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Somma T, Bove I, Migliorati K, Scala MR, Ius T, Garufi G, Santi L, Cappabianca P. The gender impact in the era of COVID-19: an Italian neurosurgical perspective. J Neurosurg Sci 2024; 68:181-185. [PMID: 33709670 DOI: 10.23736/s0390-5616.21.05330-3] [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: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to understand the impact of SARS-COV-2 disease on neurosurgeons and our profession; specifically, to trace the role of women, in particular young neurosurgeons, in addressing this health emergency. METHODS This cross-sectional study evaluated the impact of SARS-COV-2 disease on Italian neurosurgeons stratified by gender (44 [49.9%] males and 49 [52.1%] females) enrolled through a questionnaire-based online survey. RESULTS Ninety-three Italian neurosurgeons were included in this study. The percentage of female participants was 52.1% (49) and 53% (50) were younger than 40 years. Men were significantly more affected than women by complications (14 versus 3), while there was no gender difference in the COVID-19 infection rate. Furthermore, the social impact of the pandemic was the same between men and women. CONCLUSIONS Our analysis did not show significant differences between the two genders in the susceptibility, and mortality from COVID-19. The possible and immediate implementation of anti-COVID-19 measures and devices, associated with a lower risk of transmission in the treatment of neurosurgical pathologies, has likely, moderated and disregarded the socio-psychological "gender gap" of the Covid-19 pandemic.
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Affiliation(s)
- Teresa Somma
- Division of Neurosurgery, University of Naples Federico II, Naples, Italy -
| | - Ilaria Bove
- Division of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Karol Migliorati
- Department of Neurosurgery, Spedali Civili University Hospital, Brescia, Italy
| | - Maria R Scala
- Division of Neurosurgery, University of Naples Federico II, Naples, Italy
| | - Tamara Ius
- Unit of Neurosurgery, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Giada Garufi
- Division of Neurosurgery, University of Messina, G. Martino Polyclinic, Messina, Italy
| | - Laura Santi
- Unit of Neurosurgery, ASST Sondrio-Valtellina e Alto Lario, Sondrio, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, University of Naples Federico II, Naples, Italy
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Stosic M, Plavsa D, Jovanovic V, Veljkovic M, Babic D, Knezevic A, Saponjic V, Dimitrijevic D, Rancic M, Milic M, Adzic-Vukicevic T. Factors associated with COVID-19 among hospitalized patients with severe acute respiratory infections in Serbia, 2022-2023: A test negative case-control study. PLoS One 2024; 19:e0299210. [PMID: 38498428 PMCID: PMC10947665 DOI: 10.1371/journal.pone.0299210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024] Open
Abstract
Severe acute respiratory infections (SARI) are estimated to be the cause of death in about 19% of all children younger than 5 years globally. The outbreak of coronaviral disease (COVID-19) caused by SARS-CoV-2, increased considerably the burden of SARI worldwide. We used data from a vaccine effectiveness study to identify the factors associated with SARS CoV-2 infection among hospitalized SARI patients. We recruited SARI patients at 3 hospitals in Serbia from 7 April 2022-1 May 2023. We collected demographic and clinical data from patients using a structured questionnaire, and all SARI patients were tested for SARS-CoV-2 by RT-PCR. We conducted an unmatched test negative case-control study. SARS-CoV-2 infected SARI patients were considered cases, while SARS CoV-2 negative SARI patients were controls. We conducted bivariate and multivariable logistic regression analysis in order to identify variables associated with SARS-CoV-2 infection. We included 110 SARI patients: 74 were cases and 36 controls. We identified 5 factors associated with SARS-CoV-2 positivity, age (OR = 1.04; 95% CI = 1.01-1.07), having received primary COVID-19 vaccine series (OR = 0.28; 95% CI = 0.09-0.88), current smoking (OR = 8.64; 95% CI = 2.43-30.72), previous SARS CoV-2 infection (OR = 3.48; 95% CI = 1.50-8.11) and number of days before seeking medical help (OR = 0.81; 95% CI = 0.64-1.02). In Serbia during a period of Omicron circulation, we found that older age, unvaccinated, hospitalized SARI patients, previously infected with SARS CoV-2 virus and those who smoked, were more likely to be SARS-CoV-2-positive; these patient populations should be prioritized for COVID vaccination.
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Affiliation(s)
- Maja Stosic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Dragana Plavsa
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Verica Jovanovic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Marko Veljkovic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Dragan Babic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Aleksandra Knezevic
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Saponjic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Dragana Dimitrijevic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Miljan Rancic
- World Health Organization, Country Office Serbia, Belgrade, Serbia
| | - Marija Milic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
- Department of Epidemiology, Faculty of Medicine, University of Pristina Temporarily Seated in Kosovska Mitrovica, Kosovska Mitrovica, Serbia
| | - Tatjana Adzic-Vukicevic
- COVID Hospital "Batajnica", University Clinical Centre of Serbia, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Centre of Serbia, Belgrade, Serbia
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Sarıoğlu E, Sarıaltın SY, Çoban T. Neurological complications and effects of COVID-19: Symptoms and conceivable mechanisms. BRAIN HEMORRHAGES 2023; 4:154-173. [PMID: 36789140 PMCID: PMC9911160 DOI: 10.1016/j.hest.2023.02.001] [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: 01/12/2023] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. The new coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 can invade the nervous system aside from infecting the respiratory system as its primary target. The most common nervous system symptoms of COVID-19 are stated as headache, myalgia, fatigue, nausea, vomiting, sudden and unexplained anosmia, and ageusia. More severe conditions such as encephalomyelitis, acute myelitis, thromboembolic events, ischemic stroke, intracerebral hemorrhage, Guillain-Barré-syndrome, Bell's palsy, rhabdomyolysis, and even coma have also been reported. Cohort studies revealed that neurological findings are associated with higher morbidity and mortality. The neurological symptoms and manifestations caused by SARS-CoV-2 and COVID-19 are examined and summarized in this article.
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Affiliation(s)
- Elif Sarıoğlu
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Sezen Yılmaz Sarıaltın
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Tülay Çoban
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
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Gholinataj Jelodar M, Rafieian S, Allah Dini A, Khalaj F, Zare S, Dehghanpour H, Mirzaei S. Analyzing Trends in Demographic, Laboratory, Imaging, and Clinical Outcomes of ICU-Hospitalized COVID-19 Patients. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:3081660. [PMID: 37283598 PMCID: PMC10241583 DOI: 10.1155/2023/3081660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/21/2023] [Accepted: 05/18/2023] [Indexed: 06/08/2023]
Abstract
Background COVID-19 has led to significant hospitalization and intensive care unit admission rates. The demographic parameters of COVID-19 patients, such as age, underlying illnesses, and clinical symptoms, substantially influence the incidence and mortality of these individuals. The current study examined the clinical and demographic characteristics of COVID-19 intensive care unit (ICU) patients in Yazd, Iran. Methods The descriptive-analytical cross-sectional study was conducted on ICU patients with a positive RT-PCR test for coronavirus, admitted to the ICU in Yazd province, Iran, over 18 months. To this end, demographic, clinical, laboratory, and imaging data were collected. Moreover, patients were divided into good and worse clinical outcome groups based on their clinical outcomes. Subsequently, data analysis was performed at a 95% confidence interval (CI) using SPSS 26 software. Results 391 patients with positive PCR were analyzed. The average age of the patients in the study was 63.59 ± 17.76, where 57.3% were male. On the high-resolution computed tomography (HRCT) scan, the mean lung involvement score was 14.03 ± 6.04, where alveolar consolidation (34%) and ground-glass opacity (25.6%) were the most prevalent type of lung involvement. The most common underlying illnesses in the study participants were hypertension (HTN) (41.4%), diabetes mellitus (DM) (39.9%), ischemic heart disease (IHD) (21%), and chronic kidney disease (CKD) (20.7%). In hospitalized patients, the rates of endotracheal intubation and mortality were 38.9% and 38.1%, respectively. Age, DM, HTN, dyslipidemia, CKD, cerebral vascular accident (CVA), cerebral hemorrhage, and cancer were reported to be significantly different between these two groups of patients, indicating an increase in the rate of intubation and mortality among these patients. Furthermore, the multivariate logistic regression analysis revealed that DM, HTN, CKD, CVA, neutrophil-to-lymphocyte ratio (NLR), the percentage of lung involvement, and initial O2 saturation significantly increase the mortality of ICU patients. Conclusion Several features of COVID-19 patients influence the mortality in these individuals. According to the findings, early detection of this disease in people at high risk of death can prevent its progression and lower mortality rates.
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Affiliation(s)
- Mohsen Gholinataj Jelodar
- Department of Internal Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Shahab Rafieian
- Department of Thoracic Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Allah Dini
- Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Khalaj
- Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samira Zare
- Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hanieh Dehghanpour
- Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Samaneh Mirzaei
- Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Torabizadeh C, Iloonkashkooli R, Haghshenas H, Fararouei M. Prevalence of Cardiovascular Complications in Coronavirus Disease 2019 adult Patients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:243-267. [PMID: 37791325 PMCID: PMC10542931 DOI: 10.30476/ijms.2022.93701.2504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 10/05/2023]
Abstract
Background It has been found that the new coronavirus can affect various parts of the cardiovascular system. Cardiovascular complications caused by coronavirus disease 2019 (COVID-19) are often serious and can increase the mortality rate among infected patients. This study aimed to investigate the prevalence of cardiovascular complications in COVID-19 adult patients. Methods A systematic review and meta-analysis of observational studies published in English were conducted between December 2019 and February 2021. A complete search was performed in PubMed (PubMed Central and MEDLINE), Google Scholar, Cochrane Library, Science Direct, Ovid, Embase, Scopus, CINAHL, Web of Science, and WILEY, as well as BioRXiv, MedRXiv, and gray literature. A random effect model was used to examine the prevalence of cardiovascular complications among COVID-19 patients. The I2 test was used to measure heterogeneity across the included studies. Results A total of 74 studies involving 34,379 COVID-19 patients were included for meta-analysis. The mean age of the participants was 61.30±14.75 years. The overall pooled prevalence of cardiovascular complications was 23.45%. The most prevalent complications were acute myocardial injury (AMI) (19.38%, 95% CI=13.62-26.81, test for heterogeneity I2=97.5%, P<0.001), arrhythmia (11.16%, 95% CI=8.23-14.96, test for heterogeneity I2=91.5%, P<0.001), heart failure (HF) (7.56%, 95% CI=4.50-12.45, test for heterogeneity I2=96.3%, P<0.001), and cardiomyopathy (2.78%, 95% CI=0.34-9.68). The highest pooled prevalence of cardiac enzymes was lactate dehydrogenase (61.45%), troponin (23.10%), and creatine kinase-myocardial band or creatine kinase (14.52%). Conclusion The high prevalence of serious cardiovascular complications in COVID-19 patients (AMI, arrhythmia, and HF) necessitates increased awareness by healthcare administrators.
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Affiliation(s)
- Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hajar Haghshenas
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- HIV/AIDs Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Buchynskyi M, Kamyshna I, Oksenych V, Zavidniuk N, Kamyshnyi A. The Intersection of COVID-19 and Metabolic-Associated Fatty Liver Disease: An Overview of the Current Evidence. Viruses 2023; 15:v15051072. [PMID: 37243158 DOI: 10.3390/v15051072] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
The global population is currently experiencing the impact of the SARS-CoV-2 coronavirus, which has caused the Coronavirus Disease 2019 (COVID-19) pandemic. With our profound comprehension of COVID-19, encompassing the involvement sequence of the respiratory tract, gastrointestinal system, and cardiovascular apparatus, the multiorgan symptoms of this infectious disease have been discerned. Metabolic-associated fatty liver disease (MAFLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a pervasive public health concern intricately linked with metabolic dysregulation and estimated to afflict one-fourth of the global adult population. The burgeoning focus on the association between COVID-19 and MAFLD is justified by the potential role of the latter as a risk factor for both SARS-CoV-2 infection and the subsequent emergence of severe COVID-19 symptoms. Investigations have suggested that changes in both innate and adaptive immune responses among MAFLD patients may play a role in determining the severity of COVID-19. The remarkable similarities observed in the cytokine pathways implicated in both diseases imply the existence of shared mechanisms governing the chronic inflammatory responses characterizing these conditions. The effect of MAFLD on the severity of COVID-19 illness remains uncertain, as indicated by conflicting results in cohort investigations.
