1
|
Ma Y, Gao Q. Clinical characteristics and assessment of risk factors in patients with influenza A-induced severe pneumonia after the prevalence of SARS-CoV-2. Open Med (Wars) 2024; 19:20240953. [PMID: 38633219 PMCID: PMC11022039 DOI: 10.1515/med-2024-0953] [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: 07/18/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose The aim of this study is to describe the novel epidemiological and clinical characteristics of influenza A-induced severe pneumonia occurring after the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to further assess its potential risk factors for mortality. Methods We retrospectively studied the consecutive case series of 30 patients with confirmed influenza A-induced severe pneumonia treated in the intensive care unit at Dazhou Central Hospital in Sichuan, China, from March 1 to April 30, 2023. Logistic regression was used to analyze the independent risk factors, and receiver operating characteristic (ROC) curves were applied to evaluate the predictive efficacy of associated risk factors for mortality. Results The mortality rate was 33.3% in this study. Independent risk factors for mortality of patients were acute respiratory distress syndrome (ARDS) (p = 0.044) and septic shock (p = 0.012). ROC statistics for ARDS and septic shock to predict mortality in patients with influenza A-induced severe pneumonia demonstrated an area under the curve of 0.800 (sensitivity 80.0%, specificity 80.0%) and 0.825 (sensitivity 70.0%, specificity 95.0%), respectively. Conclusion ARDS and septic shock were the independent risk factors for mortality in patients with influenza A-induced severe pneumonia following the end of the SARS-CoV-2 pandemic. But high level of next generation sequencing reads Aspergillus coinfection, and comorbidities did not increase death risk of the study population.
Collapse
Affiliation(s)
- Yujie Ma
- Department of Cardiovascular Medicine, Dazhou Dachuan District People’s Hospital (Dazhou Third People’s Hospital), Dazhou, China
| | - Qiang Gao
- Department of Critical Care Medicine, Dazhou Central Hospital, No. 56 Nanyuemiao Street, Tongchuan District, Dazhou, 635000, Sichuan, China
| |
Collapse
|
2
|
Antonelli Incalzi R, Consoli A, Lopalco P, Maggi S, Sesti G, Veronese N, Volpe M. Influenza vaccination for elderly, vulnerable and high-risk subjects: a narrative review and expert opinion. Intern Emerg Med 2024; 19:619-640. [PMID: 37891453 PMCID: PMC11039544 DOI: 10.1007/s11739-023-03456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
Influenza is associated with a substantial health burden, especially in high-risk subjects such as older adults, frail individuals and those with underlying chronic diseases. In this review, we summarized clinical findings regarding the impact of influenza in vulnerable populations, highlighted the benefits of influenza vaccination in preventing severe illness and complications and reviewed the main evidence on the efficacy, effectiveness and safety of the vaccines that are best suited to older adults among those available in Italy. The adverse outcomes associated with influenza infection in elderly and frail subjects and those with underlying chronic diseases are well documented in the literature, as are the benefits of vaccination (mostly in older adults and in patients with cardiovascular diseases, diabetes and chronic lung disease). High-dose and adjuvanted inactivated influenza vaccines were specifically developed to provide enhanced immune responses in older adults, who generally have low responses mainly due to immunosenescence, comorbidities and frailty. These vaccines have been evaluated in clinical studies and systematic reviews by international immunization advisory boards, including the European Centre for Disease Prevention and Control. The high-dose vaccine is the only licensed influenza vaccine to have demonstrated greater efficacy versus a standard-dose vaccine in preventing laboratory-confirmed influenza in a randomized controlled trial. Despite global recommendations, the vaccination coverage in high-risk populations is still suboptimal. All healthcare professionals (including specialists) have an important role in increasing vaccination rates.
Collapse
Affiliation(s)
- Raffaele Antonelli Incalzi
- Gerontology Unit, Department of Internal Medicine and Geriatrics, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti, Italy
| | - Pierluigi Lopalco
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
| | - Stefania Maggi
- Institute of Neuroscience-Aging Branch, National Research Council, Padua, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome, Rome, Italy.
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, "La Sapienza" University of Rome and IRCCS San Raffaele, Rome, Italy
| |
Collapse
|
3
|
Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
Collapse
Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
4
|
Boschi E, Friedman G, Moraes RB. Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study. Indian J Crit Care Med 2024; 28:381-386. [PMID: 38585321 PMCID: PMC10998520 DOI: 10.5005/jp-journals-10071-24688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Abstract
Aim and background Hyperglycemia is considered an adaptive metabolic manifestation of stress and is associated with poor outcomes. Herein, we analyzed the association between glycemic variability (GV) and hospital mortality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and the association between GV and mechanical ventilation (MV), ICU stay, length of hospital stays, renal replacement therapy (RRT), hypoglycemia, nosocomial infections, insulin use, and corticosteroid class. Materials and methods In this retrospective observational study, we collected information on blood glucose levels during the first 10 days of hospitalization in a cohort of ICU patients with COVID-19 and its association with outcomes. Results In 239 patients, an association was observed between GV and hospital mortality between the first and last quartiles among patients without diabetes [odds ratio (OR), 3.78; confidence interval, 1.24-11.5]. A higher GV was associated with a greater need for RRT (p = 0.002), regular insulin (p < 0.001), and episodes of hypoglycemia (p < 0.001). Nosocomial infections were associated with intermediate GV quartiles (p = 0.02). The corticosteroid class had no association with GV (p = 0.21). Conclusion Glycemic variability was associated with high mortality in patients with COVID-19 and observed in the subgroup of patients without diabetes. Clinical significance Glycemic control in critically ill patients remains controversial and hyperglycemia is associated with worse outcomes. Diabetes mellitus (DM) is one of the most prevalent comorbidities in patients with COVID-19. In addition, they require corticosteroids due to pulmonary involvement, representing a challenge and an opportunity to better understand how glycemic changes can influence the outcome of these patients. How to cite this article Boschi E, Friedman G, Moraes RB. Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study. Indian J Crit Care Med 2024;28(4):381-386.
Collapse
Affiliation(s)
- Emerson Boschi
- Hospital Geral de Caxias do Sul, Postgraduate Program in Pneumological Sciences of Universidade Federal do Rio Grande do Sul (UFRGS); (RS, Brazil)
| | - Gilberto Friedman
- Programa de Pos-graduacao em Ciencias Pneumologicas, Universidade Federal do Rio Grande do Sul – School of Medicine, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael B Moraes
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
5
|
Fullana Barceló MI, Artigues Serra F, Millan Pons AR, Asensio Rodriguez J, Ferre Beltran A, Del Carmen Lopez Bilbao M, Reina Prieto J, Riera Jaume M. Analysis of viral pneumonia and risk factors associated with severity of influenza virus infection in hospitalized patients from 2012 to 2016. BMC Infect Dis 2024; 24:302. [PMID: 38475703 DOI: 10.1186/s12879-024-09173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/24/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Influenza viruses cause pneumonia in approximately one-third of cases, and pneumonia is an important cause of death. The aim was to identify risk factors associated with severity and those that could predict the development of pneumonia. METHODS This retrospective, observational study included all adult patients with confirmed influenza virus infection admitted to Son Espases University Hospital during four influenza seasons in Spain (October to May) from to 2012-2016. RESULTS Overall, 666 patients with laboratory-confirmed influenza were included, 93 (14%) of which were severe; 73 (10.9%) were admitted to Intensive Care Unit (ICU), 39 (5.8%) died, and 185 (27.7%) developed pneumonia. Compared to less severe cases, patients with severe disease: were less vaccinated (40% vs. 28%, p = 0.021); presented with more confusion (26.9% vs. 6.8%), were more hypoxemic (Horowitz index (PaO2/FiO2) 261 vs. 280), had higher C-reactive protein (CRP) (12.3 vs. 4.0), had more coinfections (26.8% vs. 6.3%) and had more pleural effusion (14% vs. 2.6%) (last six all p < 0.001). Risk factors significantly associated with severity were pneumonia [OR (95% CI) = 4.14 (2.4-7.16)], history of heart disease (1.84, 1.03-3.28), and confusion at admission (4.99, 2.55-9.74). Influenza vaccination was protective (0.53, 0.28-0.98). Compared to those without pneumonia, the pneumonia group had higher CRP (11.3 vs. 4.0, p < 0.001), lower oxygen saturation (92% vs. 94%, p < 0.001), were more hypoxic (PaO2/FiO2 266 vs. 281, p < 0.001), and incurred more mechanical ventilation, septic shock, admission to the ICU, and deaths (all four p < 0.001). Higher CRP and lower oxygen saturation were independent variables for predicting the development of pneumonia. CONCLUSIONS Pneumonia, history of heart disease, confusion and no influenza vaccination were independent variables to present complications in patients admitted with influenza infection.
