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Lafon T, Chapuis N, Guerin E, Daix T, Otranto M, Boumediene A, Jeannet R, Fontenay M, Henri Hani K, Vignon P, Monneret G, François B, Jean-Philippe J, Feuillard J. Along with PaO2/FiO2 ratio and lymphopenia, low HLA-DR monocytes are the only additional parameter that independently predicts the clinical course of undifferentiated SARS-CoV-2 patients in emergency departments. J Leukoc Biol 2024; 115:1131-1142. [PMID: 38366559 DOI: 10.1093/jleuko/qiae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/28/2023] [Accepted: 01/01/2024] [Indexed: 02/18/2024] Open
Abstract
Because one-third of patients deteriorate after their admission to the emergency department, assessing the prognosis of COVID-19 patients is of great importance. However, to date, only lymphopenia and the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio have been reported as partly predictive of COVID-19-related further deterioration, and their association has not been evaluated. We asked whether other key biomarkers of SARS-CoV-2 immunologic defects-increase in circulating immature granulocytes, loss of monocyte HLA-DR (mHLA-DR) expression, and monocyte differentiation blockade-could also predict further COVID-19 deterioration. A series of 284 consecutive COVID-19 patients, with the sole inclusion criterion of being an adult, were prospectively enrolled at emergency department admission (day 0) of 2 different hospitals: 1 for the exploratory cohort (180 patients) and 1 for the confirmatory cohort (104 patients). Deterioration was assessed over the next 7 days. Neither increased immature granulocyte levels nor monocyte differentiation blockade predicted patient worsening. Among more than 30 clinical, biological, and radiological parameters, the value of decreased P/F ratio and lymphopenia for prediction of further COVID-19 deterioration was strongly confirmed, and the loss of mHLA-DR was the only additional independent marker. Combined together in a simple OxyLymphoMono score, the 3 variables perfectly predicted patients who did not worsen and correctly predicted worsening in 59% of cases. By highlighting lymphocyte and monocyte defects as preceding COVID-19 deterioration, these results point on early immunosuppression in COVID-19 deterioration. Combining P/F ratio, lymphopenia, and loss of mHLA-DR together in a simple and robust score could offer a pragmatic method for COVID-19 patient stratification.
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Affiliation(s)
- Thomas Lafon
- Emergency Department, University Hospital Center of Limoges, 2 avenue Martin Luther King, 87042 Limoges, France
- Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1435, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Nicolas Chapuis
- Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Service d'Hématologie Biologique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Estelle Guerin
- Laboratoire d'Hématologie Biologique, Centre Hospitalier Universitaire de Limoges, Centre de Biologie et de Recherche en Santé, rue Bernard Descottes, 87042 Limoges, France
| | - Thomas Daix
- Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1435, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
- Réanimation Polyvalente, Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King, 87042 Limoges, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1092, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Marcela Otranto
- Emergency Department, University Hospital Center of Limoges, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Ahmed Boumediene
- Laboratoire Immunologie, Centre Hospitalier Universitaire de Limoges, Centre de Biologie et de Recherche en Santé, rue Bernard Descottes, 87042 Limoges, France
| | - Robin Jeannet
- Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1435, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
- Unité Mixte de Recherche Centre National de Recherche Scientifique 7276/Institut National de la Santé et de la Recherche Médicale U1262, Contrôle de la Réponse Immune B et Lymphoproliférations, Centre de Biologie et de Recherche en Santé, rue Bernard Descottes, 87025 Limoges, France
| | - Michaela Fontenay
- Institut National de la Santé et de la Recherche Médicale U1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