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Affiliation(s)
- Mykhailo Buchynskyi
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Iryna Kamyshna
- Department of Medical Rehabilitation, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Valentyn Oksenych
- Department of Clinical and Molecular Medicine (IKOM), Norwegian University of Science and Technology (NTNU), 7028 Trondheim, Norway
| | - Nataliia Zavidniuk
- Department of Infectious Diseases with Epidemiology, Dermatology and Venerology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
| | - Aleksandr Kamyshnyi
- Department of Microbiology, Virology, and Immunology, I. Horbachevsky Ternopil National Medical University, 46001 Ternopil, Ukraine
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Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0876. [PMID: 36890875 PMCID: PMC9988289 DOI: 10.1097/cce.0000000000000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
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Omer S, Gondal MF, Usman M, Sarwar MB, Roman M, Khan A, Afzal N, Qaiser TA, Yasir M, Shahzad F, Tahir R, Ayub S, Akram J, Faizan RM, Naveed MA, Jahan S. Epidemiology, Clinico-Pathological Characteristics, and Comorbidities of SARS-CoV-2-Infected Pakistani Patients. Front Cell Infect Microbiol 2022; 12:800511. [PMID: 35755851 PMCID: PMC9226825 DOI: 10.3389/fcimb.2022.800511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
SARS-CoV-2 is a causative agent for COVID-19 disease, initially reported from Wuhan, China. The infected patients experienced mild to severe symptoms, resulting in several fatalities due to a weak understanding of its pathogenesis, which is the same even to date. This cross-sectional study has been designed on 452 symptomatic mild-to-moderate and severe/critical patients to understand the epidemiology and clinical characteristics of COVID-19 patients with their comorbidities and response to treatment. The mean age of the studied patients was 58 ± 14.42 years, and the overall male to female ratio was 61.7 to 38.2%, respectively. In total, 27.3% of the patients had a history of exposure, and 11.9% had a travel history, while for 60% of patients, the source of infection was unknown. The most prevalent signs and symptoms in ICU patients were dry cough, myalgia, shortness of breath, gastrointestinal discomfort, and abnormal chest X-ray (p < 0.001), along with a high percentage of hypertension (p = 0.007) and chronic obstructive pulmonary disease (p = 0.029) as leading comorbidities. The complete blood count indicators were significantly disturbed in severe patients, while the coagulation profile and D-dimer values were significantly higher in mild-to-moderate (non-ICU) patients (p < 0.001). The serum creatinine (1.22 μmol L-1; p = 0.016) and lactate dehydrogenase (619 μmol L-1; p < 0.001) indicators were significantly high in non-ICU patients, while raised values of total bilirubin (0.91 μmol L-1; p = 0.054), C-reactive protein (84.68 mg L-1; p = 0.001), and ferritin (996.81 mg L-1; p < 0.001) were found in ICU patients. The drug dexamethasone was the leading prescribed and administrated medicine to COVID-19 patients, followed by remdesivir, meropenem, heparin, and tocilizumab, respectively. A characteristic pattern of ground glass opacities, consolidation, and interlobular septal thickening was prominent in severely infected patients. These findings could be used for future research, control, and prevention of SARS-CoV-2-infected patients.
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Affiliation(s)
- Saadia Omer
- Department of Immunology, University of Health Sciences, Lahore, Pakistan.,Institute of Public Health, Health Department, Government of Punjab, Lahore, Pakistan.,Department of Community Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | | | - Muhammad Usman
- Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | | | - Muhammad Roman
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
| | - Alam Khan
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
| | - Nadeem Afzal
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
| | - Tanveer Ahmed Qaiser
- Department of Molecular Biology, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - Muhammad Yasir
- Quadram Institute Bioscience, Norwich Research Park, Norwich, United Kingdom
| | - Faheem Shahzad
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
| | - Romeeza Tahir
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
| | - Saima Ayub
- Institute of Public Health, Health Department, Government of Punjab, Lahore, Pakistan
| | - Javed Akram
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
| | | | | | - Shah Jahan
- Department of Immunology, University of Health Sciences, Lahore, Pakistan
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Kastora S, Patel M, Carter B, Delibegovic M, Myint PK. Impact of diabetes on COVID-19 mortality and hospital outcomes from a global perspective: An umbrella systematic review and meta-analysis. Endocrinol Diabetes Metab 2022; 5:e00338. [PMID: 35441801 PMCID: PMC9094465 DOI: 10.1002/edm2.338] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION To date, COVID-19 has claimed 4.9 million lives. Diabetes has been identified as an independent risk factor of serious outcomes in people with COVID-19 infection. Whether that holds true across world regions uniformly has not been previously assessed. METHODS This study offers the first umbrella systematic review and meta-analysis to analyse the collective and geographically stratified mortality, ICU admission, ventilation requirement, illness severity and discharge rate amongst patients with diabetes. Five databases (EMBASE, MEDLINE, CAB Abstracts, PsychInfo and Web of Science) and 3 additional sources (SSRN's eLibrary, Research Square and MedRxiv) were searched from inception to 30 August 2021. Prospective and retrospective cohort studies, reporting the association between diabetes and one or more COVID-19 hospitalization outcomes, were included. This meta-analysis was registered on PROSPERO, CRD42021278579. Abbreviated MeSH terms used for search were as follows: (Diabetes) AND (2019 Novel Coronavirus Disease), adapted per database requirements. Exclusion criteria exclusion criteria were as follows: (1) none of the primary or secondary outcomes of meta-analysis reported, (2) no confirmed COVID-19 infection (laboratory or clinical) and (3) no unexposed population (solely patients with diabetes included). Quality of the included studies were assessed using the Newcastle-Ottawa Scale (NOS) whilst quality of evidence by the GRADE framework. Studies that were clinically homogeneous were pooled. Summative data and heterogeneity were generated by the Cochrane platform RevMan (V. 5.4). RESULTS Overall, 158 observational studies were included, with a total of 270,212 of participants, median age 59 [53-65 IQR] of who 56.5% were male. A total of 22 studies originated from EU, 90 from Far East, 16 from Middle East and 30 from America. Data were synthesized with mixed heterogeneity across outcomes. Pooled results highlighted those patients with diabetes were at a higher risk of COVID-19-related mortality, OR 1.87 [95%CI 1.61, 2.17]. ICU admissions increased across all studies for patients with diabetes, OR 1.59 [95%CI 1.15, 2.18], a result that was mainly skewed by Far East-originating studies, OR 1.94 [95%CI 1.51, 2.49]. Ventilation requirements were also increased amongst patients with diabetes worldwide, OR 1.44 [95%CI 1.20, 1.73] as well as their presentation with severe or critical condition, OR 2.88 [95%CI 2.29, 3.63]. HbA1C levels under <70 mmol and metformin use constituted protective factors in view of COVID-19 mortality, whilst the inverse was true for concurrent insulin use. CONCLUSIONS Whilst diabetes constitutes a poor prognosticator for various COVID-19 infection outcomes, variability across world regions is significant and may skew overall trends.
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Affiliation(s)
- Stavroula Kastora
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Manisha Patel
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mirela Delibegovic
- Aberdeen Cardiovascular and Diabetes Centre (ACDC), Institute of Medical Sciences (IMS), University of Aberdeen, Aberdeen, UK
| | - Phyo Kyaw Myint
- Aberdeen Cardiovascular and Diabetes Centre (ACDC), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Leoni MLG, Moschini E, Beretta M, Zanello M, Nolli M. The modified NUTRIC score (mNUTRIC) is associated with increased 28-day mortality in critically ill COVID-19 patients: internal validation of a prediction model. Clin Nutr ESPEN 2022; 48:202-209. [PMID: 35331492 PMCID: PMC8849901 DOI: 10.1016/j.clnesp.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Matteo Luigi Giuseppe Leoni
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy; Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy.
| | - Elisa Moschini
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Maurizio Beretta
- Department of Medicine and Surgery, University of Parma, School of Nursing, Piacenza, Italy
| | - Marco Zanello
- University Alma Mater Studiorum, Department of Biomedical and Neuromotor Sciences (DIBINEM), Bologna, Italy
| | - Massimo Nolli
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Zeng W, Qi K, Ye M, Zheng L, Liu X, Hu S, Zhang W, Tang W, Xu J, Yu D, Wei Y. Gastrointestinal symptoms are associated with severity of coronavirus disease 2019: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2022; 34:168-176. [PMID: 33470700 DOI: 10.1097/meg.0000000000002072] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Studies have suggested that coronavirus disease 2019 (COVID-19) appears to be more serious in patients with gastrointestinal symptoms. This meta-analysis was conducted to explore the relationship between gastrointestinal symptoms and the severity of COVID-19. METHODS We searched PubMed, Web of Science, Science Direct, Embase, and Google Scholar on 16 October 2020, to identify observational studies that provided data on gastrointestinal symptoms and severity of COVID-19. Gastrointestinal symptoms include diarrhea, abdominal pain, nausea, and vomiting. The severe rate and the odds ratio (OR) were pooled. Heterogeneity was assessed using the I2 statistic. RESULTS A total of 21 studies with 5285 patients were included in this meta-analysis. The severe rate of COVID-19 patients with diarrhea was 41.1% [95% confidence interval (CI): 31.0-51.5%], and the OR of association between diarrhea and severe COVID-19 was 1.41 (95% CI: 1.05-1.89); sensitivity analysis showed that the results for the OR and 95% CI were unstable. For abdominal pain, the severe rate and OR of association with severe COVID-19 were 59.3% (95% CI: 41.3-76.4%) and 2.76 (95% CI: 1.59-4.81), respectively; for nausea, 41.4% (95% CI: 23.2-60.7%) and 0.92 (95% CI: 0.59-1.43), respectively; for vomiting, 51.3% (95% CI: 36.8-65.8%) and 1.68 (95% CI: 0.97-2.92), respectively. CONCLUSION The severe rate was more than 40% in COVID-19 patients with gastrointestinal symptoms. Abdominal pain was associated with a near 2.8-fold increased risk of severe COVID-19; the relationship between diarrhea and the severity of COVID-19 was regionally different; nausea and vomiting were limited in association with an increased risk of severe COVID-19.
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Affiliation(s)
- Weibiao Zeng
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Kai Qi
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Miao Ye
- Medical College of Nanchang University
| | - Li Zheng
- Department of Gastroenterology Medicine, The Third Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinliang Liu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Sheng Hu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Wenxiong Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Wenjing Tang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine
| | - Jianjun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Dongliang Yu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
| | - Yiping Wei
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University
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12
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Al-Hadidi SH, Alhussain H, Abdel Hadi H, Johar A, Yassine HM, Al Thani AA, Eltai NO. The Spectrum of Antibiotic Prescribing During COVID-19 Pandemic: A Systematic Literature Review. Microb Drug Resist 2021; 27:1705-1725. [PMID: 34077290 PMCID: PMC8713256 DOI: 10.1089/mdr.2020.0619] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: Over the last decades, there has been a significant increase in antimicrobial prescribing and consumption associated with the development of patients' adverse events and antimicrobial resistance (AMR) to the point of becoming a global priority. This study aims at evaluating antibiotic prescribing during COVID-19 pandemic from November 2019 to December 2020. Materials and Methods: A systematic review was conducted primarily through the NCBI database, using PRISMA guidelines to identify relevant literature for the period between November 1, 2019 and December 19, 2020, using the keywords: COVID-19 OR SARS-Cov-2 AND antibiotics restricted to the English language excluding nonclinical articles. Five hundred twenty-seven titles were identified; all articles fulfilling the study criteria were included, 133 through the NCBI, and 8 through Google Scholar with a combined total of 141 studies. The patient's spectrum included all ages from neonates to elderly with all associated comorbidities, including immune suppression. Results: Of 28,093 patients included in the combined studies, 58.7% received antibiotics (16,490/28,093), ranging from 1.3% to 100% coverage. Antibiotics coverage was less in children (57%) than in adults with comorbidities (75%). Broad-spectrum antibiotics were prescribed presumptively without pathogen identifications, which might contribute to adverse outcomes. Conclusions: During the COVID-19 pandemic, there has been a significant and wide range of antibiotic prescribing in patients affected by the disease, particularly in adults with underlying comorbidities, despite the paucity of evidence of associated bacterial infections. The current practice might increase patients' immediate and long-term risks of adverse events, susceptibility to secondary infections as well as aggravating AMR.
