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Krishna B, Metaxaki M, Sithole N, Landín P, Martín P, Salinas-Botrán A. Cardiovascular disease and covid-19: A systematic review. IJC HEART & VASCULATURE 2024; 54:101482. [PMID: 39189008 PMCID: PMC11345335 DOI: 10.1016/j.ijcha.2024.101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/28/2024]
Abstract
Background Cardiovascular complications of COVID-19 are numerous and aspects of this phenomenon are not well known. The main objective of this manuscript is a systematic review of the acute and chronic cardiovascular complications secondary to COVID-19. Methods A systematic review of the literature through Medline via PubMed was conducted (2020-2024). Results There is a plethora of effects of COVID-19 on the heart in the acute setting. Here we discuss pathophysiology, myocardial infarctions, heart failure, Takotsubo Cardiomyopathy, myocardial injury, myocarditis and arrhythmias that are caused by COVID-19. Additionally, these cardiovascular injuries can linger and may be an underlying cause of some Long COVID symptoms. Conclusions Cardiovascular complications of COVID-19 are numerous and life-threatening. Long COVID can affect cardiovascular health. Microclotting induced by SARS-CoV-2 infection could be a therapeutic target for some aspects of Long Covid.
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Affiliation(s)
- B.A. Krishna
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - M. Metaxaki
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - N. Sithole
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Infectious Diseases, Cambridge University, Cambridge, United Kingdom
| | - P. Landín
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - P. Martín
- Department of Respiratory Medicine, Hospital Clínico San Carlos, Madrid, Spain
| | - A. Salinas-Botrán
- Department of Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Kalra A, Wilcox C, Holmes SD, Tonna JE, Jeong IS, Rycus P, Anders MM, Zaaqoq AM, Lorusso R, Brodie D, Keller SP, Kim BS, Whitman GJR, Cho SM. Characterizing the Racial Discrepancy in Hypoxemia Detection in Venovenous Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis. Lung 2024; 202:471-481. [PMID: 38856932 DOI: 10.1007/s00408-024-00711-4] [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: 04/02/2024] [Accepted: 05/27/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE Skin pigmentation influences peripheral oxygen saturation (SpO2) compared to arterial saturation of oxygen (SaO2). Occult hypoxemia (SaO2 ≤ 88% with SpO2 ≥ 92%) is associated with increased in-hospital mortality in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO2-SaO2 discrepancy due to significant hemolysis. METHODS Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO2 and SaO2 measurements from over 500 centers in the Extracorporeal Life Support Organization Registry (1/2018-5/2023) were included. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO2-SaO2 calculations. RESULTS Of 13,171 VV-ECMO patients, there were 7772 (59%) White, 2114 (16%) Hispanic, 1777 (14%) Black, and 1508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic patients versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively). In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18-2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95% CI = 1.16-2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95% CI = 1.15-2.55, P = 0.008) had higher risk versus White patients. Higher pump flow rates (aOR = 1.29, 95% CI = 1.08-1.55, P = 0.005) and on-ECMO 24-h lactate (aOR = 1.06, 95% CI = 1.03-1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia. CONCLUSION SaO2 should be carefully monitored if using SpO2 during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
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Affiliation(s)
- Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher Wilcox
- Department of Critical Care, Mercy Hospital of Buffalo, Buffalo, NY, USA
| | - Sari D Holmes
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery and Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, 84132, USA
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, South Korea
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI, USA
| | - Marc M Anders
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Akram M Zaaqoq
- Department of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA, USA
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA.
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Mohebbi Z, Ghaemmaghami P, Rajaei M, Keshtkar MM, Ghanbarzadeh S, Khoram B. The association between potential predictors and death of patients during the COVID-19 pandemic in Shiraz: a hierarchical multiple regression analysis. BMC Public Health 2024; 24:1975. [PMID: 39044209 PMCID: PMC11267688 DOI: 10.1186/s12889-024-19372-2] [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: 11/13/2023] [Accepted: 07/04/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Identifying clinical factors that increase the risk of mortality in COVID-19 patients is crucial. This enables targeted screening, optimizing treatment, and prevention of severe complications, ultimately reducing death rates. This study aimed to develop prediction models for the death of patients (i.e., survival or death) during the COVID-19 pandemic in Shiraz, exploring the main influencing factors. METHOD We conducted a retrospective cohort study using hospital-based records of 1030 individuals diagnosed with COVID-19, who were hospitalized for treatment between March 21, 2021, and March 21, 2022, in Shiraz, Iran. Variables related to the final outcome were selected based on criteria and univariate logistic regression. Hierarchical multiple logistic regression and classification and regression tree (CART) models were utilized to explore the relationships between potential influencing factors and the final outcome. Additionally, methods were employed to identify the high-risk population for increased mortality rates during COVID-19. Finally, accuracy was evaluated the performance of the models, with the area under the receiver operator characteristic curve(AUC), sensitivity, and specificity metrics. RESULTS In this study, 558 (54.2%) individuals infected with COVID-19 died. The final model showed that the type of medicine antiviral (OR: 11.10, p = 0.038) than reference (antiviral and corticosteroid), and discharge oxygen saturation(O2) (OR: 1.10, p < 0.001) had a positive association with the chance of survival, but other variables were not considered as predictive variables. Predictive models for the final outcome(death) achieved accuracies ranging from 81 to 87% for hierarchical multiple logistic regression and from 87 to 94% for the CART model. Therefore, the CART model performed better than the hirerical multiple logistic regression model. CONCLUSION These findings firstly elucidate the incidence and associated factors of the outcome (death) among patients in Shiraz, Iran. Furthermore, we demonstrated that antiviral medication alone (without corticosteroids) and high O2 increase the survival chances of COVID patients.