Collapse
Affiliation(s)
- M I Fullana Barceló
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain.
| | - F Artigues Serra
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | - A R Millan Pons
- IdISBa estadistic and methodological support, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - J Asensio Rodriguez
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | - A Ferre Beltran
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
| | | | - J Reina Prieto
- Microbiological Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - M Riera Jaume
- Internal Medicine Department, Infectious Diseases Section, Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, 07010, Spain
- IdISBa- Fundació Institut d'Investigació Sanitària Illes Balears, Palma de Mallorca, Spain
| |
Collapse
|
6
|
Park S, Jeong J, Woo Y, Choi YJ, Shin S. Incident infection risks depending on oral antidiabetic exposure in insulin-treated type 2 diabetes patients. Sci Rep 2023; 13:18462. [PMID: 37891260 PMCID: PMC10611756 DOI: 10.1038/s41598-023-45793-x] [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: 05/13/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
Dipeptidyl peptidase-4 inhibitors (DPP4is) and sodium glucose cotransporter-2 inhibitors (SGLT2is) have been speculated to have a potential to increase infection risks in type 2 diabetes mellitus (T2DM) patients. We performed a cohort study using the Korean health insurance data to investigate infection risks with each drug class relative to metformin in insulin-treated T2DM patients. After propensity score matching, we included 1,498 and 749 patients in DPP4i + insulin vs metformin + insulin and 300 and 549 patients in SGLT2i + insulin vs metformin + insulin, respectively. In stratified analyses per patient factor, none of the odds ratios (ORs) were associated with a statistical significance across respiratory, genital, and urinary tract infections (UTIs), except that of the male stratum for respiratory infections (OR 0.77, p = 0.04). With regard to SGLT2is, a higher risk of genital infections was analyzed with their use than with metformin therapy (OR 1.76, p = 0.03). In stratified analyses, the OR for genital infections remained significant in the baseline cardiovascular disease stratum (OR 2.29, p = 0.01). No increased UTI risk was detected with SGLT2is compared against metformin. In this study on insulin-receiving T2DM patients, DPP4is were not associated with increased infection risks, whereas SGLT2is led to a higher risk for genital infections, but not for UTIs, relative to metformin.
Collapse
Affiliation(s)
- Sanghwa Park
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Jiseon Jeong
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Yunna Woo
- College of Pharmacy, Ajou University, Suwon, Republic of Korea
| | - Yeo Jin Choi
- Department of Pharmacy, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea.
| | - Sooyoung Shin
- College of Pharmacy, Ajou University, Suwon, Republic of Korea.
- Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, Republic of Korea.
| |
Collapse
|
7
|
Dicembrini I, Silverii GA, Clerico A, Fornengo R, Gabutti G, Sordi V, Tafuri S, Peruzzi O, Mannucci E. Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies. Nutr Metab Cardiovasc Dis 2023; 33:1099-1110. [PMID: 37032254 DOI: 10.1016/j.numecd.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
AIMS In order to better define the need for influenza vaccination in people with diabetes (DM), we collected all available evidence on the effect of DM as a risk factor for complications of both seasonal and pandemic influenza, and on the specific effectiveness of vaccines in patients with DM. DATA SYNTHESIS Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and Embase databases were performed, one for each metanalysis, collecting all observational studies and randomized clinical trials performed on humans up to May 31st, 2022. We retrieved 34 observational studies comparing risk for influenza complications in people with or without diabetes, and 13 observational studies assessing vaccine effectiveness on preventing such complications. Mortality for influenza and hospitalization for influenza and pneumonia resulted significantly higher in individuals with versus without DM, both when unadjusted and adjusted data are analyzed. In diabetic individuals vaccinated for influenza overall hospitalization, hospitalization for influenza or pneumonia and overall mortality are significantly lower in comparison with not vaccinated DM subjects, both when unadjusted and adjusted data were analyzed. CONCLUSION This systematic review and meta-analysis shows that: 1) influenza is associated with more severe complications in diabetic versus not diabetic individuals and 2) influenza vaccination is effective in preventing clinically relevant outcomes in adults with DM with a NNT (number needed to treat) of 60, 319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively. The identification of diabetic patients as the target of vaccination campaigns for influenza appears to be justified by available clinical evidence.
Collapse
Affiliation(s)
- Ilaria Dicembrini
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy.
| | | | | | | | - Giovanni Gabutti
- Coordinator Working Group Vaccines and Immunization Policies, Italian Scientific Society of Hygiene, Preventive Medicine and Public Health (SItI), Italy
| | - Valeria Sordi
- Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, Aldo Moro, University of Bari, Italy
| | - Ottavia Peruzzi
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
| | - Edoardo Mannucci
- Experimental and Clinical Biomedical Sciences Mario Serio Department, University of Florence, Italy
| |
Collapse
|
8
|
Yi G, de Kraker MEA, Buetti N, Zhong X, Li J, Yuan Z, Zhu W, Zhou J, Zhou H. Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study. Antimicrob Resist Infect Control 2023; 12:25. [PMID: 37004057 PMCID: PMC10064953 DOI: 10.1186/s13756-023-01234-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza. METHODS A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively). RESULTS Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25-9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39-0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥ 65 years (csHR 2.90, 95% CI 1.27-6.62), male gender (csHR 3.78, 95% CI 1.12-12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32-6.64). CONCLUSIONS Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation.
Collapse
Affiliation(s)
- Guangzhao Yi
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China
- Department of Disease Prevention and Health Protection, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Marlieke E A de Kraker
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Niccolò Buetti
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Xiaoni Zhong
- Research Center for Medicine and Social Development, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jinyan Li
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhe Yuan
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weimin Zhu
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Disease Prevention and Health Protection, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongyu Zhou
- Department of Hospital Infection Control, The First Affiliated Hospital of Chongqing Medical University, You Yi Road 1, Chongqing, 400016, China.
- Research Center for Medicine and Social Development, School of Public Health, Chongqing Medical University, Chongqing, China.
| |
Collapse
|
9
|
Cilloniz C, Luna CM, Hurtado JC, Marcos MÁ, Torres A. Respiratory viruses: their importance and lessons learned from COVID-19. Eur Respir Rev 2022; 31:220051. [PMID: 36261158 PMCID: PMC9724808 DOI: 10.1183/16000617.0051-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.
Collapse
Affiliation(s)
- Catia Cilloniz
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Carlos M Luna
- Pneumology Division, Hospital of Clínicas, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Carlos Hurtado
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - María Ángeles Marcos
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Antoni Torres
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| |
Collapse
|
10
|
Cui XY, Wu X, Lu D, Wang D. Network pharmacology-based strategy for predicting therapy targets of Sanqi and Huangjing in diabetes mellitus. World J Clin Cases 2022; 10:6900-6914. [PMID: 36051114 PMCID: PMC9297423 DOI: 10.12998/wjcc.v10.i20.6900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/02/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A comprehensive literature search shows that Sanqi and Huangjing (SQHJ) can improve diabetes treatment in vivo and in vitro, respectively. However, the combined effects of SQHJ on diabetes mellitus (DM) are still unclear.
AIM To explore the potential mechanism of Panax notoginseng (Sanqi in Chinese) and Polygonati Rhizoma (Huangjing in Chinese) for the treatment of DM using network pharmacology.
METHODS The active components of SQHJ and targets were predicted and screened by network pharmacology through oral bioavailability and drug-likeness filtration using the Traditional Chinese Medicine Systems Pharmacology Analysis Platform database. The potential targets for the treatment of DM were identified according to the DisGeNET database. A comparative analysis was performed to investigate the overlapping genes between active component targets and DM treatment-related targets. We constructed networks of the active component-target and target pathways of SQHJ using Cytoscape software and then analyzed the gene functions. Using the STRING database to perform an interaction analysis among overlapping genes and a topological analysis, the interactions between potential targets were identified. Gene Ontology (GO) function analyses and Kyoto Encyclopedia of Genes and Genomes enrichment analyses were conducted in DAVID.
RESULTS We screened 18 active components from 157 SQHJ components, 187 potential targets for active components and 115 overlapping genes for active components and DM. The network pharmacology analysis revealed that quercetin, beta-sitosterol, baicalein, etc. were the major active components. The mechanism underlying the SQHJ intervention effects in DM may involve nine core targets (TP53, AKT1, CASP3, TNF, interleukin-6, PTGS2, MMP9, JUN, and MAPK1). The screening and enrichment analysis revealed that the treatment of DM using SQHJ primarily involved 16 GO enriched terms and 13 related pathways.
CONCLUSION SQHJ treatment for DM targets TP53, AKT1, CASP3, and TNF and participates in pathways in leishmaniasis and cancer.