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Affiliation(s)
| | | | - Hamad Abdel Hadi
- Infectious Disease Division, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Nahla O. Eltai
- Biomedical Research Center, Qatar University, Doha, Qatar
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13
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Sharma A, Kothari N, Goel AD, Narayanan B, Goyal S, Bhatia P, Kumar D, Bohra GK, Chauhan NK, Jalandra R, Dutt N, Bhardwaj P, Garg MK, Misra S. Clinical features and mortality in COVID-19 SARI versus non COVID-19 SARI cases from Western Rajasthan, India. J Family Med Prim Care 2021; 10:3240-3246. [PMID: 34760737 PMCID: PMC8565113 DOI: 10.4103/jfmpc.jfmpc_14_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 06/19/2021] [Accepted: 06/20/2021] [Indexed: 01/08/2023] Open
Abstract
Background: In March 2020, the Indian Council of Medical Research (ICMR) issued guidelines that all patients presenting with severe acute respiratory infections (SARI) should be investigated for coronavirus disease 2019 (COVID-19). Following the same protocol, in our institute, all patients with SARI were transferred to the COVID-19 suspect intensive care unit (ICU) and investigated for COVID-19. Methods: This study was planned to examine the demographical, clinical features, and outcomes of the first 500 suspected patients of COVID-19 with SARI admitted in the COVID-19 suspect ICU at a tertiary care center. Between March 7 and July 20, 2020, 500 patients were admitted to the COVID-19 suspect ICU. We analyzed the demographical, clinical features, and outcomes between COVID-19 positive and negative SARI cases. The records of all the patients were reviewed until July 31, 2020. Results: Of the 500 suspected patients admitted to the hospital, 88 patients showed positive results for COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) of the nasopharyngeal swabs. The mean age in the positive group was higher (55.31 ± 16.16 years) than in the negative group (40.46 ± 17.49 years) (P < 0.001). Forty-seven (53.4%) of these patients in the COVID-19 positive group and 217 (52.7%) from the negative group suffered from previously known comorbidities. The common symptoms included fever, cough, sore throat, and dyspnea. Eighty-five (20.6%) patients died in the COVID-19 negative group, and 30 (34.1%) died in the COVID-19 positive group (P = 0.006). Deaths among the COVID-19 positive group had a significantly higher age than deaths in the COVID-19 negative group (P < 0.001). Among the patients who died with positive COVID-19 status had substantially higher neutrophilia and lymphopenia (P < 0.001). X-ray chest abnormalities were almost three times more likely in COVID-19 deaths (P < 0.001). Conclusion: In the present article, 17.6% of SARI were due to COVID-19 infection with significantly higher mortality (34.1%) in COVID-19 positive patients with SARI. Although all patients presenting as SARI have considerable mortality rates, the COVID-19-associated SARI cases thus had an almost one-third risk of mortality.
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Affiliation(s)
- Ankur Sharma
- Department of Trauma and Emergency (Anaesthesiology), All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Nikhil Kothari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Akhil Dhanesh Goel
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Balakrishnan Narayanan
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Shilpa Goyal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Deepak Kumar
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Gopal Krishna Bohra
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Nishant Kumar Chauhan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Ramniwas Jalandra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Naveen Dutt
- Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Pankaj Bhardwaj
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Mahendra Kumar Garg
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Sanjeev Misra
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
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14
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Puri A, He L, Giri M, Wu C, Zhao Q. Comparison of comorbidities among severe and non-severe COVID-19 patients in Asian versus non-Asian populations: A systematic review and meta-analysis. Nurs Open 2021; 9:733-751. [PMID: 34761532 PMCID: PMC8661719 DOI: 10.1002/nop2.1126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/25/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the comorbidities among severe and non-severe COVID-19 patients in Asian versus non-Asian populations. DESIGN Systemic review and Meta-analysis. METHODS A systematic literature search was conducted using PubMed, Embase, Scopus and the web of science Database up to 24 March 2021. Odds ratios were calculated using a random-effects model. RESULTS We identified 66 studies including 39 Asian and 27 non-Asian studies. This study demonstrated that the proportion of hypertension was significantly higher in severe group than in non-severe group for Asian (OR = 2.46) and non-Asian (OR = 1.60, 95% CI: 1.37-1.86, I2 = 84%; p < .00001) patients. Similarly, the proportion of diabetes, cardiovascular disease and chronic kidney disease was significantly higher in severe group than in non-severe group for both Asian and non-Asian studies. We found no statistically significant difference between the severe versus non-severe group for cancer (OR = 1.26) and chronic obstructive pulmonary disease (OR = 1.32) among non-Asian patients.
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Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin He
- Department of Respiratory and Critical Care Medicine, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengfei Wu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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15
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Sahni S, Gupta G, Sarda R, Pandey S, Pandey RM, Sinha S. Impact of metabolic and cardiovascular disease on COVID-19 mortality: A systematic review and meta-analysis. Diabetes Metab Syndr 2021; 15:102308. [PMID: 34673359 PMCID: PMC8492383 DOI: 10.1016/j.dsx.2021.102308] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS This meta-analysis aims to highlight the impact of cardio-metabolic comorbidities on COVID-19 severity and mortality. METHODS A thorough search on major online databases was done for studies describing the clinical outcomes of COVID-19 patients. We used random-effects model to compute pooled estimates for critical or fatal disease. RESULTS A total of 20,475 patients from 33 eligible studies were included. Maximum risk of development of critical or fatal COVID-19 disease was seen in patients with underlying cardiovascular disease [OR: 3.44, 95% CI: 2.65-4.48] followed by chronic lung disease, hypertension and diabetes mellitus. Of the total cases, 64% had one of the four comorbidities with the most prevalent being hypertension with a pooled prevalence of 27%. CONCLUSIONS Presence of comorbidities like cardiovascular disease, chronic lung disease, hypertension and diabetes mellitus led to a higher risk of development of critical or fatal COVID-19 disease, with maximum risk seen with underlying cardiovascular disease.
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Affiliation(s)
- Shubham Sahni
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Gaurav Gupta
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Radhika Sarda
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Shivam Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi- 110029, India.
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16
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Risk factors for recurrent positive results of the nucleic acid amplification test for COVID-19 patients: a retrospective study. Hum Cell 2021; 34:1744-1754. [PMID: 34558034 PMCID: PMC8460057 DOI: 10.1007/s13577-021-00618-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
Positive retests of COVID-19 represent a public health concern because of the increased risk of transmission. This study explored whether factors other than the nucleic acid amplification test (NAAT) contribute to positive retest results. Patients with COVID-19 admitted to the Guanggu district of the Hubei Maternal and Child Health Hospital between February 17 and March 28, 2020, were retrospectively included. The patients were grouped into the negative (n = 133) and positive (n = 51) retest groups. The results showed that the proportion of patients presenting with cough was higher (P < 0.001) and the proportion of patients with dyspnea was lower (P = 0.018) in the positive than in the negative retest group. The positive retest group showed shorter durations between symptom onset and hospitalization (P < 0.001) and symptom onset and the first positive NAAT (P = 0.033). The positive retest group had higher basophil counts (P = 0.023) and direct bilirubin (P = 0.032) and chlorine concentrations (P = 0.023) but lower potassium concentrations (P = 0.001) than the negative retest group. Multivariable regression analysis showed that coughing (OR = 7.59, 95% CI 2.28–25.32, P = 0.001) and serum chloride concentrations (OR = 1.38, 95% CI 1.08–1.77, P = 0.010) were independently associated with a positive retest result. Coughing and serum chloride concentrations were independent risk factors for positive NAAT retest results. Patients with a hospital stay of < 2 weeks or a short incubation period should stay in isolation and be monitored to reduce transmission. These results could help identify patients who require closer surveillance.
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17
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Tripathy S, Verma DK, Thakur M, Patel AR, Srivastav PP, Singh S, Gupta AK, Chávez-González ML, Aguilar CN, Chakravorty N, Verma HK, Utama GL. Curcumin Extraction, Isolation, Quantification and Its Application in Functional Foods: A Review With a Focus on Immune Enhancement Activities and COVID-19. Front Nutr 2021; 8:747956. [PMID: 34621776 PMCID: PMC8490651 DOI: 10.3389/fnut.2021.747956] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
An entirely unknown species of coronavirus (COVID-19) outbreak occurred in December 2019. COVID-19 has already affected more than 180 million people causing ~3.91 million deaths globally till the end of June 2021. During this emergency, the food nutraceuticals can be a potential therapeutic candidate. Curcumin is the natural and safe bioactive compound of the turmeric (Curcuma longa L.) plant and is known to possess potent anti-microbial and immuno-modulatory properties. This review paper covers the various extraction and quantification techniques of curcumin and its usage to produce functional food. The potential of curcumin in boosting the immune system has also been explored. The review will help develop insight and new knowledge about curcumin's role as an immune-booster and therapeutic agent against COVID-19. The manuscript will also encourage and assist the scientists and researchers who have an association with drug development, pharmacology, functional foods, and nutraceuticals to develop curcumin-based formulations.
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Affiliation(s)
- Soubhagya Tripathy
- Agricultural and Food Engineering Department, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Deepak Kumar Verma
- Agricultural and Food Engineering Department, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Mamta Thakur
- Department of Food Technology, School of Sciences, ITM University, Gwalior, Madhya Pradesh, India
| | - Ami R. Patel
- Division of Dairy Microbiology, Mansinhbhai Institute of Dairy & Food Technology-MIDFT, Gujarat, India
| | - Prem Prakash Srivastav
- Agricultural and Food Engineering Department, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Smita Singh
- Department of Life Sciences (Food Technology), Graphic Era (Deemed to Be) University, Dehradun, India
- Department of Nutrition and Dietetics, University Institute of Applied Health Sciences, Chandigarh University, Chandigarh, India
| | - Alok Kumar Gupta
- Division of Post-Harvest Management, ICAR-Central Institute for Subtropical Horticulture (Ministry of Agriculture and Farmers Welfare, Government of India), Lucknow, India
| | - Mónica L. Chávez-González
- Bioprocesses Research Group, Food Research Department, School of Chemistry, Universidad Autonoma de Coahuila, Saltillo, Mexico
| | - Cristobal Noe Aguilar
- Bioprocesses Research Group, Food Research Department, School of Chemistry, Universidad Autonoma de Coahuila, Saltillo, Mexico
| | - Nishant Chakravorty
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Henu Kumar Verma
- Department of Immunopathology, Comprehensive Pneumology Center, Institute of Lungs Biology and Disease, Munich, Germany
| | - Gemilang Lara Utama
- Faculty of Agro-Industrial Technology, Universitas Padjadjaran, Sumedang, Indonesia
- Center for Environment and Sustainability Science, Universitas Padjadjaran, Bandung, Indonesia
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18
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Kohansal Vajari M, Shirin M, Pourbagheri-Sigaroodi A, Akbari ME, Abolghasemi H, Bashash D. COVID-19-related coagulopathy: A review of pathophysiology and pharmaceutical management. Cell Biol Int 2021; 45:1832-1850. [PMID: 33945651 PMCID: PMC8239905 DOI: 10.1002/cbin.11623] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 01/08/2023]
Abstract
December 2019 will never be forgotten in the history of medicine when an outbreak of pneumonia of unknown etiology in Wuhan, China sooner or later prompted the World Health Organization to issue a public health warning emergency. This is not the first nor will it be the last time that a member of β-coronaviruses (CoVs) is waging a full-scale war against human health. Notwithstanding the fact that pneumonia is the primary symptom of the novel coronavirus (2019nCoV; designated as SARS-CoV-2), the emergence of severe disease mainly due to the injury of nonpulmonary organs at the shadow of coagulopathy leaves no choice, in some cases, rather than a dreadful death. Multiple casual factors such as inflammation, endothelial dysfunction, platelet and complement activation, renin-angiotensin-aldosterone system derangement, and hypoxemia play a major role in the pathogenesis of coagulopathy in coronavirus disease 2019 (COVID-19) patients. Due to the undeniable role of coagulation dysfunction in the initiation of several complications, assessment of coagulation parameters and the platelet count would be beneficial in early diagnosis and also timely prediction of disease severity. Although low-molecular-weight heparin is considered as the first-line of treatment in COVID-19-associated coagulopathy, several possible therapeutic options have also been proposed for better management of the disease. In conclusion, this review would help us to gain insight into the pathogenesis, clinical manifestation, and laboratory findings associated with COVID-19 coagulopathy and would summarize management strategies to alleviate coagulopathy-related complications.
