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Drouin A, Plumb ID, McCullough M, James Gist J, Liu S, Theberge M, Katz J, Moreida M, Flaherty S, Chatwani B, Briggs Hagen M, Midgley CM, Fusco D. Clinical and laboratory characteristics of patients hospitalized with severe COVID-19 in New Orleans, August 2020 to September 2021. Sci Rep 2024; 14:6539. [PMID: 38503862 PMCID: PMC10951213 DOI: 10.1038/s41598-024-57306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/17/2024] [Indexed: 03/21/2024] Open
Abstract
Louisiana experienced high morbidity and mortality from COVID-19. To assess possible explanatory factors, we conducted a cohort study (ClinSeqSer) of patients hospitalized with COVID-19 in New Orleans during August 2020-September 2021. Following enrollment, we reviewed medical charts, and performed SARS-CoV-2 RT-PCR testing on nasal and saliva specimens. We used multivariable logistic regression to assess associations between patient characteristics and severe illness, defined as ≥ 6 L/min oxygen or intubation. Among 456 patients, median age was 56 years, 277 (60.5%) were Black non-Hispanic, 436 (95.2%) had underlying health conditions, and 358 were unvaccinated (92.0% of 389 verified). Overall, 187 patients (40.1%) had severe illness; 60 (13.1%) died during admission. In multivariable models, severe illness was associated with age ≥ 65 years (OR 2.08, 95% CI 1.22-3.56), hospitalization > 5 days after illness onset (OR 1.49, 95% CI 1.01-2.21), and SARS CoV-2 cycle threshold (Ct) result of < 32 in saliva (OR 4.79, 95% CI 1.22-18.77). Among patients who were predominantly Black non-Hispanic, unvaccinated and with underlying health conditions, approximately 1 in 3 patients had severe COVID-19. Older age and delayed time to admission might have contributed to high case-severity. An association between case-severity and low Ct value in saliva warrants further investigation.
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Affiliation(s)
- Arnaud Drouin
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70130, USA
- University Medical Center, New Orleans, LA, USA
| | - Ian D Plumb
- Applied Epidemiology Studies Team, Epidemiology Branch, and on detail to the Global Respiratory Viruses Branch Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control, Atlanta, GA, USA
| | | | | | - Sharon Liu
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70130, USA
| | - Marc Theberge
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70130, USA
| | - Joshua Katz
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70130, USA
| | - Matthew Moreida
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70130, USA
| | - Shelby Flaherty
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Bhoomija Chatwani
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Melissa Briggs Hagen
- Applied Epidemiology Studies Team, Epidemiology Branch, and on detail to the Global Respiratory Viruses Branch Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control, Atlanta, GA, USA
| | - Claire M Midgley
- Applied Epidemiology Studies Team, Epidemiology Branch, and on detail to the Global Respiratory Viruses Branch Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control, Atlanta, GA, USA
| | - Dahlene Fusco
- Department of Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA, 70130, USA.
- University Medical Center, New Orleans, LA, USA.
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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Altintop SE, Unalan-Altintop T, Cihangiroglu M, Onarer P, Milletli-Sezgin F, Gozukara M, Gozukara B, Zengin E. COVID-19 in elderly: Correlations of viral load, clinical course, laboratory parameters, among patients vaccinated with CoronaVac. Acta Microbiol Immunol Hung 2022; 69:277-282. [PMID: 36370367 DOI: 10.1556/030.2022.01849] [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: 08/08/2022] [Accepted: 10/21/2022] [Indexed: 11/13/2022]
Abstract
SARS-CoV-2 virus was initially identified in Wuhan, China, in December 2019 and a global pandemic was declared in March 2020 by World Health Organization. COVID-19 disease is characterized with severe pneumonia and hypoxemia, especially in the elderly population. The elderly population was primarily vaccinated with CoronaVac, which is a whole virion inactivated vaccine (Sinovac Biotech, China) in Turkey. This study aimed to investigate the association of viral load and laboratory parameters with the severity of the disease and vaccination status in elderly (older than 60 years old) COVID-19 patients. The age range of the patients was 61-97 years old with a mean of 71.80. Vaccinated patients had a lower viral load (P = 0.253) in nasopharyngeal swabs during breakthrough COVID-19 infection compared to unvaccinated ones and were hospitalized for a shorter period of time in hospital wards (P = 0.035). A lower number of patients were vaccinated in both moderate (n = 33, 29.20%) and severe/critical group (n = 46, 34.07%) (P = 0.412). Only 17 (32.08%) vaccinated patients were hospitalized in an intensive care unit (ICU), whereas 36 (67.92%) of the ICU patients were unvaccinated (P = 0.931). Severe/critical patients had higher c-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), fibrinogen, ferritin, and lactate dehydrogenase (LDH) levels compared to the moderate group on the admission day (P < 0.05). Our study suggested that elderly patients vaccinated with CoronaVac had a shorter stay in hospitals and according to our results CRP, PLR, fibrinogen, ferritin, and LDH levels could be used to determine the severity of the infections.