Collapse
Affiliation(s)
- Xiao-Yan Cui
- Hebei Institute for Drug and Medical Device Control, Shijiazhuang 050011, Hebei Province, China
| | - Xiao Wu
- Department of Basic Medical, HE’s University, Shenyang 110163, Liaoning Province, China
| | - Dan Lu
- College of Clinical, HE’s University, Shenyang 110163, Liaoning Province, China
| | - Dan Wang
- College of Human Kinesiology, Shenyang Sport University, Shenyang 110102, Liaoning Province, China
| |
Collapse
|
11
|
Perceived Changes in Emotions, Worries and Everyday Behaviors in Children and Adolescents Aged 5-18 Years with Type 1 Diabetes during the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050736. [PMID: 35626913 PMCID: PMC9139556 DOI: 10.3390/children9050736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic and the consequent restrictive measures may be related to increased stress and anxiety and to changes in daily behaviors. Children with type 1 diabetes (T1D) are a vulnerable group due to their difficulties in achieving glycemic control and to their medical and psychological comorbidities. The purpose of the current study was to the investigate the changes on emotional and behavioral parameters in children with T1D due to the Coronavirus crisis. A total of 152 children and adolescents, aged 5−18, were studied: 114 (62 boys) with T1D and 38 (19 boys) healthy volunteers (HV) (controls). The study was performed at the Diabetes Center, Aghia Sofia Children’s Hospital, during the first national lockdown in Greece. The CRISIS questionnaire was completed by parents/caregivers. The data were collected in May 2020 and referred to two time-points: three months prior (before the pandemic), and the past two weeks. During the lockdown, it was observed significant aggravation in the “Emotion/Worries (EW)” symptoms in both groups (logEW-before vs. logEW-during the crisis, T1D: 2.66 ± 0.23 vs. 3.00 ± 0.21, p < 0.001 and HV: 2.62 ± 0.16 vs. 2.83 ± 0.18, p < 0.001). Deterioration of “ΕW” was recorded for 93.0% of those with T1D and 92.1% of the HV. “EW” during the lockdown were affected by: previous psychological condition, COVID-related concerns, and “Life Changes due to the COVID-19 crisis in the past two weeks (LC)”. Deterioration was observed in the “daily behaviors” and “use of digital media” for all of the children. The crisis and the associated restrictions negatively affected both the lifestyle parameters and the behavioral and emotional variables of the children with T1D.
Collapse
|
12
|
Aggarwal A, Chakradar M, Bhatia MS, Kumar M, Stephan T, Gupta SK, Alsamhi SH, AL-Dois H. COVID-19 Risk Prediction for Diabetic Patients Using Fuzzy Inference System and Machine Learning Approaches. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4096950. [PMID: 35368915 PMCID: PMC8974235 DOI: 10.1155/2022/4096950] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 03/17/2022] [Indexed: 01/08/2023]
Abstract
Individuals with pre-existing diabetes seem to be vulnerable to the COVID-19 due to changes in blood sugar levels and diabetes complications. As observed globally, around 20-50% of individuals affected by coronavirus had diabetes. However, there is no recent finding that diabetic patients are more prone to contract COVID-19 than nondiabetic patients. However, a few recent findings have observed that it could be at least twice as likely to die from complications of diabetes. Considering the multifold mortality rate of COVID-19 in diabetic patients, this study proposes a COVID-19 risk prediction model for diabetic patients using a fuzzy inference system and machine learning approaches. This study aimed to estimate the risk level of COVID-19 in diabetic patients without a medical practitioner's advice for timely action and overcoming the multifold mortality rate of COVID-19 in diabetic patients. The proposed model takes eight input parameters, which were found as the most influential symptoms in diabetic patients. With the help of the various state-of-the-art machine learning techniques, fifteen models were built over the rule base. CatBoost classifier gives the best accuracy, recall, precision, F1 score, and kappa score. After hyper-parameter optimization, CatBoost classifier showed 76% accuracy and improvements in the recall, precision, F1 score, and kappa score, followed by logistic regression and XGBoost with 75.1% and 74.7% accuracy. Stratified k-fold cross-validation is used for validation purposes.
Collapse
Affiliation(s)
- Alok Aggarwal
- School of Computer Science, University of Petroleum & Energy Studies (UPES), Bidholi, Dehradun, India
| | - Madam Chakradar
- School of Computer Science, University of Petroleum & Energy Studies (UPES), Bidholi, Dehradun, India
| | - Manpreet Singh Bhatia
- School of Computer Science, University of Petroleum & Energy Studies (UPES), Bidholi, Dehradun, India
| | - Manoj Kumar
- School of Computer Science, University of Petroleum & Energy Studies (UPES), Bidholi, Dehradun, India
| | - Thompson Stephan
- Department of Computer Science & Engineering, Amity School of Engineering and Technology, Amity University Uttar Pradesh, Noida, India
| | - Sachin Kumar Gupta
- School of Electronics and Communication Engineering, Shri Mata Vaishno Devi University, Katra, India
| | - S. H. Alsamhi
- Software Research Institute, Athlone Institute of Technology, TUS, Athlone, Ireland
| | - Hatem AL-Dois
- Department of Electrical Engineering, IBB University, Ibb, Yemen
| |
Collapse
|
13
|
Huq AKO, Bazlur Rahim ANM, Moktadir SMG, Uddin I, Manir MZ, Siddique MAB, Islam K, Islam MS. Integrated Nutritional Supports for Diabetic Patients During COVID-19 Infection: A Comprehensive Review. Curr Diabetes Rev 2022; 18:e022821191889. [PMID: 33645486 DOI: 10.2174/1573399817666210301103233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Diabetes mellitus is an endocrine metabolic disorder, which affects the major organs in human and comorbid with others. Besides, diabetic patients are more prone to various infectious diseases as well as COVID-19 sporadic infection which is a high risk for patients with diabetes mellitus. To combat these infections and comorbid situations, an integrated balanced nutritional supportive could help in maintaining sound health and increase immunity for prevention and management of such type of viral infections. OBJECTIVES While information regarding nutritional supports in COVID-19 pandemic in diabetic patients is not available, this review aimed to accumulate the evidence from previous publications where studied about nutrition-based supports or interventions for viral diseases with special emphasis on respiratory infections. METHODS For reviewing, searches are done for getting journal articles into Google Scholar, Pub Med/Medline, Database of Open Access Journal and Science Direct for relevant data and information. RESULTS Integrated nutritional supports of both macronutrients and micronutrients guidelines, including home-based physical exercise schedule, is summarized in this comprehensive review for possible prevention and management of diabetic patients in COVID-19 infections. The immuneboosting benefits of some vitamins, trace elements, nutraceuticals and probiotics in viral infections of diabetic patients are also included. CONCLUSION There is an urgent need for a healthy diet and integrated nutritional supports with home-based physical activities for diabetic patients during the self-isolation period of COVID-19 Infection.
Collapse
Affiliation(s)
- A K Obidul Huq
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Abu Naim Mohammad Bazlur Rahim
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - S M Golam Moktadir
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Ielias Uddin
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Mohammad Zahidul Manir
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Muhammad Abu Bakr Siddique
- Department of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| | - Khaleda Islam
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka-1000, Bangladesh
| | - Md Sirajul Islam
- Department of Environmental Science and Resource Management, Mawlana Bhashani Science and Technology University, Tangail-1902, Bangladesh
| |
Collapse
|
14
|
Zheng S, Zou Q, Zhang D, Yu F, Bao J, Lou B, Xie G, Lin S, Wang R, Chen W, Wang Q, Teng Y, Feng B, Shen Y, Chen Y. Serum level of testosterone predicts disease severity of male COVID-19 patients and is related to T-cell immune modulation by transcriptome analysis. Clin Chim Acta 2021; 524:132-138. [PMID: 34774827 PMCID: PMC8585551 DOI: 10.1016/j.cca.2021.11.006] [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: 08/18/2021] [Revised: 10/02/2021] [Accepted: 11/03/2021] [Indexed: 12/18/2022]
Abstract
Background Severe disease of COVID-19 and mortality occur more frequently in male patients than that in female patients may be related to testosterone level. However, the diagnostic value of changes in the level of testosterone in predicting severe disease of male COVID-19 patients has not been determined yet. Methods Sixty-one male COVID-19 patients admitted to the First Affiliated Hospital of Zhejiang University School of Medicine were enrolled. Serum samples at different stages of the patients after admission were collected and testosterone levels were detected to analyze the correlation between testosterone level and disease severity. Transcriptome analysis of PBMC was performed in 34 patients. Results Testosterone levels at admission in male non-ICU COVID-19 patients (3.7 nmol/L, IQR: 1.5 ∼ 4.7) were significantly lower than those in male ICU COVID-19 patients (6.7 nmol/L, IQR: 4.2 ∼ 8.7). Testosterone levels in the non-ICU group increased gradually during the progression of the disease, while those in the ICU group remained low. In addition, testosterone level of enrolled patients in the second week after onset was significantly correlated with the severity of pneumonia, and ROC curve showed that testosterone level in the second week after onset was highly effective in predicting the severity of COVID-19. Transcriptome studies have found that testosterone levels of COVID-19 patients were associated with immune response, including T cell activation and regulation of lymphocyte activation. In addition, CD28 and Inositol Polyphosphate-4-Phosphatase Type II B (INPP4B) were found positively correlated with testosterone. Conclusions Serum testosterone is an independent risk factor for predicting the severity of COVID-19 in male patients, and the level of serum testosterone in the second week after onset is valuable for evaluating the severity of COVID-19. Testosterone level is associated with T cell immune activation. The monitoring of serum testosterone should be highlighted in clinical treatment and the related mechanism should be further studied.