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Affiliation(s)
- Mahdi Kohansal Vajari
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Shirin
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atieh Pourbagheri-Sigaroodi
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Esmaeil Akbari
- Cancer Research Center, Department of General Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Bashash
- Department of Hematology and Blood Banking, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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19
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D V, Sharma A, Kumar A, Flora SJS. Neurological Manifestations in COVID-19 Patients: A Meta-Analysis. ACS Chem Neurosci 2021; 12:2776-2797. [PMID: 34260855 PMCID: PMC8291134 DOI: 10.1021/acschemneuro.1c00353] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
Common symptoms such as dizziness, headache, olfactory dysfunction, nausea, vomiting, etc. in COVID-19 patients have indicated the involvement of the nervous system. However, the exact association of the nervous system with COVID-19 infection is still unclear. Thus, we have conducted a meta-analysis of clinical studies associated with neurological problems in COVID-19 patients. We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The Stats Direct (version 3) was used for the analysis. The pooled prevalence with 95% confidence interval of various neurological manifestations reported in the COVID-19 patients was found to be headache 14.6% (12.2-17.2), fatigue 33.6% (29.5-37.8), olfactory dysfunction 26.4% (21.8-31.3), gustatory dysfunction 27.2% (22.3-32.3), vomiting 6.7% (5.5-8.0), nausea 9.8% (8.1-11.7), dizziness 6.7% (4.7-9.1), myalgia 21.4% (18.8-24.1), seizure 4.05% (2.5-5.8), cerebrovascular diseases 9.9% (6.8-13.4), sleep disorders 14.9% (1.9-36.8), altered mental status 17.1% (12.3-22.5), neuralgia 2.4% (0.8-4.7), arthralgia 19.9% (15.3-25.0), encephalopathy 23.5% (14.3-34.1), encephalitis 0.6% (0.2-1.3), malaise 38.3% (24.7-52.9), confusion 14.2% (6.9-23.5), movement disorders 5.2% (1.7-10.4), and Guillain-Barre syndrome 6.9% (2.3-13.7). However, the heterogeneity among studies was found to be high. Various neurological manifestations related to the central nervous system (CNS) and peripheral nervous system (PNS) are associated with COVID-19 patients.
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Affiliation(s)
- Vitalakumar D
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
| | - Ankita Sharma
- Department of Biotechnology, National
Institute of Pharmaceutical Education and Research (NIPER)-Raeberali,
Lucknow 226002, India
| | - Anoop Kumar
- Department of Pharmacology and Clinical Research, Delhi
Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi
Pharmaceutical Sciences & Research University (DPSRU), New Delhi
110017, India
| | - S. J. S. Flora
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
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20
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Abu-Rub LI, Abdelrahman HA, Johar ARA, Alhussain HA, Hadi HA, Eltai NO. Antibiotics Prescribing in Intensive Care Settings during the COVID-19 Era: A Systematic Review. Antibiotics (Basel) 2021; 10:935. [PMID: 34438985 PMCID: PMC8389042 DOI: 10.3390/antibiotics10080935] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 02/07/2023] Open
Abstract
The prevalence of patients admitted to intensive care units (ICUs) with SARS-CoV-2 infection who were prescribed antibiotics is undetermined and might contribute to the increased global antibiotic resistance. This systematic review evaluates the prevalence of antibiotic prescribing in patients admitted to ICUs with SARS-CoV-2 infection using PRISMA guidelines. We searched and scrutinized results from PubMed and ScienceDirect databases for published literature restricted to the English language up to 11 May 2021. In addition, we included observational studies of humans with laboratory-confirmed SARS-CoV-2 infection, clinical characteristics, and antibiotics prescribed for ICU patients with SARS-CoV-2 infections. A total of 361 studies were identified, but only 38 were included in the final analysis. Antibiotic prescribing data were available from 2715 patients, of which prevalence of 71% was reported in old age patients with a mean age of 62.7 years. From the reported studies, third generation cephalosporin had the highest frequency amongst reviewed studies (36.8%) followed by azithromycin (34.2%). The estimated bacterial infection in 12 reported studies was 30.8% produced by 15 different bacterial species, and S. aureus recorded the highest bacterial infection (75%). The fundamental outcomes were the prevalence of ICU COVID-19 patients prescribed antibiotics stratified by age, type of antibiotics prescribed, and the presence of co-infections and comorbidities. In conclusion, more than half of ICU patients with SARS-CoV-2 infection received antibiotics, and prescribing is significantly higher than the estimated frequency of identified bacterial co-infection.
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Affiliation(s)
- Lubna I. Abu-Rub
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
| | - Hana A. Abdelrahman
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
| | | | - Hashim A. Alhussain
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
| | - Hamad Abdel Hadi
- Communicable Diseases Centre, Infectious Disease Division, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Nahla O. Eltai
- Biomedical Research Center, Qatar University, Doha 2713, Qatar; (L.I.A.-R.); (H.A.A.); (H.A.A.)
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21
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Katzenschlager S, Zimmer AJ, Gottschalk C, Grafeneder J, Schmitz S, Kraker S, Ganslmeier M, Muth A, Seitel A, Maier-Hein L, Benedetti A, Larmann J, Weigand MA, McGrath S, Denkinger CM. Can we predict the severe course of COVID-19 - a systematic review and meta-analysis of indicators of clinical outcome? PLoS One 2021; 16:e0255154. [PMID: 34324560 PMCID: PMC8321230 DOI: 10.1371/journal.pone.0255154] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 has been reported in over 40million people globally with variable clinical outcomes. In this systematic review and meta-analysis, we assessed demographic, laboratory and clinical indicators as predictors for severe courses of COVID-19. METHODS This systematic review was registered at PROSPERO under CRD42020177154. We systematically searched multiple databases (PubMed, Web of Science Core Collection, MedRvix and bioRvix) for publications from December 2019 to May 31st 2020. Random-effects meta-analyses were used to calculate pooled odds ratios and differences of medians between (1) patients admitted to ICU versus non-ICU patients and (2) patients who died versus those who survived. We adapted an existing Cochrane risk-of-bias assessment tool for outcome studies. RESULTS Of 6,702 unique citations, we included 88 articles with 69,762 patients. There was concern for bias across all articles included. Age was strongly associated with mortality with a difference of medians (DoM) of 13.15 years (95% confidence interval (CI) 11.37 to 14.94) between those who died and those who survived. We found a clinically relevant difference between non-survivors and survivors for C-reactive protein (CRP; DoM 69.10 mg/L, CI 50.43 to 87.77), lactate dehydrogenase (LDH; DoM 189.49 U/L, CI 155.00 to 223.98), cardiac troponin I (cTnI; DoM 21.88 pg/mL, CI 9.78 to 33.99) and D-Dimer (DoM 1.29mg/L, CI 0.9 to 1.69). Furthermore, cerebrovascular disease was the co-morbidity most strongly associated with mortality (Odds Ratio 3.45, CI 2.42 to 4.91) and ICU admission (Odds Ratio 5.88, CI 2.35 to 14.73). DISCUSSION This comprehensive meta-analysis found age, cerebrovascular disease, CRP, LDH and cTnI to be the most important risk-factors that predict severe COVID-19 outcomes and will inform clinical scores to support early decision-making.
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Affiliation(s)
| | - Alexandra J. Zimmer
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Claudius Gottschalk
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Stephani Schmitz
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Sara Kraker
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marlene Ganslmeier
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Amelie Muth
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Benedetti
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sean McGrath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Claudia M. Denkinger
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), partner site Heidelberg, Heidelberg, Germany
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22
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Leoni MLG, Lombardelli L, Colombi D, Bignami EG, Pergolotti B, Repetti F, Villani M, Bellini V, Rossi T, Halasz G, Caprioli S, Micheli F, Nolli M. Prediction of 28-day mortality in critically ill patients with COVID-19: Development and internal validation of a clinical prediction model. PLoS One 2021; 16:e0254550. [PMID: 34255793 PMCID: PMC8277063 DOI: 10.1371/journal.pone.0254550] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has rapidly required a high demand of hospitalization and an increased number of intensive care units (ICUs) admission. Therefore, it became mandatory to develop prognostic models to evaluate critical COVID-19 patients. MATERIALS AND METHODS We retrospectively evaluate a cohort of consecutive COVID-19 critically ill patients admitted to ICU with a confirmed diagnosis of SARS-CoV-2 pneumonia. A multivariable Cox regression model including demographic, clinical and laboratory findings was developed to assess the predictive value of these variables. Internal validation was performed using the bootstrap resampling technique. The model's discriminatory ability was assessed with Harrell's C-statistic and the goodness-of-fit was evaluated with calibration plot. RESULTS 242 patients were included [median age, 64 years (56-71 IQR), 196 (81%) males]. Hypertension was the most common comorbidity (46.7%), followed by diabetes (15.3%) and heart disease (14.5%). Eighty-five patients (35.1%) died within 28 days after ICU admission and the median time from ICU admission to death was 11 days (IQR 6-18). In multivariable model after internal validation, age, obesity, procaltitonin, SOFA score and PaO2/FiO2 resulted as independent predictors of 28-day mortality. The C-statistic of the model showed a very good discriminatory capacity (0.82). CONCLUSIONS We present the results of a multivariable prediction model for mortality of critically ill COVID-19 patients admitted to ICU. After adjustment for other factors, age, obesity, procalcitonin, SOFA and PaO2/FiO2 were independently associated with 28-day mortality in critically ill COVID-19 patients. The calibration plot revealed good agreements between the observed and expected probability of death.
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Affiliation(s)
- Matteo Luigi Giuseppe Leoni
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Luisa Lombardelli
- Unit of Operating Room and Waiting Lists Management, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Davide Colombi
- Department of Radiological Functions, Radiology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Elena Giovanna Bignami
- Unit of Anesthesiology, Division of Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Benedetta Pergolotti
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Francesca Repetti
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Matteo Villani
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Valentina Bellini
- Unit of Anesthesiology, Division of Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tommaso Rossi
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy
| | - Geza Halasz
- Cardiology Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Serena Caprioli
- Controller and data management of Administrative Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Fabrizio Micheli
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
- Unit of Interventional Pain Management, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Massimo Nolli
- Department of Anesthesia and Intensive Care Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
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23
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Rejinold N S, Choi G, Piao H, Choy JH. Bovine Serum Albumin-Coated Niclosamide-Zein Nanoparticles as Potential Injectable Medicine against COVID-19. MATERIALS 2021; 14:ma14143792. [PMID: 34300711 PMCID: PMC8307271 DOI: 10.3390/ma14143792] [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: 06/05/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 12/24/2022]
Abstract
(1) Background: COVID-19 has affected millions of people worldwide, but countries with high experimental anti-SARS-CoV-2 vaccination rates among the general population respectively show progress in achieving general herd immunity in the population (a combination of natural and vaccine-induced acquired immunity), resulting in a significant reduction in both newly detected infections and mortality rates. However, the longevity of the vaccines’ ability to provide protection against the ongoing pandemic is still unclear. Therefore, it is of utmost importance to have new medications to fight against the pandemic at the earliest point possible. Recently, it has been found that repurposing already existing drugs could, in fact, be an ideal strategy to formulate effective medication for COVID-19. Though there are many FDA-approved drugs, it has been found that niclosamide (NIC), an anthelmintic drug, has significantly high potential against the SARS-CoV-2 virus. (2) Methods: Here we deployed a simple self-assembling technique through which Zein nanoparticles were successfully used to encapsulate NIC, which was then coated with bovine serum albumin (BSA) in order to improve the drugs’ stability, injectablity, and selectivity towards the virus-infected cells. (3) Results: The particle size for the BSA-stabilized Zein-NIC nanohybrid was found to be less than 200 nm, with excellent colloidal stability and sustained drug release properties. In addition, the nanohybrid showed enhanced drug release behavior under serum conditions, indicating that such a hybrid drug delivery system could be highly beneficial for treating COVID-19 patients suffering from high endothelial glycocalyx damage followed by a cytokine storm related to the severe inflammations.
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Affiliation(s)
- Sanoj Rejinold N
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (S.R.N.); (G.C.); (H.P.)
| | - Goeun Choi
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (S.R.N.); (G.C.); (H.P.)
- College of Science and Technology, Dankook University, Cheonan 31116, Korea
- Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
| | - Huiyan Piao
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (S.R.N.); (G.C.); (H.P.)
| | - Jin-Ho Choy
- Intelligent Nanohybrid Materials Laboratory (INML), Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea; (S.R.N.); (G.C.); (H.P.)