- Service d'Hématologie Biologique, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Centre-Université Paris Cité, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Karam Henri Hani
- Emergency Department, University Hospital Center of Limoges, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Philippe Vignon
- Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1435, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
- Réanimation Polyvalente, Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King, 87042 Limoges, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1092, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Guillaume Monneret
- Laboratoire d'Immunologie, Hôpital E. Herriot, Hospices Civils de Lyon, 5 Pl. d'Arsonval, 69003 Lyon, France
| | - Bruno François
- Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1435, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
- Réanimation Polyvalente, Centre Hospitalier Universitaire de Limoges, 2 avenue Martin Luther King, 87042 Limoges, France
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1092, Centre Hospitalier Universitaire Dupuytren, 2 avenue Martin Luther King, 87042 Limoges, France
| | - Jais Jean-Philippe
- Imagine Institute, Université Paris Cité, 24 Bd du Montparnasse, 75015 Paris, France
- Biostatistic Unit, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, 149 rue de Sèvre, 75015 Paris, France
- Human Genetics of Infectious Diseases: Complex Predisposition, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, 24 Bd du Montparnasse, 75015 Paris, France
| | - Jean Feuillard
- Laboratoire d'Hématologie Biologique, Centre Hospitalier Universitaire de Limoges, Centre de Biologie et de Recherche en Santé, rue Bernard Descottes, 87042 Limoges, France
- Unité Mixte de Recherche Centre National de Recherche Scientifique 7276/Institut National de la Santé et de la Recherche Médicale U1262, Contrôle de la Réponse Immune B et Lymphoproliférations, Centre de Biologie et de Recherche en Santé, rue Bernard Descottes, 87025 Limoges, France
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Galderisi S, Perrottelli A, Giuliani L, Pisaturo MA, Monteleone P, Pagliano P, Vita A, Muiesan ML, Amore M, Bassetti M, Siracusano A, Mucci A, Bucci P, Cascino G, Barlati S, Amerio A, Di Lorenzo G, Niolu C, Coppola N, Maj M. Cognitive impairment after recovery from COVID-19: Frequency, profile, and relationships with clinical and laboratory indices. Eur Neuropsychopharmacol 2024; 79:22-31. [PMID: 38065006 DOI: 10.1016/j.euroneuro.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 02/06/2024]
Abstract
Cognitive impairment (CI) is regarded as a remarkable burden in COVID-19 survivors. Its prevalence and profile, and relationships with the disease clinical and laboratory indices, remain unclear. The present study investigated, in a large sample of patients recovered from COVID-19, the frequency of CI with both a face-to-face screening tool and comprehensive test battery (MCCB). The study also evaluated the profile of CI and its relationships with COVID-19 clinical and laboratory indices and with psychopathological features. Out of 1344 subjects assessed for eligibility, 736 completed the screening phase 11 months after the COVID-19 infection; 402 participated in the baseline phase and completed an in depth cognitive, clinical and laboratory assessment about one month later. More than one third of the screened subjects presented a CI (COG+); it was associated to age, education, male gender, COVID-19 severity, and presence of anosmia, dyspnea at rest and exertional dyspnea during the acute phase. COG+ subjects showed a higher severity of depression, anxiety and post-traumatic distress, and worse global functioning, than subjects without CI. The MCCB showed that 45% of the subjects had a CI involving attention, working memory, verbal learning, visual learning, and reasoning and problem solving. Finally, neurocognitive functioning was inversely correlated with LDH blood levels, a potential biomarker of disease severity. According to our findings, cognitive functioning should be routinely and periodically assessed in COVID-19 patients, especially in older subjects, who experienced more severe COVID-19 symptoms. In case of persisting dysfunctions cognitive training programs should be considered as treatment strategies.