Collapse
Affiliation(s)
- Shufa Zheng
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Qianda Zou
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Dan Zhang
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Fei Yu
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Jiaqi Bao
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Bin Lou
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Guoliang Xie
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Sha Lin
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China
| | - Ruonan Wang
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Weizhen Chen
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Qi Wang
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Yun Teng
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Baihuan Feng
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China
| | - Yifei Shen
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China.
| | - Yu Chen
- Center of Clinical Laboratory, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China; Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, PR China; Institute of Laboratory Medicine, Zhejiang University, Hangzhou, PR China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, PR China.
| |
Collapse
|
15
|
Chen L, Han X, Li Y, Zhang C, Xing X. The severity and risk factors for mortality in immunocompromised adult patients hospitalized with influenza-related pneumonia. Ann Clin Microbiol Antimicrob 2021; 20:55. [PMID: 34429126 PMCID: PMC8383249 DOI: 10.1186/s12941-021-00462-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
Objective To explore disease severity and risk factors for 30-day mortality of adult immunocompromised (IC) patients hospitalized with influenza-related pneumonia (Flu-p). Method A total of 122 IC and 1191 immunocompetent patients hospitalized with Flu-p from January 2012 to December 2018 were recruited retrospectively from five teaching hospitals in China. Results After controlling for confounders, multivariate logistic regression analysis showed that immunosuppression was associated with increased risks for invasive ventilation [odds ratio: (OR) 2.475, 95% confidence interval (CI): 1.511–4.053, p < 0.001], admittance to the intensive care unit (OR: 3.247, 95% CI 2.064–5.106, p < 0.001), and 30-day mortality (OR: 3.206, 95% CI 1.926–5.335, p < 0.001) in patients with Flu-p. Another multivariate logistic regression model revealed that baseline lymphocyte counts (OR: 0.993, 95% CI 0.990–0.996, p < 0.001), coinfection (OR: 5.450, 95% CI 1.638–18.167, p = 0.006), early neuraminidase inhibitor therapy (OR 0.401, 95% CI 0.127–0.878, p = 0.001), and systemic corticosteroid use at admission (OR: 6.414, 95% CI 1.348–30.512, p = 0.020) were independently related to 30-day mortality in IC patients with Flu-p. Based on analysis of the receiver operating characteristic curve (ROC), the optimal cutoff for lymphocyte counts was 0.6 × 109/L [area under the ROC (AUROC) = 0.824, 95% CI 0.744—0.887], sensitivity: 97.8%, specificity: 73.7%]. Conclusions IC conditions are associated with more severe outcomes in patients with Flu-p. The predictors for mortality that we identified may be valuable for the management of Flu-p among IC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-021-00462-7.
Collapse
Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Nanjing Lishui People's Hospital, Lishui District, No. 86 Chongwen Road, Nanjing, China. .,Department of Infectious Diseases, Beijing Jishuitan Hospital, 4Th Medical College of Peking University, Beijing, China.
| | - Xiudi Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, Shandong Province, China
| | - YanLi Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunxiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, China
| | - Xiqian Xing
- Department of Pulmonary and Critical Care Medicine, The 2Nd People's Hospital of Yunnan Province, Kunming City, Yunnan Province, China
| |
Collapse
|
16
|
Piazza T, Moreira DP, Rocha HAD, Lana AP, Reis IA, Santos MADC, Guerra-Júnior AA, Cherchiglia ML. Comorbidities and in-hospital death of viral pneumonia adults admitted to SUS (2002-2015). Rev Saude Publica 2021; 55:43. [PMID: 34259785 PMCID: PMC8275093 DOI: 10.11606/s1518-8787.2021055003109] [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: 09/02/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To identify demographic and clinical characteristics of adult patients hospitalized in the Brazilian Unified Health System (SUS) due to viral pneumonia and investigate the association between some comorbidities and death during hospitalization. METHODS This retrospective cohort study was conducted with secondary data of adults admitted to SUS due to viral pneumonia between 2002 and 2015. Patient profile was characterized based on demographic and clinical variables. The association between the ten Elixhauser comorbidities and in-hospital death was investigated using Poisson regression models with robust standard errors. Results were quantified as incidence rate ratio (IRR) with 95% confidence intervals (CI), and we built five models using successive inclusion of variables blocks. RESULTS Hospital admissions for viral pneumonias decreased throughout the study period, and it was observed that 5.8% of hospitalized patients had an in-hospital death. We observed significant differences in demographic and clinical characteristics by comparing individuals who died during hospitalization with those who did not, with the occurrence of one or more comorbidities being more expressive among patients who died. Although not considered risk factors for in-hospital death, chronic pulmonary disease and congestive heart failure were the most common comorbidities. Conversely, IRR for in-hospital death increased with other neurological disorders, diabetes, cancer, obesity, and especially with HIV/AIDS. CONCLUSIONS Individuals presenting with pulmonary and cardiovascular diseases require proper attention during hospitalization, as well as those with other neurological diseases, diabetes, cancer, obesity, and especially HIV/AIDS. Understanding the influence of chronic diseases on viral infections may support the healthcare system in achieving better outcomes.
Collapse
Affiliation(s)
- Thais Piazza
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Daniela Pena Moreira
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Hugo André da Rocha
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Agner Pereira Lana
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil
| | - Ilka Afonso Reis
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| | - Marcos Antônio da Cunha Santos
- Universidade Federal de Minas Gerais. Instituto de Ciências Exatas. Departamento de Estatística. Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra-Júnior
- Universidade Federal de Minas Gerais. Faculdade de Farmácia. Departamento de Farmácia Social. Belo Horizonte, MG, Brasil
| | - Mariangela Leal Cherchiglia
- Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil
| |
Collapse
|
17
|
Behavior of hospitalized severe influenza cases according to the outcome variable in Catalonia, Spain, during the 2017-2018 season. Sci Rep 2021; 11:13587. [PMID: 34193898 PMCID: PMC8245597 DOI: 10.1038/s41598-021-92895-5] [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: 11/24/2020] [Accepted: 06/14/2021] [Indexed: 12/04/2022] Open
Abstract
Influenza is an important cause of severe illness and death among patients with underlying medical conditions and in the elderly. The aim of this study was to investigate factors associated with ICU admission and death in patients hospitalized with severe laboratory-confirmed influenza during the 2017–2018 season in Catalonia. An observational epidemiological case-to-case study was carried out. Reported cases of severe laboratory-confirmed influenza requiring hospitalization in 2017–2018 influenza season were included. Mixed-effects regression analysis was used to estimate the factors associated with ICU admission and death. A total of 1306 cases of hospitalized severe influenza cases were included, of whom 175 (13.4%) died and 217 (16.6%) were ICU admitted. Age 65–74 years and ≥ 75 years and having ≥ 2 comorbidities were positively associated with death (aOR 3.19; 95%CI 1.19–8.50, aOR 6.95, 95%CI 2.76–1.80 and aOR 1.99; 95%CI 1.12–3.52, respectively). Neuraminidase inhibitor treatment and pneumonia were negatively associated with death. The 65–74 years and ≥ 75 years age groups were negatively associated with ICU admission (aOR 0.41; 95%CI 0.23–0.74 and aOR 0.30; 95%CI 0.17–0.53, respectively). A factor positively associated with ICU admission was neuraminidase inhibitor treatment. Our results support the need to investigate the worst outcomes of hospitalized severe cases, distinguishing between death and ICU admission.
Collapse
|
18
|
Analysis of Pneumonia Occurrence in Relation to Climate Change in Tanga, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094731. [PMID: 33946714 PMCID: PMC8125699 DOI: 10.3390/ijerph18094731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
In 2018, 70% of global fatalities due to pneumonia occurred in about fifteen countries, with Tanzania being among the top eight countries contributing to these deaths. Environmental and individual factors contributing to these deaths may be multifaceted, but they have not yet been explored in Tanzania. Therefore, in this study, we explore the association between climate change and the occurrence of pneumonia in the Tanga Region, Tanzania. A time series study design was employed using meteorological and health data of the Tanga Region collected from January 2016 to December 2018 from the Tanzania Meteorological Authority and Health Management Information System, respectively. The generalized negative binomial regression technique was used to explore the associations between climate indicators (i.e., precipitation, humidity, and temperature) and the occurrence of pneumonia. There were trend differences in climate indicators and the occurrence of pneumonia between the Tanga and Handeni districts. We found a positive association between humidity and increased rates of non-severe pneumonia (incidence rate ratio (IRR) = 1.01; 95% CI: 1.01–1.02; p ≤ 0.05) and severe pneumonia (IRR = 1.02; 95% CI: 1.01–1.03; p ≤ 0.05). There was also a significant association between cold temperatures and the rate of severe pneumonia in Tanga (IRR = 1.21; 95% CI: 1.11–1.33; p ≤ 0.001). Other factors that were associated with pneumonia included age and district of residence. We found a positive relationship between humidity, temperature, and incidence of pneumonia in the Tanga Region. Policies focusing on prevention and control, as well as promotion strategies relating to climate change-related health effects should be developed and implemented.