- Department of Pre-medical Course, College of Medicine, Dankook University, Cheonan 31116, Korea
- Tokyo Tech World Research Hub Initiative (WRHI), Institute of Innovative Research, Tokyo Institute of Technology, Yokohama 226-8503, Japan
- Correspondence:
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24
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Mahat RK, Panda S, Rathore V, Swain S, Yadav L, Sah SP. The dynamics of inflammatory markers in coronavirus disease-2019 (COVID-19) patients: A systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021; 11:100727. [PMID: 33778183 PMCID: PMC7979575 DOI: 10.1016/j.cegh.2021.100727] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) is a global pandemic and high mortality rate among severe or critical COVID-19 is linked with SARS-CoV-2 infection-induced hyperinflammation of the innate and adaptive immune systems and the resulting cytokine storm. This paper attempts to conduct a systematic review and meta-analysis of published articles, to evaluate the association of inflammatory parameters with the severity and mortality in COVID-19 patients. METHODS A comprehensive systematic literature search of medical electronic databases including Pubmed/Medline, Europe PMC, and Google Scholar was performed for relevant data published from January 1, 2020 to June 26, 2020. Observational studies reporting clear extractable data on inflammatory parameters in laboratory-confirmed COVID-19 patients were included. Screening of articles, data extraction and quality assessment were carried out by two authors independently. Standardized mean difference (SMD)/mean difference (MD/WMD) and 95% confidence intervals (CIs) were calculated using random or fixed-effects models. RESULTS A total of 83 studies were included in the meta-analysis. Of which, 54 studies were grouped by severity, 25 studies were grouped by mortality, and 04 studies were grouped by both severity and mortality. Random effect model results demonstrated that patients with severe COVID-19 group had significantly higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-2R (IL-2R), serum amyloid A (SAA) and neutrophil-to-lymphocyte ratio (NLR) compared to those in the non-severe group. Similarly, the fixed-effect model revealed significant higher ferritin level in the severe group when compared with the non-severe group. Furthermore, the random effect model results demonstrated that the non-survivor group had significantly higher levels of CRP, PCT, IL-6, ferritin, and NLR when compared with the survivor group. CONCLUSION In conclusion, the measurement of these inflammatory parameters could help the physicians to rapidly identify severe COVID-19 patients, hence facilitating the early initiation of effective treatment. PROSPERO REGISTRATION NUMBER CRD42020193169.
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Affiliation(s)
- Roshan Kumar Mahat
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Suchismita Panda
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Vedika Rathore
- Department of Biochemistry, Shyam Shah Medical College, Rewa, Madhya Pradesh, 486001, India
| | - Sharmistha Swain
- Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India
| | - Lalendra Yadav
- Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Center, Moradabad, Uttar Pradesh, 244001, India
| | - Sumesh Prasad Sah
- Department of Biochemistry, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, 251203, India
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25
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van der Zalm MM, Lishman J, Verhagen LM, Redfern A, Smit L, Barday M, Ruttens D, da Costa A, van Jaarsveld S, Itana J, Schrueder N, Van Schalkwyk M, Parker N, Appel I, Fourie B, Claassen M, Workman JJ, Goussard P, Van Zyl G, Rabie H. Clinical Experience With Severe Acute Respiratory Syndrome Coronavirus 2-Related Illness in Children: Hospital Experience in Cape Town, South Africa. Clin Infect Dis 2021; 72:e938-e944. [PMID: 33170927 PMCID: PMC7717210 DOI: 10.1093/cid/ciaa1666] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Children seem relatively protected from serious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease, but little is known about children living in settings with high tuberculosis and human immunodeficiency virus (HIV) burden. This study reflects clinical data on South African children with SARS-CoV-2. METHODS We collected clinical data of children aged <13 years with laboratory-confirmed SARS-CoV-2 presenting to Tygerberg Hospital, Cape Town, between 17 April and 24 July 2020. RESULTS One hundred fifty-nine children (median age, 48.0 months [interquartile range {IQR}, 12.0-106.0 months]) were included. Hospitalized children (n = 62), with a median age of 13.5 months (IQR, 1.8-43.5 months) were younger than children not admitted (n = 97; median age, 81.0 months [IQR, 34.5-120.5 months]; P < .01.). Thirty-three of 159 (20.8%) children had preexisting medical conditions. Fifty-one of 62 (82.3%) hospitalized children were symptomatic; lower respiratory tract infection was diagnosed in 21 of 51 (41.2%) children, and in 11 of 16 (68.8%) children <3 months of age. Respiratory support was required in 25 of 51 (49.0%) children; 13 of these (52.0%) were <3 months of age. One child was HIV infected and 11 of 51 (21.2%) were HIV exposed but uninfected, and 7 of 51 (13.7%) children had a recent or new diagnosis of tuberculosis. CONCLUSIONS Children <1 year of age hospitalized with SARS-CoV-2 in Cape Town frequently required respiratory support. Access to oxygen may be limited in some low- and middle-income countries, which could potentially drive morbidity and mortality. HIV infection was uncommon but a relationship between HIV exposure, tuberculosis, and SARS-CoV-2 should be explored.
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Affiliation(s)
- Marieke M van der Zalm
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health,
Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
- Correspondence: M. M. van der Zalm, Department of Paediatrics and Child
Health, Desmond Tutu TB Centre, Stellenbosch University, Fransie van Zyl drive, 8000, Cape
Town, South Africa ()
| | - Juanita Lishman
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Lilly M Verhagen
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
- Department of Pediatric Infectious Diseases Immunology, Wilhelmina Children’s
Hospital, University Medical Centre Utrecht, Utrecht University,
Utrecht, The Netherlands
| | - Andrew Redfern
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Liezl Smit
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Mikhail Barday
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Dries Ruttens
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
- Department of Paediatrics, KU Leuven University,
Leuven, Belgium
| | - A’ishah da Costa
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Sandra van Jaarsveld
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Justina Itana
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Neshaad Schrueder
- Division of General Internal Medicine, Department of Medicine, Tygerberg
Hospital, Stellenbosch University, Cape Town,
South Africa
| | - Marije Van Schalkwyk
- Division of Adult Infectious Diseases, Department of Medicine, Tygerberg
Hospital, Stellenbosch University, Cape Town,
South Africa
| | - Noor Parker
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Ilse Appel
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Barend Fourie
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Mathilda Claassen
- Division of Medical Virology, Stellenbosch University, National Health
Laboratory services, Cape Town, South Africa
| | - Jessica J Workman
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health,
Faculty of Medicine and Health Sciences, Stellenbosch University,
Cape Town, South Africa
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
| | - Gert Van Zyl
- Division of Medical Virology, Stellenbosch University, National Health
Laboratory services, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Tygerberg Hospital, Faculty of
Medicine and Health Sciences, Stellenbosch University, Cape
Town, South Africa
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Wang Y, Pang SC, Yang Y. A potential association between immunosenescence and high COVID-19 related mortality among elderly patients with cardiovascular diseases. Immun Ageing 2021; 18:25. [PMID: 34074305 PMCID: PMC8166579 DOI: 10.1186/s12979-021-00234-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
Elderly patients with cardiovascular diseases account for a large proportion of Corona virus Disease 2019(COVID-19)related deaths. COVID-19, as a new coronavirus, mainly targets the patient's lung triggering a cascade of innate and adaptive immune responses in the host. The principal causes of death among COVID-19 patients, especially elderly subjects with cardiovascular diseases, are acute respiratory distress syndrome(ARDS), multiple organ dysfunction syndrome (MODS), and microvascular thrombosis. All prompted by an excessive uncontrolled systemic inflammatory response. Immunosenescence, characterized by systemic and chronic inflammation as well as innate/adaptive immune imbalance, presents both in the elderly and cardiovascular patients. COVID-19 infection further aggravates the existing inflammatory process and lymphocyte depletion leading to uncontrollable systemic inflammatory responses, which is the primary cause of death. Based on the higher mortality, this study attempts to elucidate the pathophysiological mechanisms of COVID-19 in elderly subjects with cardiovascular diseases as well as the cause of the high mortality result from COVID-19.
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Affiliation(s)
- Yuanyuan Wang
- Department of Cardiology, Hangzhou Xiacheng Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, 310004, Zhejiang, China
| | - Shu-Chao Pang
- The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ying Yang
- Department of Cardiology, SirRunRunShaw Hospital, College of Medicine, Zhejiang University, No.3 Qingchun East Road, Hangzhou, 310016, Zhejiang, China.
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Reiner Benaim A, Sobel JA, Almog R, Lugassy S, Ben Shabbat T, Johnson A, Eytan D, Behar JA. Comparing COVID-19 and Influenza Presentation and Trajectory. Front Med (Lausanne) 2021; 8:656405. [PMID: 34055833 PMCID: PMC8160103 DOI: 10.3389/fmed.2021.656405] [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: 01/20/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background: COVID-19 is a newly recognized illness with a predominantly respiratory presentation. It is important to characterize the differences in disease presentation and trajectory between COVID-19 patients and other patients with common respiratory illnesses. These differences can enhance knowledge of pathogenesis and help in guiding treatment. Methods: Data from electronic medical records were obtained from individuals admitted with respiratory illnesses to Rambam Health Care Campus, Haifa, Israel, between October 1st, 2014 and October 1st, 2020. Four groups of patients were defined: COVID-19 (693), influenza (1,612), severe acute respiratory infection (SARI) (2,292), and Others (4,054). The variable analyzed include demographics (7), vital signs (8), lab tests (38), and comorbidities (15) from a total of 8,651 hospitalized adult patients. Statistical analysis was performed on biomarkers measured at admission and for their disease trajectory in the first 48 h of hospitalization, and on comorobidity prevalence. Results: COVID-19 patients were overall younger in age and had higher body mass index, compared to influenza and SARI. Comorbidity burden was lower in the COVID-19 group compared to influenza and SARI. Severely- and moderately-ill COVID-19 patients older than 65 years of age suffered higher rate of in-hospital mortality compared to hospitalized influenza patients. At admission, white blood cells and neutrophils were lower among COVID-19 patients compared to influenza and SARI patients, while pulse rate and lymphoctye percentage were higher. Trajectories of variables during the first 2 days of hospitalization revealed that white blood count, neutrophils percentage and glucose in blood increased among COVID-19 patients, while decreasing among other patients. Conclusions: The intrinsic virulence of COVID-19 appeared higher than influenza. In addition, several critical functions, such as immune response, coagulation, heart and respiratory function, and metabolism were uniquely affected by COVID-19.
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Affiliation(s)
| | - Jonathan A. Sobel
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Snir Lugassy
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Tsviel Ben Shabbat
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Alistair Johnson
- MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Danny Eytan
- Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Joachim A. Behar
- Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
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28
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Kang S, Gong X, Yuan Y. Association of smoking and cardiovascular disease with disease progression in COVID-19: A systematic review and meta-analysis. Epidemiol Infect 2021; 149:1-26. [PMID: 33975666 PMCID: PMC8220032 DOI: 10.1017/s0950268821001138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to systematically assess the association between smoking and cardiovascular disease (CVD) and disease progression among novel coronavirus pneumonia (coronavirus disease 2019 (COVID-19)) cases. PubMed database and Cochrane Library database were searched by computer to seek the epidemiological data of COVID-19 cases and literatures regarding CVDs from 1 Jan to 6 October 2020. Two researchers independently conducted literature screening, data collection and the assessment of the risk of bias of the studies included. RevMan 5.2 software was employed for meta-analysis. Funnel plot was adopted to assess the publication bias. On the whole, 21 studies comprising 7041 COVID-19 cases were included. As revealed from the meta-analysis, 14.0% (984/7027) of cases had a history of smoking, and 9.7% (675/6931) were subject to underlying CVDs. Cases with a history of smoking achieved a higher rate of COVID-19 disease progression as opposed to those having not smoked (OR 1.53, 95% CI 1.29–1.81, P < 0.00001), while no significant association could be found between smoking status and COVID-19 disease progression (OR 1.23, 95% CI 0.93–1.63, P = 0.15). Besides, smoking history elevated the mortality rate by 1.91-fold (OR 1.91, 95% CI 1.35–2.69, P = 0.0002). Moreover, underlying CVD elevated the incidence of severe disease by 2.87-fold (OR 2.87, 95% CI 2.29–3.61, P < 0.00001) and mortality by 3.05-fold (OR 3.05, 95% CI 1.82–5.11, P < 0.0001) in COVID-19 cases. As demonstrated from the current evidence, smoking displays a strong association with COVID-19 disease progression and mortality, and intensive tobacco control is imperative. Moreover, cases with CVD show a significantly elevated risk of disease progression and death when subject to COVID-19. However, the association between COVID-19 and CVD, and the potential effect exerted by smoking in the development of the two still require further verifications by larger and higher quality studies.