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Affiliation(s)
| | | | | | | | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Baronissi, Salerno, Italy
| | - Pasquale Pagliano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Baronissi, Salerno, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Internal Medicine, ASST Spedali Civili of Brescia, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy; Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Armida Mucci
- University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paola Bucci
- University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana" Baronissi, Salerno, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Mario Maj
- University of Campania Luigi Vanvitelli, Naples, Italy
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Russo A, Pisaturo M, Zollo V, Martini S, Maggi P, Numis FG, Gentile I, Sangiovanni N, Rossomando AM, Bianco V, Calabria G, Pisapia R, Codella AV, Masullo A, Manzillo E, Russo G, Parrella R, Dell'Aquila G, Gambardella M, Ponticiello A, Onorato L, Coppola N. Obesity as a Risk Factor of Severe Outcome of COVID-19: A Pair-Matched 1:2 Case-Control Study. J Clin Med 2023; 12:4055. [PMID: 37373748 DOI: 10.3390/jcm12124055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIM The nature of the association between obesity and poor prognosis of COVID-19 without the evaluation of other co-pathologies associated has not yet been clearly evaluated. The aim of the present pair-matched case-control study was to investigate the outcome of patients with SARS-CoV-2 infection in obese and non-obese patients matched considering gender, age, number of comorbidities, and Charlson Comorbidity Index. METHODS All the adults hospitalized for SARS-CoV-2 infection and with BMI ≥ 30 kg/m2 were included (Cases). For each Case, two patients with BMI < 30 kg/m2 pair matched for gender, age (±5 years), number of comorbidities (excluding obesity), and Charlson Comorbidity Index (±1) were enrolled (Controls). RESULTS Of the 1282 patients with SARS-CoV-2 infection followed during the study period, 141 patients with obesity and 282 patients without were enrolled in the case and control groups, respectively. Considering matching variables, there was no statistical difference between the two groups. Patients in the Control group developed more frequently a mild-moderate disease (67% vs. 46.1%, respectively), whereas obese patients were more prone to need intensive care treatment (41.8% vs. 26.6%, respectively; p = 0.001). Moreover, the prevalence of death during hospitalization was higher in the Case group than in the Control group (12.1% vs. 6.4%, p = 0.046). DISCUSSION We confirmed an association between obesity and severe outcome of patients with COVID-19, also considering other factors associated with a severe outcome of COVID-19. Thus, in the case of SARS-CoV-2 infection, the subjects with BMI ≥ 30 kg/m2 should be evaluated for early antiviral treatment to avoid the development of a severe course.
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Affiliation(s)
- Antonio Russo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", 80138 Napoli, Italy
| | - Mariantonietta Pisaturo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", 80138 Napoli, Italy
| | - Verdiana Zollo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", 80138 Napoli, Italy
| | - Salvatore Martini
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", 80138 Napoli, Italy
| | - Paolo Maggi
- Infectious Diseases Unit, A.O. S Anna e S Sebastiano Caserta, 81100 Caserta, Italy
| | | | - Ivan Gentile
- Infectious Disease Unit, Department of Clinical Medicine and Surgery, University Federico II, 80131 Naples, Italy
| | - Nadia Sangiovanni
- UOC Systemic and Immunosuppressed Infections, Azienda Ospedaliera di Rilievo Nazionale dei Colli, P.O. Cotugno, 80131 Naples, Italy
| | - Anna Maria Rossomando
- IV Infectious Diseases Unit and Gender Medicine, Azienda Ospedaliera di Rilievo Nazionale dei Coli, P.O. Cotugno, 80131 Naples, Italy
| | - Vincenzo Bianco
- Hepatic Infectious Diseases Unit, Azienda Ospedaliera di Rilievo Nazionale dei Colli, P.O. Cotugno, 80131 Naples, Italy
| | - Giosuele Calabria
- IX Infectious Diseases Unit, Azienda Ospedaliera di Rilievo Nazionale dei Colli, P.O. Cotugno, 80131 Naples, Italy
| | - Raffaella Pisapia
- First Infectious Diseases Unit, Azienda Ospedaliera di Rilievo Nazionale dei Coli, P.O. Cotugno, 80131 Naples, Italy
| | | | - Alfonso Masullo
- Infectious Diseases Unit, A.O. San Giovanni di Dio e Ruggi D'Aragona, 84131 Salerno, Italy
| | - Elio Manzillo
- VIII Infectious Diseases Unit, Azienda Ospedaliera di Rilievo Nazionale dei Coli, P.O. Cotugno, 80131 Naples, Italy
| | - Grazia Russo
- Infectious Diseases Unit, Ospedale Maria S.S. Addolorata di Eboli, 84025 Eboli, Italy
| | - Roberto Parrella
- Respiratory Infectious Diseases Unit, Azienda Ospedaliera di Rilievo Nazionale dei Colli, P.O. Cotugno, 80131 Naples, Italy
| | | | | | - Antonio Ponticiello
- Pneumology Unit and Respiratory Pathophysiology, Azienda Ospedaliera di Rilievo Nazionale Sant' Anna and San Sebastiano, 81100 Caserta, Italy
| | - Lorenzo Onorato
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", 80138 Napoli, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "L. Vanvitelli", 80138 Napoli, Italy
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