Collapse
|
19
|
Ruslan A, Williams DM, Purnell O, Edwards R, Peter R, Stephens JW, Chudleigh R. A physician's approach and experience of managing patients with diabetes during
COVID
‐19. PRACTICAL DIABETES 2021. [PMCID: PMC8251266 DOI: 10.1002/pdi.2329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Aliya Ruslan
- Department of Diabetes & Endocrinology, Singleton Hospital Swansea Bay University Health Board Swansea UK
| | - David M Williams
- Department of Diabetes & Endocrinology, Singleton Hospital Swansea Bay University Health Board Swansea UK
| | - Oliver Purnell
- Department of Diabetes & Endocrinology, Singleton Hospital Swansea Bay University Health Board Swansea UK
| | - Rhodri Edwards
- Department of Diabetes & Endocrinology, Singleton Hospital Swansea Bay University Health Board Swansea UK
| | - Raj Peter
- Department of Diabetes & Endocrinology, Singleton Hospital Swansea Bay University Health Board Swansea UK
| | - Jeffrey W Stephens
- Department of Diabetes & Endocrinology, Morriston Hospital Swansea Bay University Health Board Swansea UK
- Swansea University Medical School, Swansea University Swansea UK
| | - Richard Chudleigh
- Department of Diabetes & Endocrinology, Singleton Hospital Swansea Bay University Health Board Swansea UK
| |
Collapse
|
20
|
Chen Y, Zhou X, Yan H, Huang H, Li S, Jiang Z, Zhao J, Meng Z. CANPT Score: A Tool to Predict Severe COVID-19 on Admission. Front Med (Lausanne) 2021; 8:608107. [PMID: 33681245 PMCID: PMC7930838 DOI: 10.3389/fmed.2021.608107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
Background and Aims: Patients with critical coronavirus disease 2019 (COVID-19) have a mortality rate higher than 50%. The purpose of this study was to establish a model for the prediction of the risk of severe disease and/or death in patients with COVID-19 on admission. Materials and Methods: Patients diagnosed with COVID-19 in four hospitals in China from January 22, 2020 to April 15, 2020 were retrospectively enrolled. The demographic, laboratory, and clinical data of the patients with COVID-19 were collected. The independent risk factors related to the severity of and death due to COVID-19 were identified with a multivariate logistic regression; a nomogram and prediction model were established. The area under the receiver operating characteristic curve (AUROC) and predictive accuracy were used to evaluate the model's effectiveness. Results: In total, 582 patients with COVID-19, including 116 patients with severe disease, were enrolled. Their comorbidities, body temperature, neutrophil-to-lymphocyte ratio (NLR), platelet (PLT) count, and levels of total bilirubin (Tbil), creatinine (Cr), creatine kinase (CK), and albumin (Alb) were independent risk factors for severe disease. A nomogram was generated based on these eight variables with a predictive accuracy of 85.9% and an AUROC of 0.858 (95% CI, 0.823–0.893). Based on the nomogram, the CANPT score was established with cut-off values of 12 and 16. The percentages of patients with severe disease in the groups with CANPT scores <12, ≥12, and <16, and ≥16 were 4.15, 27.43, and 69.64%, respectively. Seventeen patients died. NLR, Cr, CK, and Alb were independent risk factors for mortality, and the CAN score was established to predict mortality. With a cut-off value of 15, the predictive accuracy was 97.4%, and the AUROC was 0.903 (95% CI 0.832, 0.974). Conclusions: The CANPT and CAN scores can predict the risk of severe disease and mortality in COVID-19 patients on admission.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiaolin Zhou
- Department of Liver Diseases, Yichang Central People's Hospital, China Three Gorges University, Yichang, China
| | - Huadong Yan
- Department of Liver Diseases, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Huihong Huang
- Department of Infectious Diseases, Ankang Central Hospital, Hubei University of Medicine, Ankang, China
| | - Shengjun Li
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zicheng Jiang
- Department of Infectious Diseases, Ankang Central Hospital, Hubei University of Medicine, Ankang, China
| | - Jun Zhao
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,School of Public Health, Hubei University of Medicine, Shiyan, China
| | - Zhongji Meng
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Shiyan, China
| |
Collapse
|
21
|
Chen Y, Zhou X, Yan H, Huang H, Li S, Jiang Z, Zhao J, Meng Z. CANPT Score: A Tool to Predict Severe COVID-19 on Admission. Front Med (Lausanne) 2021; 8:608107. [PMID: 33681245 PMCID: PMC7930838 DOI: 10.3389/fmed.2021.608107/full 10.3389/fmed.2021.608107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Patients with critical coronavirus disease 2019 (COVID-19) have a mortality rate higher than 50%. The purpose of this study was to establish a model for the prediction of the risk of severe disease and/or death in patients with COVID-19 on admission. Materials and Methods: Patients diagnosed with COVID-19 in four hospitals in China from January 22, 2020 to April 15, 2020 were retrospectively enrolled. The demographic, laboratory, and clinical data of the patients with COVID-19 were collected. The independent risk factors related to the severity of and death due to COVID-19 were identified with a multivariate logistic regression; a nomogram and prediction model were established. The area under the receiver operating characteristic curve (AUROC) and predictive accuracy were used to evaluate the model's effectiveness. Results: In total, 582 patients with COVID-19, including 116 patients with severe disease, were enrolled. Their comorbidities, body temperature, neutrophil-to-lymphocyte ratio (NLR), platelet (PLT) count, and levels of total bilirubin (Tbil), creatinine (Cr), creatine kinase (CK), and albumin (Alb) were independent risk factors for severe disease. A nomogram was generated based on these eight variables with a predictive accuracy of 85.9% and an AUROC of 0.858 (95% CI, 0.823-0.893). Based on the nomogram, the CANPT score was established with cut-off values of 12 and 16. The percentages of patients with severe disease in the groups with CANPT scores <12, ≥12, and <16, and ≥16 were 4.15, 27.43, and 69.64%, respectively. Seventeen patients died. NLR, Cr, CK, and Alb were independent risk factors for mortality, and the CAN score was established to predict mortality. With a cut-off value of 15, the predictive accuracy was 97.4%, and the AUROC was 0.903 (95% CI 0.832, 0.974). Conclusions: The CANPT and CAN scores can predict the risk of severe disease and mortality in COVID-19 patients on admission.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China,Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiaolin Zhou
- Department of Liver Diseases, Yichang Central People's Hospital, China Three Gorges University, Yichang, China
| | - Huadong Yan
- Department of Liver Diseases, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Huihong Huang
- Department of Infectious Diseases, Ankang Central Hospital, Hubei University of Medicine, Ankang, China
| | - Shengjun Li
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zicheng Jiang
- Department of Infectious Diseases, Ankang Central Hospital, Hubei University of Medicine, Ankang, China
| | - Jun Zhao
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China,School of Public Health, Hubei University of Medicine, Shiyan, China,Jun Zhao
| | - Zhongji Meng
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China,Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China,Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Shiyan, China,*Correspondence: Zhongji Meng
| |
Collapse
|
22
|
Murillo-Zamora E, Mendoza-Cano O, Delgado-Enciso I, Guzmán-Esquivel J. National retrospective cohort study to identify risk factors for in-hospital 30-day lethality in laboratory-confirmed cases of influenza. Rev Clin Esp 2021; 221:76-85. [PMID: 32674849 DOI: 10.1016/j.rce.2020.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify factors associated with the risk of death in adolescent and adult inpatients with laboratory-positive (reverse-transcription polymerase chain reaction) influenza in Mexico during consecutive influenza seasons (2018-2020). PATIENTS AND METHODS A retrospective cohort study used national surveillance system data, enrolling 3422 individuals. The association between various risk factors and 30-day in-hospital lethality were evaluated through risk ratios (RR) and 95% confidence intervals (CI). RESULTS The lethality rate was 18.1%. Flu vaccination history (RR = 0.56, 95% CI 0.42-0.78), early antiviral drug administration (≤ two days from symptom onset [reference ≥ 5 days], RR = 0.68, 95% CI 0.58-0.81), and a history of asthma (RR = 0.66, 95% CI 0.47-0.95) showed protective effects against influenza-attributable death. Mechanical ventilator support produced the highest increase in death risk (RR = 3.31, 95% CI 2.89-3.79). Male sex, older age, AH1N1 subtype, and other chronic diseases were also associated with fatal in-hospital influenza-related outcomes. CONCLUSIONS Our findings highlight the major relevance of promoting immunization in high-risk individuals, together with ensuring early and effective antiviral management in suspected influenza cases.
Collapse
Affiliation(s)
- E Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro Social, Colima, México
| | - O Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, Colima, México
| | | | - J Guzmán-Esquivel
- Facultad de Medicina, Universidad de Colima, Colima, México; Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, México.
| |
Collapse
|
23
|
Rondón-Quintana HA, Zafra-Mejía CA. Covid 19 death analysis in Colombia. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: This article shows an analysis of the evolution up until date (May 4-2021), of official coronavirus cases statistics (CC) and the total number of deaths (TND) due to SARS-CoV-2 in Colombia. Additionally, said information is shown in correlation to other variables such as Case Fatality Rate (CFR), age range of persons, their typical reported co-morbidities and the cities where there has been highest concentration of cases. Materials and Methods: From March 16 2020 until today, information regarding the daily number of new confirmed cases (DNC) and daily confirmed deaths (DD) was registered in a database with the purpose of estimating the evolution of CC, TND and CFR. The age of deceased was also registered, as well as their gender, prior co-morbidities and city of death. The evolution of TND with the time of other countries were compared to that of Colombia. A mathematical equation that represents the epidemiological curve of TND evolution of different countries across time was defined. Results: In Colombia, the average age of people who die due to COVID-19 is of 69.5±14.7 years (median and mode of 71 and 80 years, respectively), and the virus is less lethal amongst a population under the age of 40. The greater part of deaths have taken place in people with prior co-morbidities and of the male gender. Conclusion: Most of the persons that have deceased are those of senior age, mainly with prior co-morbidities, and predominantly of male gender. Epidemiological peaks of COVID-19 are consistent with the rainy and winter seasons, and with the traditional epidemiological peaks of flu or influenza.