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Affiliation(s)
- Shiwei Kang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaowei Gong
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yadong Yuan
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Kim HJ, Hwang H, Hong H, Yim JJ, Lee J. A systematic review and meta-analysis of regional risk factors for critical outcomes of COVID-19 during early phase of the pandemic. Sci Rep 2021; 11:9784. [PMID: 33963250 PMCID: PMC8105319 DOI: 10.1038/s41598-021-89182-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023] Open
Abstract
The mortality rates of COVID-19 vary across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes of COVID-19 according to the location of the infected patients, from various literature databases from January 1 through June 8, 2020. Candidate variables to predict the outcome included patient demographics, underlying medical conditions, symptoms, and laboratory findings. The risk factors in the overall population included sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia and Europe, but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe, but not from Asia and North America. Symptoms of vomiting, anorexia, dizziness, and fatigue were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Such regional discrepancies should be considered when treating patients with COVID-19.
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Affiliation(s)
- Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Hyeontaek Hwang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hyunsook Hong
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
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Giri M, Puri A, Wang T, Guo S. Comparison of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in severe and non-severe COVID-19 patients: A systemic review and meta-analysis. Sci Prog 2021; 104:368504211000906. [PMID: 33752530 PMCID: PMC7992103 DOI: 10.1177/00368504211000906] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The global pandemic of novel coronavirus disease 2019 (COVID-19) has become an emergency of major international concern. We aim to assess the prevalence of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in COVID-19 patients and compare incidence of these clinical data of severe patients with non-severe patients. An electronic search was performed in four databases to identify studies reporting clinical data of severe and non-severe COVID-19 patients. We calculated the odds ratio (OR) using fixed or random effect model. The analysis included 41 studies with 16,495 patients. The most prevalent clinical manifestations were fever 78.1%, cough 64.6%, fatigue 40.8%, and dyspnea 38.6%. Dyspnea (OR: 4.20, 95% CI: 3.09–5.72), cough (OR: 1.45, 95% CI: 1.18–1.78), and fatigue (OR: 1.40, 95% CI: 1.14–1.72) were found to be statistically significant higher in severe COVID-19 patients. We found that the most prevalent comorbidities were hypertension 32.2%, diabetes 17.1%, and cardiovascular disease 15.3%. Compared with non-severe group, proportion of hypertension (OR: 1.98, 95% CI: 1.62–2.42), diabetes (OR: 2.04, 95% CI: 1.67–2.50), cardiovascular disease (OR: 2.78, 95% CI: 2.00–3.86), and cancer (OR: 1.75, 95% CI: 1.40–2.18) were statistically significant higher in severe group. 24.7% patients presented with ARDS. The pooled effect of ARDS in severe and non-severe cases was 42.69 (OR: 42.69, 95% CI: 21.62–84.31). There was significant higher incidence of antiviral drugs, antibiotics, and glucocorticoids use in severe patients. Compared with non-severe patients, symptoms such as fever, cough, dyspnea, existing comorbidities, and complications are prevalent in severe COVID-19 patients.
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Affiliation(s)
- Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Anju Puri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ouyang L, Yu M, Zhu Y, Gong J. Respiratory supports of COVID-19 patients in intensive care unit: A systematic review. Heliyon 2021; 7:e06813. [PMID: 33898856 PMCID: PMC8051865 DOI: 10.1016/j.heliyon.2021.e06813] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 03/06/2021] [Accepted: 04/12/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION We aimed to describe the respiratory supports and determine their association with clinical outcomes of COVID-19 patients in intensive care unit (ICU). METHODS A systemic literature search was conducted in PubMed, EMBASE, MedRxiv and BioRxiv database from December 2019 to 2 July 2020. Studies reporting the application of respiratory supports in COVID-19 patients admitted to ICU were included. RESULTS Forty studies with 15320 COVID-19 patients were included in this systematic review. The proportion of invasive mechanical ventilation (IMV) application in ICU patients with COVID-19 was 73.8%. Further analysis elucidated that the use rate of IMV in Asia, Europe and North America was 47%, 76.2% and 80.2%, respectively. The proportion of patients treated with prone positioning and IMV was 29.4%. 25.5% of COVID-19 patients requiring IMV developed ventilator-associated pneumonia. The mortality of patients treated with IMV was 51.1%, while only 17.5% of critically ill COVID-19 patients treated with non-IMV respiratory support died. Additionally, the utilization rate of IMV in non-survival patients was shown 17.26-folds (95%CI 2.89-103.24, p = 0.002) higher than that in survival patients, while the use rate of ECMO was no significant difference. CONCLUSIONS Our findings highlight respiratory supports of COVID-19 patients admitted to ICU in different continents. IMV is a life-saving strategy for critically ill COVID-19 patients with ARDS, yet the mortality remains very high.
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Affiliation(s)
- Lichen Ouyang
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, China
| | - Muqing Yu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zhu
- Reproductive Medicine Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Gong
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- The First Clinical College, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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How the Heart Was Involved in COVID-19 during the First Pandemic Phase: A Review. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:124-139. [PMID: 36417195 PMCID: PMC9620895 DOI: 10.3390/epidemiologia2010011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/10/2021] [Accepted: 03/12/2021] [Indexed: 12/15/2022]
Abstract
Coronavirus disease (COVID-19) was first observed in Wuhan, Hubei Province (China) in December 2019, resulting in an acute respiratory syndrome. Only later was COVID-19 considered a public health emergency of international concern and, on 11 March 2020, the WHO classified it as pandemic. Despite being a respiratory virus, the clinical manifestations are also characterized by cardiological involvement, especially in patients suffering from previous comorbidities such as hypertension and diabetes mellitus, its complications being potentially serious or fatal. Despite the efforts made by the scientific community to identify pathophysiological mechanisms, they still remain unclear. A fundamental role is played by the angiotensin 2 converting enzyme, known for its effects at the cardiovascular level and for its involvement in COVID-19 pathogenesis. The goal of this paper was to highlight the mechanisms and knowledge related to cardiovascular involvement during the first pandemic phase, as well as to emphasize the main cardiological complications in infected patients.
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Booth A, Reed AB, Ponzo S, Yassaee A, Aral M, Plans D, Labrique A, Mohan D. Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. PLoS One 2021; 16:e0247461. [PMID: 33661992 PMCID: PMC7932512 DOI: 10.1371/journal.pone.0247461] [Citation(s) in RCA: 303] [Impact Index Per Article: 101.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/06/2021] [Indexed: 02/06/2023] Open
Abstract
AIM COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. METHODS The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable. RESULTS Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81-3.90), male sex (OR: 2.05, 95% CI: 1.39-3.04) and severe obesity (OR: 2.57, 95% CI: 1.31-5.05). Active cancer (OR: 1.46, 95% CI: 1.04-2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles. CONCLUSIONS Based on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.
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Affiliation(s)
- Adam Booth
- Huma Therapeutics Limited, London, United Kingdom
| | | | - Sonia Ponzo
- Huma Therapeutics Limited, London, United Kingdom
| | | | - Mert Aral
- Huma Therapeutics Limited, London, United Kingdom
| | - David Plans
- Huma Therapeutics Limited, London, United Kingdom
- INDEX Group, Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, United Kingdom
- * E-mail:
| | - Alain Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Diwakar Mohan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis. Chest 2021; 159:1019-1040. [PMID: 33129791 PMCID: PMC7598533 DOI: 10.1016/j.chest.2020.10.054] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/17/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial. RESEARCH QUESTION What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients? STUDY DESIGN AND METHODS We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group. RESULTS A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens. INTERPRETATION Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.
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Kiss S, Gede N, Hegyi P, Németh D, Földi M, Dembrovszky F, Nagy B, Juhász MF, Ocskay K, Zádori N, Molnár Z, Párniczky A, Hegyi PJ, Szakács Z, Pár G, Erőss B, Alizadeh H. Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19: a systematic review and meta-analysis. Med Microbiol Immunol 2021; 210:33-47. [PMID: 33219397 PMCID: PMC7679241 DOI: 10.1007/s00430-020-00696-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/31/2020] [Indexed: 01/08/2023]
Abstract
Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMDALC = - 0.35 × 109/L [CI - 0.43, - 0.27], p < 0.001, I2 = 94.2%; < 0.8 × 109/L, ORALC = 3.74 [CI 1.77, 7.92], p = 0.001, I2 = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention.
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Affiliation(s)
- Szabolcs Kiss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Dávid Németh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Mária Földi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- First Department of Medicine, University of Szeged, Szeged, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Bettina Nagy
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Márk Félix Juhász
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Klementina Ocskay
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy, Poznan University for Medical Sciences, Poznan, Poland
| | - Andrea Párniczky
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Péter Jenő Hegyi
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Gabriella Pár
- Division of Gastroenterology, First Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary
- János Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Hussain Alizadeh
- Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.
- First Department of Medicine, University of Szeged, Szeged, Hungary.
- Division of Hematology, First Department of Internal Medicine, University of Pécs Medical School, Pécs, Hungary.
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Tan E, Song J, Deane AM, Plummer MP. Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU: A Systematic Review and Meta-analysis. Chest 2021; 159:524-536. [PMID: 33069725 PMCID: PMC7557272 DOI: 10.1016/j.chest.2020.10.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented burden on the delivery of intensive care services worldwide. RESEARCH QUESTION What is the global point estimate of deaths and risk factors for patients who are admitted to ICUs with severe COVID-19? STUDY DESIGN AND METHODS In this systematic review and meta-analysis Medline, Embase, and the Cochrane library were searched up to August 1, 2020. Pooled prevalence of participant characteristics, clinical features, and outcome data was calculated with the use of random effects models. Subgroup analyses were based on geographic distribution, study type, quality assessment, sample size, end date, and patient disposition. Studies that reported in-hospital mortality rate of adult patients (age >18 years) with confirmed COVID-19 admitted to an ICU met study eligibility criteria. Critical evaluation was performed with the Newcastle Ottawa Scale for nonrandomized studies. RESULTS Forty-five studies with 16,561 patients from 17 countries across four continents were included. Patients with COVID-19 who were admitted to ICUs had a mean age of 62.6 years (95% CI, 60.4-64.7). Common comorbidities included hypertension (49.5%; 95% CI, 44.9-54.0) and diabetes mellitus (26.6%; 95% CI, 22.7-30.8). More than three-quarters of cases experienced the development of ARDS (76.1%; 95% CI, 65.7-85.2). Invasive mechanical ventilation was required in 67.7% (95% CI, 59.1-75.7) of case, vasopressor support in 65.9% (95% CI, 52.4-78.4) of cases, renal replacement therapy in 16.9% (95% CI, 12.1-22.2) of cases, and extracorporeal membrane oxygenation in 6.4% (95% CI, 4.1-9.1) of cases. The duration of ICU and hospital admission was 10.8 days (95% CI, 9.3-18.4) and 19.1 days (95% CI, 16.3-21.9), respectively, with in-hospital mortality rate of 28.1% (95% CI, 23.4-33.0; I2 = 96%). No significant subgroup effect was observed. INTERPRETATION Critically ill patients with COVID-19 who are admitted to the ICU require substantial organ support and prolonged ICU and hospital level care. The pooled estimate of global death from severe COVID-19 is <1 in 3.
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Affiliation(s)
- Elinor Tan
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - Jialu Song
- Intensive Care Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Adam M Deane
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia; University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Mark P Plummer
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, VIC, Australia; University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia
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Nasiri N, Rahmati S, Etminan A, Sharifi H, Bazrafshan A, Karamouzian M, Sharifi A. Kidney Complications of COVID-19: A Systematic Review and Meta-Analysis. J Res Health Sci 2021; 21:e00503. [PMID: 34024761 PMCID: PMC8957695 DOI: 10.34172/jrhs.2021.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Some patients with coronavirus disease 2019 (COVID-19) have been reported to have developed mild to severe kidney injuries. The current systematic review and meta-analysis was carried out to estimate the prevalence and incidence of acute kidney injury (AKI) among COVID-19 patients.
Study design: A systematic review and meta-analysis
Methods: PubMed, Embase, Scopus, Web of Science, and MedRxiv databases were searched from December 1, 2019, up to July 27, 2020. Two independent co-authors completed the screening process, data extraction, and quality assessment of the retrieved records. Random-effects meta-analyses were used to determine the pooled prevalence and 95% confidence interval (CI) of AKI among COVID-19 patients.
Results: Out of 2,332 unique identified records, 51 studies were included in the review. Overall, the studies were carried out on 25,600 patients. A total of 6,505 patients (in 18 cross-sectional studies) were included to estimate the pooled prevalence of AKI, and 18,934 patients (in 27 cohort studies) were included to determine the pooled incidence of AKI. The pooled prevalence of AKI was estimated as 10.08% (95% CI: 4.59, 17.32; I 2=98.56%; P<0.001). Furthermore, the pooled incidence of AKI was 12.78% (95% CI: 7.38, 19.36; I 2=99.27%; P<0.001). The mean (95% CI) values of serum creatinine (SCr), blood urea nitrogen (BUN), potassium, and sodium were 76.10 (69.36, 82.84), 4.60 (4.04, 5.30), 3.94 (3.78, 4.11), and 139.30 (138.26, 140.36) mmol/L, respectively.
