is one of the major characteristics of several cardiovascular diseases; thus, adjustment of this system is the main therapeutic target. RAS inhibitors-particularly angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs)-are commonly used for treatment of hypertension and cardiovascular disease. Patients with cardiovascular diseases are the group most commonly seen among those with COVID-19 comorbidity. At the beginning of this pandemic, a dilemma occurred regarding the use of ACEIs and ARBs, potentially aggravating cardiovascular and pulmonary dysfunction in COVID-19 patients. Urgent clinical trials from different countries and hospitals reported that there is no association between RAS inhibitor treatment and COVID-19 infection or comorbidity complication. Nevertheless, the disturbance of the RAS that is associated with COVID-19 infection and the potential treatment targeting this area have yet to be resolved. In this review, the link between the dysregulation of classical RAS and counter-regulatory RAS activities in COVID-19 patients with cardiovascular metabolic diseases is investigated. In addition, the latest findings based on ACEI and ARB administration and ACE-2 availability in relation to COVID-19, which may provide a better understanding of the RAS contribution to COVID-19 pathology, are discussed, as they are of the utmost importance amid the current pandemic.
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Affiliation(s)
- Moudhi Almutlaq
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
- Moudhi Almutlaq, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh 11461, Saudi Arabia. Tel.: +1-966-543-159145.
| | - Abir Abdullah Alamro
- Department of Biochemistry, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Fayhan Alroqi
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Department of Pediatrics, King Abdulaziz Medical City, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Tlili Barhoumi
- King Abdullah International Medical Research Centre, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Corresponding authors: Dr Tlili Barhoumi, King Abdullah International Medical Research Centre, Ministry of National Guard Health Affairs, Riyadh 11461, Saudi Arabia. Tel.: +1-966-543-159145.
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14
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Loader J, Lampa E, Gustafsson S, Cars T, Sundström J. Renin-Angiotensin Aldosterone System Inhibitors in Primary Prevention and COVID-19. J Am Heart Assoc 2021; 10:e021154. [PMID: 34320843 PMCID: PMC8475700 DOI: 10.1161/jaha.120.021154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Considering the widespread risk of collider bias and confounding by indication in previous research, the associations between renin‐angiotensin aldosterone system (RAAS) inhibitor use and COVID‐19 remain unknown. Accordingly, this study tested the hypothesis that RAAS inhibitors influence the summation effect of COVID‐19 and its progression to severe outcomes. Methods and Results This nationwide cohort study compared all residents of Sweden, without prior cardiovascular disease, in monotherapy (as of January 1, 2020) with a RAAS inhibitor to those using a calcium channel blocker or a thiazide diuretic. Comparative cohorts were balanced using machine‐learning‐derived propensity score methods. Of 165 355 people in the analysis (51% women), 367 were hospitalized or died with COVID‐19 (246 using a RAAS inhibitor versus 121 using a calcium channel blocker or thiazide diuretic; Cox proportional hazard ratio [HR], 0.97; 95% CI, 0.74–1.27). When each outcome was assessed separately, 335 people were hospitalized with COVID‐19 (HR, 0.92; 95% CI, 0.70–1.22), and 64 died with COVID‐19 (HR, 1.22; 95% CI, 0.68–2.19). The severity of COVID‐19 outcomes did not differ between those using a RAAS inhibitor and those using a calcium channel blocker or thiazide diuretic (ordered logistic regression odds ratio, 1.01; 95% CI, 0.89–1.14). Conclusions Despite potential limitations, this study is among the best available evidence that RAAS inhibitor use in primary prevention does not increase the risk of severe COVID‐19 outcomes; presenting strong data from which scientists and policy makers alike can base, with greater confidence, their current position on the safety of using RAAS inhibitors during the COVID‐19 pandemic.