Collapse
|
24
|
Murillo-Zamora E, Mendoza-Cano O, Delgado-Enciso I, Guzmán-Esquivel J. National retrospective cohort study to identify risk factors for in-hospital 30-day lethality in laboratory-confirmed cases of influenza. Rev Clin Esp 2020; 221:76-85. [PMID: 33998492 DOI: 10.1016/j.rceng.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To identify factors associated with the risk of death in adolescent and adult inpatients with laboratory-positive (reverse-transcription polymerase chain reaction) influenza in Mexico during consecutive influenza seasons (2018-2020). METHODS A retrospective cohort study used national surveillance system data, enrolling 3.422 individuals. The association between various risk factors and 30-day in-hospital lethality were evaluated through risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS The lethality rate was 18.1%. Flu vaccination history (RR=0.56, 95% CI 0.42-0.78), early antiviral drug administration (≤2 days from symptom onset [reference ≥5 days], RR=0.68, 95% CI 0.58-0.81), and a history of asthma (RR=0.66, 95% CI 0.47-0.95) showed protective effects against influenza-attributable death. Mechanical ventilator support produced the highest increase in death risk (RR=3.31, 95% CI 2.89-3.79). Male sex, older age, AH1N1 subtype, and other chronic diseases were also associated with fatal in-hospital influenza-related outcomes. CONCLUSIONS Our findings highlight the major relevance of promoting immunization in high-risk individuals, together with ensuring early and effective antiviral management in suspected influenza cases.
Collapse
Affiliation(s)
- E Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar No. 19, Instituto Mexicano del Seguro, Colima, Colima, Mexico
| | - O Mendoza-Cano
- Facultad de Ingeniería Civil, Universidad de Colima, km. 9 carretera Colima-Coquimatlán, Colima, Mexico
| | - I Delgado-Enciso
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Colima, Mexico
| | - J Guzmán-Esquivel
- Facultad de Medicina, Universidad de Colima, Av. Universidad 333, Colima, Mexico; Unidad de Investigación en Epidemiología Clínica, Instituto Mexicano del Seguro Social, Colima, Mexico.
| |
Collapse
|
25
|
Xu M, Yang W, Huang T, Zhou J. Diabetic patients with COVID-19 need more attention and better glycemic control. World J Diabetes 2020; 11:644-653. [PMID: 33384770 PMCID: PMC7754170 DOI: 10.4239/wjd.v11.i12.644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a pandemic disease spreading all over the world and has aroused global concerns. The increasing mortality has revealed its severity. It is important to distinguish severe patients and provide appropriate treatment and care to prevent damages. Diabetes is reported to be a common comorbidity in COVID-19 patients and associated with higher mortality. We attempted to clarify the relationship between diabetes and COVID-19 patients' severity. AIM To determine the role of type 2 diabetes in COVID-19 patients. METHODS To study the relationship between diabetes and COVID-19, we retrospectively collected 61 patients' data from a tertiary medical center in Wuhan. All the patients were diagnosed with laboratory-confirmed COVID-19 and admitted to the center from February 13 to March 1, 2020. Patients' age, sex, laboratory tests, chest computed tomography findings, capillary blood glucose (BG), and treatments were collected and analyzed. Fisher exact test was used for categorical data. Univariate and multivariate logistic regressions were used to explore the relationship between clinical characteristics and patients' severity. RESULTS In the 61 patients, the comorbidity of type 2 diabetes, hypertension, and heart diseases were 24.6% (15 out of 61), 37.7% (23 out of 61), and 11.5% (7 out of 61), respectively. The diabetic group was related to more invasive treatments (P = 0.02) and severe status (P = 0.003). In univariate logistic regression, histories of diabetes (OR = 7.13, P = 0.003), hypertension (OR = 3.41, P = 0.039), and hepatic dysfunction (OR = 7.69, P = 0.002) were predictors of patients' severity while heart disease (OR = 4.21, P = 0.083) and large lung involvement (OR = 2.70, P = 0.093) also slightly exacerbated patients' conditions. In the multivariate analysis, diabetes (OR = 6.29, P = 0.016) and hepatic dysfunction (OR = 5.88, P = 0.018) were risk factors for severe patients. Diabetic patients showed elevated BG in 61.7% of preprandial tests and 33.3% of postprandial tests, revealing the limited control of glycemia in COVID-19 patients. CONCLUSION A history of type 2 diabetes is correlated with invasive treatments and severe status. Suboptimal glycemic control and hepatic dysfunction have negative effects on severity status and may lead to the exacerbation of COVID-19 patients.
Collapse
Affiliation(s)
- Ming Xu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Wen Yang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jun Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| |
Collapse
|
26
|
Zhang Y, Wu L, Yang J, Zhou C, Liu Y. A Nomogram-Based Prediction for Severe Pneumonia in Patients with Coronavirus Disease 2019 (COVID-19). Infect Drug Resist 2020; 13:3575-3582. [PMID: 33116677 PMCID: PMC7567552 DOI: 10.2147/idr.s261725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/19/2020] [Indexed: 12/23/2022] Open
Abstract
Background The outbreak of a novel coronavirus disease 2019 (COVID-19) is currently ongoing worldwide. A proportion of COVID-19 patients progress rapidly to acute respiratory failure. Objective We aimed to build a model to predict the risk of developing severe pneumonia in patients with COVID-19 in the early stage. Methods Data from patients who were confirmed to have COVID-19 and were admitted within 7 days from the onset of respiratory symptoms were retrospectively collected. The patients were classified into severe and non-severe groups according to the presence or absence of severe pneumonia during 1–2 weeks of follow-up. The clinical characteristics and laboratory indicators were screened by cross-validation based on LASSO regression to build a prediction model presented by a nomogram. The discrimination and stability, as well as the prediction performance of the model, were analysed. Results The neutrophil–lymphocyte ratio, monocyte counts, eosinophil percentage, serum lactate dehydrogenase level and history of diabetes mellitus were collected for the model. Bootstrap resampling showed the apparent C-statistics, and the brier scores were 0.929 and 0.098. The optimism of the C-statistics and brier score was 0.0172 and −0.019, respectively. The adjusted C-statistics and brier score were 0.9108 and 0.1169, respectively. The optimal cut-off value of the total nomogram score was determined to be 119 according to the maximal Youden index. The sensitivity, specificity, positive predictive value, and negative predictive value for differentiating the presence and absence of severe pneumonia were 83%, 89%, 74%, and 94%, respectively. Conclusion In our study, the neutrophil–lymphocyte ratio, monocyte counts, eosinophil percentage, serum lactate dehydrogenase level and history of diabetes mellitus showed great discrimination and stability for the prediction of the presence of severe pneumonia and were selected for the model.
Collapse
Affiliation(s)
- Yue Zhang
- Health Management Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, Peoples' Republic of China
| | - Lin Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, Peoples' Republic of China
| | - Jibin Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, Peoples' Republic of China
| | - Congyang Zhou
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, Peoples' Republic of China
| | - Ying Liu
- Department of Emergency Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, Peoples' Republic of China
| |
Collapse
|
27
|
Zhou Y, Yang J, Xu C, Hu C, Lu F, Xue F, Zhang P. The Effects of Diabetes and Hypertension on the Severity of COVID-19 - Yichang, Hubei Province, 2020. China CDC Wkly 2020; 2:833-837. [PMID: 34594777 PMCID: PMC8393137 DOI: 10.46234/ccdcw2020.135] [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: 03/19/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
What is already known on this topic? COVID-19 has become a serious public health issue. A higher proportion of severe patients were senior patients with underlying diseases such as diabetes and hypertension and had a lack of statistical evidence so far. What is added by this report? When severe illness was compared with non-severe illness, senior patients were at a greater risk (4.71) than young and middle-aged patients, as well as the odds ratio was about 2.99 patients with diabetes compared to patients without diabetes and hypertension. COVID-19-infectious senior patients with diabetes were inclined to suffer severe illness. What are the implications for public health practice? Much more attention should be provided for the elderly and individuals with diabetes, for which a community-based education and surveillance program could be considered.