Conclusions: The AKI is a considerable complication among COVID-19 patients and should be screened for on clinical examinations. The BUN, SCr, potassium, and sodium levels were within the normal ranges.
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Affiliation(s)
- Naser Nasiri
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Shoboo Rahmati
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Etminan
- Department of Internal Medicine, School of Medicine, Endocrinology and Metabolism Research Center, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azam Bazrafshan
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Karamouzian
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
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Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27:520-531. [PMID: 33418017 PMCID: PMC7785281 DOI: 10.1016/j.cmi.2020.12.018] [Citation(s) in RCA: 433] [Impact Index Per Article: 144.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
Background The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. Objective The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. Data Sources We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. Study Eligibility Criteria We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. Participants The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). Methods The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. Results We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Conclusions Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
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Huang Z, Huang P, Du B, Kong L, Zhang W, Zhang Y, Dong J. Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2021; 31:2-13. [PMID: 33229199 PMCID: PMC7485447 DOI: 10.1016/j.numecd.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Emerging data have linked the presence of cardiac injury with a worse prognosis in novel coronavirus disease 2019 (COVID-19) patients. However, available data cannot clearly characterize the correlation between cardiac injury and COVID-19. Thus, we conducted a meta-analysis of recent studies to 1) explore the prevalence of cardiac injury in different types of COVID-19 patients and 2) evaluate the association between cardiac injury and worse prognosis (severe disease, admission to ICU, and mortality) in patients with COVID-19. METHODS AND RESULTS Literature search was conducted through PubMed, the Cochrane Library, Embase, and MedRxiv databases. A meta-analysis was performed with Stata 14.0. A fixed-effects model was used if the I2 values ≤ 50%, otherwise the random-effects model was performed. The prevalence of cardiac injury was 19% (95% CI: 0.15-0.22, and p < 0.001) in total COVID-19 patients, 36% (95% CI: 0.25-0.47, and p < 0.001) in severe COVID-19 patients, and 48% (95% CI: 0.30-0.66, and p < 0.001) in non-survivors. Furthermore, cardiac injury was found to be associated with a significant increase in the risk of poor outcomes with a pooled effect size (ES) of 8.46 (95% CI: 3.76-19.06, and p = 0.062), severe disease with an ES of 3.54 (95% CI: 2.25-5.58, and p < 0.001), admission to ICU with an ES of 5.03 (95% CI: 2.69-9.39, and p < 0.001), and mortality with an ES of 4.99 (95% CI: 3.38-7.37, and p < 0.001). CONCLUSIONS The prevalence of cardiac injury was greatly increased in COVID-19 patients, particularly in patients with severe disease and non-survivors. COVID-19 patients with cardiac injury are more likely to be associated with poor outcomes, severity of disease, admission to ICU, and mortality.
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Affiliation(s)
- Zhen Huang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Pan Huang
- College of Nursing, Gannan Medical University, Ganzhou, Jiangxi province, China
| | - Binbin Du
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Lingyao Kong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Wenyuan Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Yanzhou Zhang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan province, China
| | - Jianzeng Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan province, China; Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Hariyanto TI, Japar KV, Kwenandar F, Damay V, Siregar JI, Lugito NPH, Tjiang MM, Kurniawan A. Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis. Am J Emerg Med 2020; 41:110-119. [PMID: 33418211 PMCID: PMC7831442 DOI: 10.1016/j.ajem.2020.12.076] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease. Method We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19. Results There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05–0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10–44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31–0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10–126.49; p < 0.00001) but lower levels of albumin (mean difference −4.58; 95% CI −5.76 to −3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 μ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity. Conclusion This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.
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Affiliation(s)
- Timotius Ivan Hariyanto
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Karunia Valeriani Japar
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Felix Kwenandar
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Vika Damay
- Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Jeremia Immanuel Siregar
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Nata Pratama Hardjo Lugito
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Margaret Merlyn Tjiang
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
| | - Andree Kurniawan
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
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Ad’hiah AH, Abdullah MH, Alsudani MY, Shnawa RMS, Al-Sa’ady AJR, Allami RH, Misha’al KI, Jassim IA, Taqi EA. Association between ABO blood groups and susceptibility to COVID-19: profile of age and gender in Iraqi patients. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2020; 21:76. [PMID: 38624655 PMCID: PMC7744128 DOI: 10.1186/s43042-020-00115-y] [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: 09/17/2020] [Accepted: 11/25/2020] [Indexed: 01/01/2023] Open
Abstract
Background A case-control study was performed to examine age, gender, and ABO blood groups in 1014 Iraqi hospitalized cases with Coronavirus disease 2019 (COVID-19) and 901 blood donors (control group). The infection was molecularly diagnosed by detecting coronavirus RNA in nasal swabs of patients. Results Mean age was significantly elevated in cases compared to controls (48.2 ± 13.8 vs. 29.9 ± 9.0 year; probability [p] < 0.001). Receiver operating characteristic analysis demonstrated the predictive significance of age in COVID-19 evolution (Area under curve = 0.858; 95% CI: 0.841 - 0.875; p < 0.001). Males outnumbered females in cases (60.4 vs. 39.6%) and controls (56 vs. 44%). Stratification by age group (< 30, 30 - 39, 40 - 49 and ≥ 50 years) revealed that 48.3% of cases clustered in the age group ≥ 50 years. ABO blood group analysis showed that group A was the most common among cases, while group O was the most common among controls (35.5 and 36.7%, respectively). Blood groups A (35.5 vs. 32.7; corrected p [pc] = 0.021), A+AB (46.3 vs. 41.7%; pc = 0.021) and A+B+AB (68.0 vs. 63.3%; pc = 0.007) showed significantly elevated frequencies in cases compared to controls. Logistic regression analysis estimated odds ratios (ORs) of 1.53 (95% confidence interval [CI]: 1.16 - 2.02), 1.48 (95% CI: 1.14 - 1.93) and 1.50 (95% CI: 1.17 - 1.82) for blood groups A, A+AB and A+B+AB, respectively. Blood group frequencies showed no significant differences between age groups of cases or controls. Regarding gender, male cases were marked with increased frequency of group A (39.9 vs. 28.9%) and decreased frequency of group O (25.9 vs. 41.0%) compared to female cases. Independent re-analysis of ABO blood groups in male and female cases demonstrated that group A was increased in male cases compared to male controls (39.9 vs. 33.1%; OR = 1.65; 95% CI: 1.24 - 2.21; pc = 0.006). On the contrary, no significant differences were found between females of cases and controls. Conclusions The study results indicated that blood group A may be associated with an increased risk of developing COVID-19, particularly in males.
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Affiliation(s)
- Ali H. Ad’hiah
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Al-Jadriya, Baghdad, Iraq
| | | | - Mustafa Y. Alsudani
- Basrah Health Office, Basrah, Ministry of Health and Environment, Baghdad, Iraq
| | - Rasool M. S. Shnawa
- Alforat Hospital, Baghdad, Ministry of Health and Environment, Baghdad, Iraq
| | - Ali J. R. Al-Sa’ady
- Biotechnology Department, College of Science, University of Baghdad, Baghdad, Iraq
| | | | - Khawla I. Misha’al
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Al-Jadriya, Baghdad, Iraq
| | - Iftikhar A. Jassim
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Al-Jadriya, Baghdad, Iraq
| | - Estabraq A. Taqi
- Tropical-Biological Research Unit, College of Science, University of Baghdad, Al-Jadriya, Baghdad, Iraq
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Fabrizi F, Alfieri CM, Cerutti R, Lunghi G, Messa P. COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis. Pathogens 2020; 9:pathogens9121052. [PMID: 33334023 PMCID: PMC7765425 DOI: 10.3390/pathogens9121052] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background: coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome—coronavirus-2 (SARS-CoV-2)—is an ongoing pandemic with high morbidity and mortality rates. Preliminary evidence suggests that acute kidney injury (AKI) is uncommon in patients with COVID-19 and associated with poor outcomes. Study aims and design: we performed a systematic review of the literature with a meta-analysis of clinical studies to evaluate the frequency of AKI and dialysis requirement in patients who underwent hospitalization due to COVID-19. The incidence of AKI according to the death risk was calculated in these patients. The random-effects model of DerSimonian and Laird was adopted, with heterogeneity and stratified analyses. Results: thirty-nine clinical studies (n = 25,566 unique patients) were retrieved. The pooled incidence of AKI was 0.154 (95% CI, 0.107; 0.201; p < 0.0001) across the studies. Significant heterogeneity was found (p = 0.0001). The overall frequency of COVID-19-positive patients who underwent renal replacement therapy (RRT) was 0.043 (95% CI, 0.031; 0.055; p < 0.0001); no publication bias was found (Egger’s test, p = 0.11). The pooled estimate of AKI incidence in patients with severe COVID-19 was 0.53 (95% CI, 0.427; 0.633) and heterogeneity occurred (Q = 621.08, I2 = 97.26, p = 0.0001). According to our meta-regression, age (p < 0.007) and arterial hypertension (p < 0.001) were associated with AKI occurrence in hospitalized COVID-19 positive patients. The odds ratio (OR) for the incidence of AKI in deceased COVID-19 positive patients was greater than among survivors, 15.4 (95% CI, 20.99; 11.4; p < 0.001). Conclusions: AKI is a common complication in hospitalized COVID-19 positive patients. Additional studies are under way to assess the risk of AKI in COVID-19 patients and to deepen the mechanisms of kidney injury.
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Affiliation(s)
- Fabrizio Fabrizi
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
- Correspondence: ; Tel.: +39-2-55034552; Fax: +39-2-55034550
| | - Carlo M. Alfieri
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
| | - Roberta Cerutti
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
| | - Giovanna Lunghi
- Virology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Piergiorgio Messa
- Division of Nephrology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy; (C.M.A.); (R.C.); (P.M.)
- Department of Clinical Sciences and Community Health, University of Milan, 20133 Milan, Italy
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Khokhar M, Purohit P, Roy D, Tomo S, Gadwal A, Modi A, Banerjee M, Sharma P. Acute kidney injury in COVID 19 - an update on pathophysiology and management modalities. Arch Physiol Biochem 2020; 129:626-639. [PMID: 33320717 DOI: 10.1080/13813455.2020.1856141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acute kidney injury (AKI), characterised by fluid imbalance and overload, is prevalent in severe disease phenotypes of coronavirus disease 2019 (COVID-19). The elderly immunocompromised patients with pre-existing comorbidities being more risk-prone to severe COVID-19, the importance of early diagnosis and intervention in AKI is imperative. Histopathological examination of COVID-19 patients with AKI reveals viral invasion of the renal parenchyma and evidence of AKI. The definitive treatment for AKI includes renal replacement therapy and renal transplant. Immunosuppressant regimens and its interactions with COVID-19 have to be further explored to devise effective treatment strategies in COVID-19 transplant patients. Other supportive strategies for AKI patients include hemodynamic monitoring and maintenance of fluid balance. Antiviral drugs should be meticulously monitored in the management of these high-risk patients. We have focussed on the development of renal injury provoked by the SARS-CoV-2, the varying clinical characteristics, and employment of different management strategies, including renal replacement therapy, alongside the emerging cytokine lowering approaches.
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Affiliation(s)
- Manoj Khokhar
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Purvi Purohit
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sojit Tomo
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ashita Gadwal
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anupama Modi
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, Ceirano A, Espinosa F, Saavedra E, Sanguine V, Tassara A, Cid C, Catalano HN, Agarwal A, Foroutan F, Rada G. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One 2020; 15:e0241955. [PMID: 33201896 PMCID: PMC7671522 DOI: 10.1371/journal.pone.0241955] [Citation(s) in RCA: 366] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE The objective of our systematic review is to identify prognostic factors that may be used in decision-making related to the care of patients infected with COVID-19. DATA SOURCES We conducted highly sensitive searches in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The searches covered the period from the inception date of each database until April 28, 2020. No study design, publication status or language restriction were applied. STUDY SELECTION AND DATA EXTRACTION We included studies that assessed patients with confirmed or suspected SARS-CoV-2 infectious disease and examined one or more prognostic factors for mortality or disease severity. Reviewers working in pairs independently screened studies for eligibility, extracted data and assessed the risk of bias. We performed meta-analyses and used GRADE to assess the certainty of the evidence for each prognostic factor and outcome. RESULTS We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infectious disease: Demographic factors (age, male sex, smoking), patient history factors (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score (sequential organ failure assessment score). CONCLUSION Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infectious disease while researchers can utilise our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes. SYSTEMATIC REVIEW REGISTRATION Prospero registration number: CRD42020178802. Protocol available at: https://www.medrxiv.org/content/10.1101/2020.04.08.20056598v1.