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Affiliation(s)
- Jordan Loader
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Erik Lampa
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | | | - Thomas Cars
- Department of Medical Sciences Uppsala University Uppsala Sweden
| | - Johan Sundström
- Department of Medical Sciences Uppsala University Uppsala Sweden.,The George Institute for Global HealthUniversity of New South Wales Sydney NSW Australia
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15
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Parisi R, Costanzo S, Di Castelnuovo A, de Gaetano G, Donati MB, Iacoviello L. Different Anticoagulant Regimens, Mortality, and Bleeding in Hospitalized Patients with COVID-19: A Systematic Review and an Updated Meta-Analysis. Semin Thromb Hemost 2021; 47:372-391. [PMID: 33851386 DOI: 10.1055/s-0041-1726034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We conducted a systematic review and a meta-analysis to assess the association of anticoagulants and their dosage with in-hospital all-cause mortality in COVID-19 patients. Articles were retrieved until January 8, 2021, by searching in seven electronic databases. The main outcome was all-cause mortality occurred during hospitalization. Data were combined using the general variance-based method on the effect estimate for each study. Separate meta-analyses according to type of COVID-19 patients (hospitalized or intensive care unit [ICU] patients), anticoagulants (mainly heparin), and regimens (therapeutic or prophylactic) were conducted. A total of 29 articles were selected, but 23 retrospective studies were eligible for quantitative meta-analyses. No clinical trial was retrieved. The majority of studies were of good quality; however, 34% did not distinguish heparin from other anticoagulants. Meta-analysis on 25,719 hospitalized COVID-19 patients showed that anticoagulant use was associated with 50% reduced in-hospital mortality risk (pooled risk ratio [RR]: 0.50, 95% confidence interval [CI]: 0.40-0.62; I 2: 87%). Both anticoagulant regimens (therapeutic and prophylactic) reduced in-hospital all-cause mortality, compared with no anticoagulation. Particularly in ICU patients, the anticoagulant therapeutic regimen was associated with a reduced in-hospital mortality risk (RR: 0.30, 95% CI: 0.15-0.60; I 2: 58%) compared with the prophylactic one. However, the former was also associated with a higher risk of bleeding (RR: 2.53, 95% CI: 1.60-4.00; I 2: 65%). Anticoagulant use, mainly heparin, reduced all-cause mortality in COVID-19 patients during hospitalization. Due to the higher risk of bleeding at therapeutic doses, the use of prophylactic dosages of anticoagulant is probably to be preferred in noncritically ill COVID-19 patients.
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Affiliation(s)
- Roberta Parisi
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | | | - Giovanni de Gaetano
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | - Maria Benedetta Donati
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention. IRCCS Neuromed, via dell'Elettronica, Pozzilli, Isernia, Italy.,Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy
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16
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Desai A, Caltagirone G, Sari S, Pocaterra D, Kogan M, Azzolini E, Savevski V, Martinelli-Boneschi F, Voza A. The Use of Antiviral Agents against SARS-CoV-2: Ineffective or Time and Age Dependent Result? A Retrospective, Observational Study among COVID-19 Older Adults. J Clin Med 2021; 10:686. [PMID: 33578922 PMCID: PMC7916694 DOI: 10.3390/jcm10040686] [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: 12/11/2020] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration. METHODS Data from 143 COVID-19 patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (<6 days from symptoms onset) vs. late treatment onset, signs and symptoms at COVID-19 presentation, type of antiviral treatment (LPV/r or DVR/c) and patients' age (65-80 vs. >80 years old). RESULTS Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65-80 years-old patients (p = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; p = 0.04). CONCLUSIONS There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19 patients aged 65-80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.
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Affiliation(s)
- Antonio Desai
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (A.V.)
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy;
| | - Giuseppe Caltagirone
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (A.V.)
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy;
| | - Sharon Sari
- Internal Medicine Department, Geriatrics, Santa Margherita Rehabilitation and Cure Institute, ASP, 27100 Pavia, Italy;
| | - Daria Pocaterra
- Department of Infectious Diseases, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy;
| | - Maria Kogan
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (A.V.)
| | - Elena Azzolini
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy;
- Health Directorate, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy;
| | - Filippo Martinelli-Boneschi
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy;
- Neurology Unit and MS Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Policlinico, 20122 Milan, Italy
| | - Antonio Voza
- Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy; (G.C.); (M.K.); (A.V.)
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17
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Mackey K, Kansagara D, Vela K. Update Alert 7: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults. Ann Intern Med 2021; 174:W25-W29. [PMID: 33395346 PMCID: PMC7791405 DOI: 10.7326/l20-1446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Kathryn Vela
- VA Portland Health Care System, Portland, Oregon
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18
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Mackey K, Kansagara D, Vela K. Update Alert 6: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults. Ann Intern Med 2021; 174:W17. [PMID: 33253036 PMCID: PMC7729487 DOI: 10.7326/l20-1355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Kathryn Vela
- VA Portland Health Care System, Portland, Oregon
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