Collapse
Affiliation(s)
- Yuchang Zhou
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiajuan Yang
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Chengzhong Xu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Chi Hu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Fangfang Lu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Pei Zhang
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| |
Collapse
|
28
|
Li H, Tian S, Chen T, Cui Z, Shi N, Zhong X, Qiu K, Zhang J, Zeng T, Chen L, Zheng J. Newly diagnosed diabetes is associated with a higher risk of mortality than known diabetes in hospitalized patients with COVID-19. Diabetes Obes Metab 2020; 22:1897-1906. [PMID: 32469464 PMCID: PMC7283710 DOI: 10.1111/dom.14099] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the association between different degrees of hyperglycaemia and the risk of all-cause mortality among hospitalized patients with COVID-19. MATERIALS AND METHODS In a retrospective study conducted from 22 January to 17 March 2020, 453 patients were admitted to Union Hospital in Wuhan, China, with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Patients were classified into four categories: normal glucose, hyperglycaemia (fasting glucose 5.6-6.9 mmol/L and/or HbA1c 5.7%-6.4%), newly diagnosed diabetes (fasting glucose ≥7 mmol/L and/or HbA1c ≥6.5%) and known diabetes. The major outcomes included in-hospital mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). RESULTS Patients with newly diagnosed diabetes constituted the highest percentage to be admitted to the ICU (11.7%) and require IMV (11.7%), followed by patients with known diabetes (4.1%; 9.2%) and patients with hyperglycaemia (6.2%; 4.7%), compared with patients with normal glucose (1.5%; 2.3%), respectively. The multivariable-adjusted hazard ratios of mortality among COVID-19 patients with normal glucose, hyperglycaemia, newly diagnosed diabetes and known diabetes were 1.00, 3.29 (95% confidence interval [CI] 0.65-16.6), 9.42 (95% CI 2.18-40.7) and 4.63 (95% CI 1.02-21.0), respectively. CONCLUSION We showed that COVID-19 patients with newly diagnosed diabetes had the highest risk of all-cause mortality compared with COVID-19 patients with known diabetes, hyperglycaemia and normal glucose. Patients with COVID-19 need to be kept under surveillance for blood glucose screening.
Collapse
Affiliation(s)
- Huiqing Li
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Shenghua Tian
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Ting Chen
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Zhenhai Cui
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Ningjie Shi
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Xueyu Zhong
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Kangli Qiu
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Jiaoyue Zhang
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Tianshu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Provincial Clinical Research Center for Diabetes and Metabolic DisordersWuhanChina
| |
Collapse
|
29
|
Morieri ML, Bonora BM, Longato E, Di Camilo B, Sparacino G, Tramontan L, Avogaro A, Fadini GP. Exposure to dipeptidyl-peptidase 4 inhibitors and the risk of pneumonia among people with type 2 diabetes: Retrospective cohort study and meta-analysis. Diabetes Obes Metab 2020; 22:1925-1934. [PMID: 32691492 DOI: 10.1111/dom.14142] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
AIM Concerns have been raised that dipeptidyl-peptidase 4 inhibitors (DPP-4i) may increase the risk of pneumonia. We analysed observational data and clinical trials to explore whether use of DPP-4i modifies the risk of pneumonia. METHODS We identified patients with diabetes in the Veneto region administrative database and performed propensity score matching between new users of DPP-4 inhibitors and new users of other oral glucose-lowering medications (OGLMs). We compared the rate of hospitalization for pneumonia between matched cohorts using the Cox proportional hazard model. The same analysis was repeated using the database of a local diabetes outpatient clinic. We retrieved similar observational studies from the literature to perform a meta-analysis. Results from trials reporting pneumonia rates among patients randomized to DPP-4 inhibitors versus placebo/active comparators were also meta-analysed. RESULTS In the regional database, after matching 6495 patients/group, new users of DPP-4 inhibitors had a lower rate of hospitalization for pneumonia than new users of other OGLMs (HR 0.76; 95% CI 0.61-0.95). In the outpatient database, after matching 867 patients/group, new users of DPP-4 inhibitors showed a non-significantly lower rate of hospitalization for pneumonia (HR 0.65; 95% CI 0.41-1.04). The meta-analysis of observational studies yielded an overall non-significant lower risk of hospitalization for pneumonia among DPP-4 inhibitor users (RR 0.81; 95% CI 0.65-1.01). The meta-analysis of randomized controlled trials showed no overall effect of DPP-4 inhibitors on pneumonia risk (RR 1.06; 95% CI 0.93-1.20). CONCLUSION The use of DPP-4 inhibitors can be considered as safe with regard to the risk of pneumonia.
Collapse
Affiliation(s)
| | | | - Enrico Longato
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Barbara Di Camilo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Lara Tramontan
- Arsenàl.IT, Veneto's Research Centre for eHealth Innovation, Treviso, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
| | | |
Collapse
|
30
|
Cornejo-Pareja IM, Gómez-Pérez AM, Fernández-García JC, Barahona San Millan R, Aguilera Luque A, de Hollanda A, Jiménez A, Jimenez-Murcia S, Munguia L, Ortega E, Fernandez-Aranda F, Fernández Real JM, Tinahones F. Coronavirus disease 2019 (COVID-19) and obesity. Impact of obesity and its main comorbidities in the evolution of the disease. EUROPEAN EATING DISORDERS REVIEW 2020; 28:799-815. [PMID: 32974994 DOI: 10.1002/erv.2770] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic is posing a great challenge worldwide. Its rapid progression has caused thousands of deaths worldwide. Although multiple aspects remain to be clarified, some risk factors associated with a worse prognosis have been identified. These include obesity and some of its main complications, such as diabetes and high blood pressure. Furthermore, although the possible long-term complications and psychological effects that may appear in survivors of COVID-19 are not well known yet, there is a concern that those complications may be greater in obese patients. In this manuscript, we review some of the data published so far and the main points that remain to be elucidated are emphasized.
Collapse
Affiliation(s)
- Isabel M Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ana M Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - José C Fernández-García
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - Rebeca Barahona San Millan
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain
| | - Alexandre Aguilera Luque
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain
| | - Ana de Hollanda
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Amanda Jiménez
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Susana Jimenez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Lucero Munguia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - José M Fernández Real
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| |
Collapse
|
31
|
Qiu Y, Pan X, Su L, Lui H, Li YD. Effects and safety of Tanreqing injection on viral pneumonia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22022. [PMID: 32925736 PMCID: PMC7489681 DOI: 10.1097/md.0000000000022022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Influenza-related viral pneumonia is a severe threat to human health, which has caused high morbidity and mortality each year. The objective of this study was to assess the efficacy and safety of Tanreqing Injection therapy in patients with viral pneumonia. MATERIALS AND METHODS This protocol established in this study has been reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Web of Science, PubMed, EMBASE and the Cochrane Library were searched for clinical randomized trials in cases with viral pneumonia until 1st of July 2020. We will use a combination of Medical Subject Heading and free-text terms with various synonyms to search based on the Eligibility criteria. Two investigators independently reviewed the included studies and extracted relevant data. The relative risk (RR) and 95% confidence intervals (CIs) of were used as effect estimate. I-square (I) test, substantial heterogeneity, sensitivity analysis and publication bias assessment will be performed accordingly. Stata 14.0 and Review Manger 5.3 are used for meta-analysis and systematic review. RESULTS The results will be published in a peer-reviewed journal. CONCLUSION The results of this review will be widely disseminated through peer-reviewed publications and conference presentations. This evidence may also provide helpful evidence of whether Tanreqing Injection therapy was efficient and safe in patients with viral pneumonia. PROSPERO REGISTRATION NUMBER CRD42020164164.
Collapse
Affiliation(s)
- Yue Qiu
- Department of General Internal Medicine, The Third Affiliated Hospital of Beijing University of Chinese Medicine
| | - Xue Pan
- Beijing University of Chinese Medicine
| | - Lin Su
- Department of Chinese Medicine, Rehabilitation Hospital affiliated to National Research Center For Rehabilitation Technical Aids
| | - Hui Lui
- Department of General Internal Medicine, The Third Affiliated Hospital of Beijing University of Chinese Medicine
| | - Ya-Dong Li
- School of Life Science, Beijing University of Chinese Medicine, Beijing, China
| |
Collapse
|
32
|
Montagnani A, Pieralli F, Gnerre P, Pomero F, Campanini M, Dentali F, Fontanella A, Manfellotto D. Diabetes and CoViD-19: Experience from the frontline of Internal Medicine wards in Italy. Diabetes Res Clin Pract 2020; 167:108335. [PMID: 32687955 PMCID: PMC7367793 DOI: 10.1016/j.diabres.2020.108335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
Abstract
Available data suggest that the issue of CoViD-19 is particularly critical in patients with diabetes. In Italy, Internal Medicine (IM) wards have played a pivotal role in contrasting the spread of SARS-Cov2. During this pandemic, FADOI submitted a brief questionnaire to a group of its members acting as Head of IM units. Considering 38 units, 58% of beds dedicated to CoViD patients in CoViD Hospitals were in charge of IM, and globally cared for 6650 patients during a six-week period. Of these patients, 1264 (19%) had diabetes. Mortality rate in CoViD patients with or without diabetes were 20.5% and 14%, respectively (p < 0.001). Our survey seems to confirm that diabetes is a major comorbidity of CoViD-19, but it does not support an increased incidence of CoViD-19 infection in people with diabetes, if compared with the figures of patients with diabetes and hospitalized before the outbreak. On the other side, patients with diabetes appeared at a significantly increased risk of worse outcome. This finding underlines the importance of paying special attention to this patient population and its management.