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Affiliation(s)
- Ariel Izcovich
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | | | - Fernando Tortosa
- Departamento Médico, Hospital “Ramón Carrillo”, San Carlos de Bariloche, Argentina
| | | | - Camila Agnoletti
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Agustín Bengolea
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Agustina Ceirano
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Federico Espinosa
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Ezequiel Saavedra
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Verónica Sanguine
- Dirección Nacional de Calidad en Servicios de Salud y Regulación Sanitaria, Ministerio de Salud de la Nación, Buenos Aires, Argentina
| | - Alfredo Tassara
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | - Candelaria Cid
- Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina
| | | | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Canada
| | - Gabriel Rada
- Fundación Epistemonikos, Santiago, Chile
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Internal Medicine Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Meng M, Zhao Q, Kumar R, Bai C, Deng Y, Wan B. Impact of cardiovascular and metabolic diseases on the severity of COVID-19: a systematic review and meta-analysis. Aging (Albany NY) 2020; 12:23409-23421. [PMID: 33199670 PMCID: PMC7746376 DOI: 10.18632/aging.103991] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/15/2020] [Indexed: 02/05/2023]
Abstract
We examined the effects of coronary heart disease (CHD), hypertension and diabetes on the development of severe COVID-19. We performed a comprehensive, systematic literature search for studies published between December 2019 and July 5, 2020 in five databases. The prevalence of severe COVID-19 in patients with CHD, hypertension and diabetes was evaluated through a meta-analysis. Thirty-five articles with 8,170 patients were included, and all the available studies were case series. The pooled odds ratio for the development of severe COVID-19 was 3.21 for patients with CHD (fixed-effects model, 95% CI: 2.58-3.99), 2.27 for patients with hypertension (random-effects model, 95% CI: 1.79-2.90) and 2.34 for patients with diabetes (random-effects model, 95% CI: 1.79-3.05). The heterogeneity of the studies was moderate for the effect of CHD on COVID-19 severity, but was high for the effects of diabetes and hypertension. Funnel plots and Egger's tests revealed no publication bias in the CHD and hypertension analyses, but suggested publication bias in the diabetes analysis. This bias was corrected using the trim-and-fill method, and was ultimately found to have no effect on the results. Our findings suggest patients with CHD, hypertension and diabetes are at greater risk for developing severe COVID-19 than those without these conditions.
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Affiliation(s)
- Meng Meng
- Digestion Center, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Qianwen Zhao
- Department of Gastroenterology and Hepatology, Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Rahul Kumar
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Chen Bai
- Beijing University of Chinese Medicine, Beijing, China
| | - Yunlei Deng
- Department of Nephrology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Bo Wan
- Centre for Stem Cells and Regenerative Medicine, King's College London, Guy's Hospital, Great Maze Pond, London, UK
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Katzenschlager S, Zimmer AJ, Gottschalk C, Grafeneder J, Seitel A, Maier-Hein L, Benedetti A, Larmann J, Weigand MA, McGrath S, Denkinger CM. Can we predict the severe course of COVID-19 - a systematic review and meta-analysis of indicators of clinical outcome? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.11.09.20228858. [PMID: 33200148 PMCID: PMC7668761 DOI: 10.1101/2020.11.09.20228858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background COVID-19 has been reported in over 40million people globally with variable clinical outcomes. In this systematic review and meta-analysis, we assessed demographic, laboratory and clinical indicators as predictors for severe courses of COVID-19. Methods We systematically searched multiple databases (PubMed, Web of Science Core Collection, MedRvix and bioRvix) for publications from December 2019 to May 31st 2020. Random-effects meta-analyses were used to calculate pooled odds ratios and differences of medians between (1) patients admitted to ICU versus non-ICU patients and (2) patients who died versus those who survived. We adapted an existing Cochrane risk-of-bias assessment tool for outcome studies. Results Of 6,702 unique citations, we included 88 articles with 69,762 patients. There was concern for bias across all articles included. Age was strongly associated with mortality with a difference of medians (DoM) of 13.15 years (95% confidence interval (CI) 11.37 to 14.94) between those who died and those who survived. We found a clinically relevant difference between non-survivors and survivors for C-reactive protein (CRP; DoM 69.10, CI 50.43 to 87.77), lactate dehydrogenase (LDH; DoM 189.49, CI 155.00 to 223.98), cardiac troponin I (cTnI; DoM 21.88, CI 9.78 to 33.99) and D-Dimer (DoM 1.29mg/L, CI 0.9 - 1.69). Furthermore, cerebrovascular disease was the co-morbidity most strongly associated with mortality (Odds Ratio 3.45, CI 2.42 to 4.91) and ICU admission (Odds Ratio 5.88, CI 2.35 to 14.73). Discussion This comprehensive meta-analysis found age, cerebrovascular disease, CRP, LDH and cTnI to be the most important risk-factors in predicting severe COVID-19 outcomes and will inform decision analytical tools to support clinical decision-making.
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Affiliation(s)
| | - Alexandra J. Zimmer
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Claudius Gottschalk
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Juergen Grafeneder
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Benedetti
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Jan Larmann
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A. Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sean McGrath
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Claudia M. Denkinger
- Division of Tropical Medicine, Center for Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
- German Center for Infection Research (DZIF), partner site Heidelberg
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Tohidinia M, Sefid F. Identification B and T-Cell epitopes and functional exposed amino acids of S protein as a potential vaccine candidate against SARS-CoV-2/COVID-19. Microb Pathog 2020; 148:104459. [PMID: 32835775 PMCID: PMC7441888 DOI: 10.1016/j.micpath.2020.104459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 01/01/2023]
Abstract
Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus that it disease spreads in over the world. Coronaviruses are single-stranded, positive-sense RNA viruses with a genome of approximately 30 KD, the largest genome among RNA viruses. Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. At this time, there are no specific vaccines or treatments for COVID-19. So, there is an emergency need for vaccines and antiviral strategies. The spike protein is the major surface protein that it uses to bind to a receptor of another protein that acts as a doorway into a human cell. The putative antigenic epitopes may prove effective as novel vaccines for eradication and combating of COV19 infection. A combination of available bioinformatics tools are used to synthesis of such peptides that are important for the development of a vaccine. In conclusion, amino acids 250-800 were selected as effective B cell epitopes, T cell epitopes, and functional exposed amino acids in order to a recombinant vaccine against coronavirus.
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MESH Headings
- Binding Sites
- COVID-19/immunology
- COVID-19/prevention & control
- COVID-19/virology
- COVID-19 Vaccines/immunology
- Drug Design
- Epitopes, B-Lymphocyte/chemistry
- Epitopes, B-Lymphocyte/genetics
- Epitopes, B-Lymphocyte/immunology
- Epitopes, B-Lymphocyte/isolation & purification
- Epitopes, T-Lymphocyte/chemistry
- Epitopes, T-Lymphocyte/genetics
- Epitopes, T-Lymphocyte/immunology
- Epitopes, T-Lymphocyte/isolation & purification
- Humans
- Models, Molecular
- Protein Conformation
- SARS-CoV-2/immunology
- Sequence Alignment
- Sequence Homology, Amino Acid
- Spike Glycoprotein, Coronavirus/chemistry
- Spike Glycoprotein, Coronavirus/immunology
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Affiliation(s)
- Maryam Tohidinia
- Department of Biology, Faculty of Science, Yazd University, Yazd, Iran.
| | - Fatemeh Sefid
- Department of Medical Genetics, Shahid Sadoughi University of Medical Science, Yazd, Iran; Department of Biology, Science and Art University, Yazd, Iran.
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Shao M, Li X, Liu F, Tian T, Luo J, Yang Y. Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic review and meta-analysis of 40 studies and 24,527 patients. Pharmacol Res 2020; 161:105107. [PMID: 32739424 PMCID: PMC7393179 DOI: 10.1016/j.phrs.2020.105107] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
Currently, coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. This study aimed to investigate whether the presence of acute kidney injury (AKI) might increase the risk of severe infection and fatality in COVID-19 patients. We searched the PubMed, Web of Science, ScienceDirect, MedRxiv and COVID-19 academic research communication platforms for studies reporting severe infection rates and case-fatality rates in COVID-19 patients with and without AKI up to June 20, 2020. The main outcomes were the comparisons of the severe infection rates and fatality rates in COVID-19 patients with and without AKI and the estimation of the odds ratio (OR) and its 95 % confidence interval (CI) for severe infection and mortality. Statistical analyses were performed with R statistical software. A total of 40 studies involving 24,527 patients with COVID-19 were included in our meta-analysis. The incidence of AKI was 10 % (95 % CI 8%-13 %) in COVID-19 patients. The patients had higher severe infection and fatality rates (55.6 % vs. 17.7 % and 63.1 % vs. 12.9 %, respectively, all P < 0.01) with COVID-19. AKI was a predictor of fatality (OR = 14.63, 95 % CI: 9.94-21.51, P < 0.00001) and severe infection (OR = 8.11, 95 % CI: 5.01-13.13, P < 0.00001) in patients with COVID-19. Higher levels of serum creatinine (Scr) and blood urea nitrogen (BUN) were associated with a significant increase in fatality [Scr: mean difference (MD): 20.19 μmol/L, 95 % CI: 14.96-25.42, P < 0.001; BUN: MD: 4.07 mmol/L, 95 % CI: 3.33-4.81, P < 0.001] and severe infection (Scr: MD: 7.78 μmol/L, 95 % CI: 4.43-11.14, P < 0.00001, BUN: MD: 2.12 mmol/L, 95 % CI: 1.74-2.50, P < 0.00001) in COVID-19 patients. In conclusion, AKI is associated with severe infection and higher fatality rates in patients with COVID-19. Clinicians should pay more attention to the monitoring and treatment of COVID-19 patients with AKI.
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Affiliation(s)
- Mengjiao Shao
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - XiaoMei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fen Liu
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ting Tian
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junyi Luo
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China; Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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Aziz M, Haghbin H, Lee-Smith W, Goyal H, Nawras A, Adler DG. Gastrointestinal predictors of severe COVID-19: systematic review and meta-analysis. Ann Gastroenterol 2020; 33:615-630. [PMID: 33162738 PMCID: PMC7599357 DOI: 10.20524/aog.2020.0527] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has created a need to identify potential predictors of severe disease. We performed a systematic review and meta-analysis of gastrointestinal predictors of severe COVID-19. METHODS An extensive literature search was performed using PubMed, Embase, Web of Science and Cochrane. Odds ratio (OR) and mean difference (MD) were calculated for proportional and continuous outcomes using a random-effect model. For each outcome, a 95% confidence interval (CI) and P-value were generated. RESULTS A total of 83 studies (26912 patients, mean age 43.5±16.4 years, 48.2% female) were included. Gastrointestinal predictors of severe COVID-19 included the presence of diarrhea (OR 1.50, 95%CI 1.10-2.03; P=0.01), elevated serum aspartate aminotransferase (AST) (OR 4.00, 95%CI 3.02-5.28; P<0.001), and elevated serum alanine aminotransferase (ALT) (OR 2.54, 95%CI 1.91-3.37; P<0.001). Significantly higher levels of mean AST (MD 14.78 U/L, 95%CI 11.70-17.86 U/L; P<0.001), ALT (MD 11.87 U/L, 95%CI 9.23-14.52 U/L; P<0.001), and total bilirubin (MD 2.08 mmol/L, 95%CI 1.36-2.80 mmol/L; P<0.001) were observed in the severe COVID-19 group compared to non-severe COVID-19 group. CONCLUSION Gastrointestinal symptoms and biomarkers should be assessed early to recognize severe COVID-19.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Hossein Haghbin)
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Hossein Haghbin)
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio (Wade Lee-Smith)
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania (Hemant Goyal)
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio (Ali Nawras)
| | - Douglas G. Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah (Douglas G. Adler), USA
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Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci 2020; 41:3437-3470. [PMID: 33089477 PMCID: PMC7577367 DOI: 10.1007/s10072-020-04801-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. METHODS We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. RESULTS Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4-50.2), taste disturbances (38.5%; 95%CI 24.0-53.0), myalgia (19.3%; 95% CI 15.1-23.6), headache (14.7%; 95% CI 10.4-18.9), dizziness (6.1%; 95% CI 3.1-9.2), and syncope (1.8%; 95% CI 0.9-4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0-3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9-3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2-0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1-0.6). CONCLUSIONS Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.
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