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Affiliation(s)
| | - Tugce Unalan-Altintop
- 2Department of Medical Microbiology, Amasya University Sabuncuoglu Serefeddin Research and Training Hospital, Amasya, Turkey
| | - Mustafa Cihangiroglu
- 3Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Pelin Onarer
- 2Department of Medical Microbiology, Amasya University Sabuncuoglu Serefeddin Research and Training Hospital, Amasya, Turkey
| | | | - Melih Gozukara
- 5Amasya Provincial Directorate of Health, Amasya, Turkey
| | - Bilge Gozukara
- 1Suluova State Hospital, Department of Internal Medicine, Amasya, Turkey
| | - Erman Zengin
- 5Amasya Provincial Directorate of Health, Amasya, Turkey
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Gomes da Silva K, Almeida Barros WM, da Silva Souza AP, de Oliveira Nogueira Souza V, Lopes de Souza S. Letter to the editor: Impact of COVID-19 in nutritional and functional status of survivors admitted in intensive care units during the first outbreak. Preliminary results of the NUTRICOVID study. Clin Nutr 2022; 41:3131-3132. [PMID: 35778282 PMCID: PMC9174101 DOI: 10.1016/j.clnu.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/01/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Karollainy Gomes da Silva
- Corresponding author. Federal University of Pernambuco, Av, Prof. Moraes Rego, 1235 - University City, Recife, PE, 50670-901, Brazil
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Leowattana W, Leowattana T, Leowattana P. SARS-CoV-2 viral load in the upper respiratory tract and disease severity in COVID-19 patients. World J Meta-Anal 2022; 10:195-205. [DOI: 10.13105/wjma.v10.i4.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/23/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
Due to the disease's broad clinical spectrum, it is currently unclear how to predict the future prognosis of patients at the time of diagnosis of coronavirus disease 2019 (COVID-19). Real-time reverse transcription-polymerase chain reaction (RT-PCR) is the gold standard molecular technique for diagnosing COVID-19. The number of amplification cycles necessary for the target genes to surpass a threshold level is represented by the RT-PCR cycle threshold (Ct) values. Ct values were thought to be an adequate proxy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load. A body of evidence suggests that SARS-CoV-2 viral load is a possible predictor of COVID-19 severity. The link between SARS-CoV-2 viral load and the likelihood of severe disease development in COVID-19 patients is not clearly elucidated. In this review, we describe the scientific data as well as the important findings from many clinical studies globally, emphasizing how viral load may be related to disease severity in COVID-19 patients. Most of the evidence points to the association of SARS-CoV-2 viral load and disease severity in these patients, and early anti-viral treatment will reduce the severe clinical outcomes.
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Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
| | - Pathomthep Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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Kurzeder L, Jörres RA, Unterweger T, Essmann J, Alter P, Kahnert K, Bauer A, Engelhardt S, Budweiser S. A simple risk score for mortality including the PCR Ct value upon admission in patients hospitalized due to COVID-19. Infection 2022; 50:1155-1163. [PMID: 35218511 PMCID: PMC8881702 DOI: 10.1007/s15010-022-01783-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/10/2022] [Indexed: 12/12/2022]
Abstract
Purpose To develop a simple score for the outcomes from COVID-19 that integrates information obtained at the time of admission including the Ct value (cycle threshold) for SARS-CoV-2. Methods Patients with COVID-19 hospitalized from February 1st to May 31st 2021 in RoMed hospitals, Germany, were included. Clinical and laboratory parameters upon admission were recorded and patients followed until discharge or death. Logistic regression analysis was used to determine predictors of outcomes. Regression coefficients were used to develop a risk score for death. Results Of 289 patients (46% female, median age 66 years), 29% underwent high-flow nasal oxygen (HFNO) therapy, 28% were admitted to the Intensive Care Unit (ICU, 51% put on invasive ventilation, IV), and 15% died. Age > 70 years, oxygen saturation ≤ 90%, oxygen supply upon admission, eGFR ≤ 60 ml/min and Ct value ≤ 26 were significant (p < 0.05 each) predictors for death, to which 2, 2, 1, 1 and 2 score points, respectively, could be attributed. Sum scores of ≥ 4 or ≥ 5 points were associated with a sensitivity of 95.0% or 82.5%, and a specificity of 72.5% or 81.7% regarding death. The high predictive value of the score was confirmed using data obtained between December 15th 2020 and January 31st 2021 (n = 215). Conclusion In COVID-19 patients, a simple scoring system based on data available shortly after hospital admission including the Ct value had a high predictive value for death. The score may also be useful to estimate the likelihood for required interventions at an early stage. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01783-1.
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Affiliation(s)
- Luis Kurzeder
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Thomas Unterweger
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Julian Essmann
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Research (DZL), University of Marburg (UMR), Marburg, Germany
| | - Kathrin Kahnert
- Department of Medicine V, Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Andreas Bauer
- Institute for Anesthesiology and Surgical Intensive Care Medicine, RoMed Hospital Rosenheim, Rosenheim, Germany
| | - Sebastian Engelhardt
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany
| | - Stephan Budweiser
- Department of Internal Medicine III, Division of Pulmonary and Respiratory Medicine, RoMed Hospital Rosenheim, Pettenkoferstrasse 10, 83022, Rosenheim, Germany.