Collapse
Affiliation(s)
- A Montagnani
- Internal Medicine, Hospital of Pitigliano, Grosseto, Italy
| | - F Pieralli
- Internal Medicine, Hospital "Careggi", Florence, Italy
| | - P Gnerre
- Internal Medicine, Hospital "San Paolo", Savona, Italy
| | - F Pomero
- Internal Medicine, Hospital "San Lazzaro", Alba, Cuneo, Italy
| | - M Campanini
- Department of Medicine, Hospital "Maggiore della Carità", Novara, Italy
| | - F Dentali
- Department of Medicine, ASST "Sette Laghi", Varese, Italy
| | - A Fontanella
- Department of Medicine, Hospital "Buon Consiglio Fatebenefratelli", Naples, Italy
| | - D Manfellotto
- Department of Internal Medicine, Hospital "Fatebenefratelli-AFaR", Rome, Italy
| |
Collapse
|
33
|
Bornstein SR, Rubino F, Khunti K, Mingrone G, Hopkins D, Birkenfeld AL, Boehm B, Amiel S, Holt RI, Skyler JS, DeVries JH, Renard E, Eckel RH, Zimmet P, Alberti KG, Vidal J, Geloneze B, Chan JC, Ji L, Ludwig B. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol 2020; 8:546-550. [PMID: 32334646 PMCID: PMC7180013 DOI: 10.1016/s2213-8587(20)30152-2] [Citation(s) in RCA: 536] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
Diabetes is one of the most important comorbidities linked to the severity of all three known human pathogenic coronavirus infections, including severe acute respiratory syndrome coronavirus 2. Patients with diabetes have an increased risk of severe complications including Adult Respiratory Distress Syndrome and multi-organ failure. Depending on the global region, 20-50% of patients in the coronavirus disease 2019 (COVID-19) pandemic had diabetes. Given the importance of the link between COVID-19 and diabetes, we have formed an international panel of experts in the field of diabetes and endocrinology to provide some guidance and practical recommendations for the management of diabetes during the pandemic. We aim to briefly provide insight into potential mechanistic links between the novel coronavirus infection and diabetes, present practical management recommendations, and elaborate on the differential needs of several patient groups.
Collapse
Affiliation(s)
- Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
| | - Francesco Rubino
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Geltrude Mingrone
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Department of Internal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - David Hopkins
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - Andreas L Birkenfeld
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany; Department of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany
| | - Bernhard Boehm
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
| | - Stephanie Amiel
- Department of Diabetes, School of Life Course Science and Medicine, King's College London, London, UK
| | - Richard Ig Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, UK
| | - Jay S Skyler
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - J Hans DeVries
- Department of Endocrinology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Profil Institute for Metabolic Research, Neuss, Germany
| | - Eric Renard
- Montpellier University Hospital and Institute of Functional Genomics, Centre national de la recherche scientifique, INSERM, University of Montpellier, Montpellier, France
| | - Robert H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kurt George Alberti
- Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, UK
| | - Josep Vidal
- Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas, Barcelona, Spain
| | - Bruno Geloneze
- Obesity and Comorbities Research Center, Laboratory of Investigation in Metabolism and Diabetes/Gastrocentro, Universidade de Campinas, Campinas, São Paulo, Brazil
| | - Juliana C Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong Special Administrative Region, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China
| | - Barbara Ludwig
- Department of Medicine III, University Hospital Carl Gustav Carus, Dresden, Germany; Paul Langerhans Institute Dresden of the Helmholtz Center Munich, University Hospital Carl Gustav Carus, Dresden, Germany; Department of Endocrinology and Diabetology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Deutsche Forschungsgemeinschaft-Center for Regenerative Therapies Dresden, Technische Universität Dresden, Dresden, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| |
Collapse
|
34
|
Orioli L, Hermans MP, Thissen JP, Maiter D, Vandeleene B, Yombi JC. COVID-19 in diabetic patients: Related risks and specifics of management. ANNALES D'ENDOCRINOLOGIE 2020; 81:101-109. [PMID: 32413342 PMCID: PMC7217100 DOI: 10.1016/j.ando.2020.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023]
Abstract
Diabetes is among the most frequently reported comorbidities in patients infected with COVID-19. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. On the other hand, diabetes is a risk factor for developing severe and critical forms of COVID-19, the latter requiring admission to an intensive care unit and/or use of invasive mechanical ventilation, with high mortality rates. The characteristics of diabetic patients at risk for developing severe and critical forms of COVID-19, as well as the prognostic impact of diabetes on the course of COVID-19, are under current investigation. Obesity, the main risk factor for incident type 2 diabetes, is more common in patients with critical forms of COVID-19 requiring invasive mechanical ventilation. On the other hand, COVID-19 is usually associated with poor glycemic control and a higher risk of ketoacidosis in diabetic patients. There are currently no recommendations in favour of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Metformin and SGLT2 inhibitors should be discontinued in patients with severe forms of COVID-19 owing to the risks of lactic acidosis and ketoacidosis. Finally, we advise for systematic screening for (pre)diabetes in patients with proven COVID-19 infection.
Collapse
MESH Headings
- Acidosis, Lactic/chemically induced
- Acidosis, Lactic/epidemiology
- Acidosis, Lactic/virology
- Betacoronavirus/physiology
- COVID-19
- Comorbidity
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/epidemiology
- Coronavirus Infections/therapy
- Critical Illness/epidemiology
- Critical Illness/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/therapy
- Diabetic Ketoacidosis/chemically induced
- Diabetic Ketoacidosis/epidemiology
- Diabetic Ketoacidosis/virology
- Humans
- Mass Screening/methods
- Mass Screening/standards
- Metformin/therapeutic use
- Obesity/complications
- Obesity/epidemiology
- Obesity/therapy
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/therapy
- Prediabetic State/complications
- Prediabetic State/diagnosis
- Prediabetic State/epidemiology
- Prediabetic State/therapy
- Renin-Angiotensin System/physiology
- Risk Factors
- Risk Management
- SARS-CoV-2
- Severity of Illness Index
- Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
- Withholding Treatment
Collapse
Affiliation(s)
- Laura Orioli
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium; Department of Endocrinology, Diabetology and Nutrition, IREC, UCLouvain, avenue Hippocrate 55, Brussels, Belgium.
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jean-Paul Thissen
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium; Department of Endocrinology, Diabetology and Nutrition, IREC, UCLouvain, avenue Hippocrate 55, Brussels, Belgium
| | - Dominique Maiter
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Bernard Vandeleene
- Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jean-Cyr Yombi
- Department of internal medicine, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Brussels, Belgium
| |
Collapse
|
35
|
Zheng C, Wang J, Guo H, Lu Z, Ma Y, Zhu Y, Xia D, Wang Y, He H, Zhou J, Wang Y, Fei M, Yin Y, Zheng M, Xu Y. Risk-adapted Treatment Strategy For COVID-19 Patients. Int J Infect Dis 2020; 94:74-77. [PMID: 32229257 PMCID: PMC7270846 DOI: 10.1016/j.ijid.2020.03.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 01/15/2023] Open
Abstract
There are no clear expert consensus or guidelines on how to treat COVID-19. We developed a risk-adapted treatment approach according to the illness severity. This strategy was effective in symptoms alleviation and chest CT recovery. This strategy is a useful and efficient approach for COVID-19 patients.
Background There are no clear expert consensus or guidelines on how to treat 2019 coronavirus disease (COVID-19). The objective of this study is to investigate the short-term effect of risk-adapted treatment strategy on patients with COVID-19. Methods We collected the medical records of 55 COVID-19 patients for analysis. We divided these patients into mild, moderate and severe groups, and risk-adapted treatment approaches were given according to the illness severity. Results Twelve patients were in mild group and 22 were in moderate group (non-severe group, n = 34), and 21 patients were in severe group. At the end of the first two weeks after admission, clinical manifestations had completely despeared in 31(91.2%)patients in non-severe group, and 18(85.7%) patients in severe group (p = 0.85). Both groups had a satisfied chest CT imaging recovery, which includes 22(64.7%) patients in non-severe group and 12(57.1%) patients in severe group recovered at least 50% of the whole leisions in the first week, and 28(82.4%) and 16(76.2%) recovered at least 75% in the second week, respectively. There were no significant differences in SARS-CoV-2 nucleic acid negativity (p = 0.92). There were also no significant differences in the levels of SARS-CoV-2-IgM and IgG antibody production between the two groups (p = 0.13, 0.62). There were 45 cases were discharged from the hospital, and no patients died at the time of this clinical analysis. Conclusions Risk-adapted treatment strategy was associated with significant clinical manifestations alleviation and clinical imaging recovery. In severe COVID-19 patients, early and short-term use of low-dose methylprednisolone was beneficial and did not delay SARS-CoV-2 nucleic acid clearance and influence IgG antibody production.
Collapse
Affiliation(s)
- Changcheng Zheng
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| | - Jinquan Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
| | - Hui Guo
- Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhaohui Lu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yan Ma
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yuyou Zhu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Daqing Xia
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yinzhong Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hongliang He
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jian Zhou
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yong Wang
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Mingming Fei
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yihong Yin
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Mao Zheng
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yehong Xu
- The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | | |
Collapse
|