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dos Santos MERA, Almeida Barros WM, de Sousa Fernandes MS, Januário da Silva AB, Nogueira Souza VDO. Letter to the editor: Vitamin D deficiency in critically ill COVID-19 ARDS patients. Clin Nutr 2022; 41:2036-2037. [PMID: 35123824 PMCID: PMC8761579 DOI: 10.1016/j.clnu.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022]
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7
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Notz Q, Stoppe C. Reply - Letter to the Editor: Vitamin D deficiency in critically ill COVID-19 ARDS patients. Clin Nutr 2022; 41:2038-2039. [PMID: 35120775 PMCID: PMC8762833 DOI: 10.1016/j.clnu.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
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Pérez-García F, Martin-Vicente M, Rojas-García RL, Castilla-García L, Muñoz-Gomez MJ, Hervás Fernández I, González Ventosa V, Vidal-Alcántara EJ, Cuadros-González J, Bermejo-Martin JF, Resino S, Martínez I. High SARS-CoV-2 viral load and low CCL5 expression levels in the upper respiratory tract are associated with COVID-19 severity. J Infect Dis 2021; 225:977-982. [PMID: 34910814 PMCID: PMC8754799 DOI: 10.1093/infdis/jiab604] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/13/2021] [Indexed: 01/01/2023] Open
Abstract
Mucosal immune response in the upper respiratory tract is crucial for the initial control of viral replication, the clearance of SARS-CoV-2, and the progression of the coronavirus disease 2019 (COVID-19). We analyzed the SARS-CoV-2 RNA load and the expression of selected immune genes in the upper respiratory tract (nasopharynx) of 255 SARS-CoV-2 infected patients and evaluated their association with severe COVID-19. SARS-CoV-2 replication in the nasopharyngeal mucosa induces the expression of several innate immune genes. High SARS-CoV-2 viral load and low CCL5 expression levels were associated with ICU admission or death, although CCL5 was the best predictor of COVID-19 severity.
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Affiliation(s)
- Felipe Pérez-García
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.,Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,Departamento de Biomedicina y Biotecnología, Facultad de Medicina. Universidad de Alcalá de Henares, Madrid, Spain
| | - María Martin-Vicente
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Rosa Lía Rojas-García
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Lucia Castilla-García
- Servicio de Hematología y Hemoterapia, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - María José Muñoz-Gomez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Irene Hervás Fernández
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | | | - Erick Joan Vidal-Alcántara
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Juan Cuadros-González
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain.,Departamento de Biomedicina y Biotecnología, Facultad de Medicina. Universidad de Alcalá de Henares, Madrid, Spain
| | - Jesús F Bermejo-Martin
- Group for Biomedical Research in Sepsis (BioSepsis). Instituto de Investigación Biomédica de Salamanca, (IBSAL), Salamanca, Spain.,Hospital Universitario Río Hortega, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Isidoro Martínez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Ulloque-Badaracco JR, Hernandez-Bustamante EA, Herrera-Añazco P, Benites-Zapata VA. Prognostic value of apolipoproteins in COVID-19 patients: A systematic review and meta-analysis. Travel Med Infect Dis 2021; 44:102200. [PMID: 34752921 PMCID: PMC8575373 DOI: 10.1016/j.tmaid.2021.102200] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Apolipoproteins are predictive biomarkers for cardiovascular, neoplasms and cerebrovascular diseases and are postulated as prognostic biomarkers in infectious diseases, as COVID-19. Thus, we assessed the prognosis value of apolipoproteins for COVID-19 severity and mortality. METHODS We conducted a systematic review and meta-analysis using observational studies that reported the association between apolipoproteins and severity or mortality in COVID-19 patients. Newcastle-Ottawa was used for the quality assessment of included studies. Effects measurements were shown as odds ratios (ORs) with 95% confidence intervals (CIs), and Egger-test was developed for assessing the risk of bias publication. RESULTS We analyzed 12 cohort studies (n = 3580). Patients with low ApoliproteinA1 (ApoA1) (OR 0.35; 95%CI 0.24 to 0.49; P < 0.001) and ApoliproteinB (ApoB) (OR = 0.78; 95%CI 0.69 to 0.87; P < 0.001) values had a higher risk of developing severe disease. ApoB/ApoA1 ratio showed no statistically significant association with higher odds of severity. Low ApoA1 levels were associated with higher odds of all-cause mortality (OR = 0.34; 95%CI 0.20 to 0.57; P < 0.001). ApoB values showed no statistically significant association with a high risk of all-cause mortality. CONCLUSION We suggest that adequate levels of ApoA1 and ApoB can be a protective factor for severity in COVID-19, and ApoB/ApoA1 ratio did not show predictive utility for severity.
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Affiliation(s)
| | - Enrique A Hernandez-Bustamante
- Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru; Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Percy Herrera-Añazco
- Universidad Privada San Juan Bautista, Lima, Peru; Instituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud, Lima, Peru
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