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Affiliation(s)
- Zinat Mohebbi
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parvin Ghaemmaghami
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Melika Rajaei
- Nurse, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sina Ghanbarzadeh
- Medical Student, Student Research Committee, Medical College, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bagher Khoram
- Instructor of Critical-Care Nursing, MSN, Department of Anesthesia, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Kalra A, Shou BL, Zhao D, Wilcox C, Keller SP, Kim BS, Whitman GJR, Cho SM. Extracorporeal Membrane Oxygenation Physiological Factors Influence Pulse Oximetry and Arterial Oxygen Saturation Discrepancies. Ann Thorac Surg 2024; 117:1221-1228. [PMID: 37748529 PMCID: PMC10959762 DOI: 10.1016/j.athoracsur.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/24/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Cannulation strategy, vasopressors, and hemolysis are important physiological factors that influence hemodynamics in extracorporeal membrane oxygenation (ECMO). We hypothesized these factors influence the discrepancy between oxygen saturation measured by pulse oximetry (Spo2) and arterial blood gas (Sao2) in patients on ECMO. METHODS We retrospectively analyzed adults (aged ≥18 years) on venoarterial or venovenous ECMO at a tertiary academic ECMO center. Spo2-Sao2 pairs with oxygen saturation ≥70% and measured within 10 minutes were included. Occult hypoxemia was defined as Sao2 ≤88% with a time-matched Spo2 ≥92%. Adjusted linear mixed-effects modeling was used to assess the Spo2-Sao2 discrepancy with preselected demographics and time-matched laboratory variables. Vasopressor use was quantified by vasopressor dose equivalences. RESULTS Of 139 venoarterial-ECMO and 88 venovenous-ECMO patients, we examined 20,053 Spo2-Sao2 pairs. The Spo2-Sao2 discrepancy was greater in venovenous-ECMO (1.15%) vs venoarterial-ECMO (-0.35%, P < .001). Overall, 81 patients (35%) experienced occult hypoxemia during ECMO. Occult hypoxemia was more common in venovenous-ECMO (65%) than in venoarterial-ECMO (17%, P < .001). In linear mixed-effects modeling, Spo2 underestimated Sao2 by 9.48% in central vs peripheral venoarterial-ECMO (95% CI, -17.1% to -1.79%; P = .02). Higher vasopressor dose equivalences significantly worsened the Spo2-Sao2 discrepancy (P < .001). In linear mixed-effects modeling, Spo2 overestimated Sao2 by 25.43% in single lumen-cannulated vs double lumen-cannulated venovenous-ECMO (95% CI, 5.27%-45.6%; P = .03). Higher vasopressor dose equivalences and lactate dehydrogenase levels significantly worsened the Spo2-Sao2 discrepancy (P < .001). CONCLUSIONS Venovenous-ECMO patients are at higher risk for occult hypoxemia compared with venoarterial-ECMO. A higher vasopressor requirement and different cannulation strategies (central venoarterial-ECMO; single-lumen venovenous-ECMO) were significant factors for clinically significant Spo2-Sao2 discrepancy in both ECMO modes.
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Affiliation(s)
- Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin L Shou
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - David Zhao
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Christopher Wilcox
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Steven P Keller
- Division of Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Bo Soo Kim
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland.
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Gugo K, Tandara L, Juricic G, Pavicic Ivelja M, Rumora L. Effects of Hypoxia and Inflammation on Hepcidin Concentration in Non-Anaemic COVID-19 Patients. J Clin Med 2024; 13:3201. [PMID: 38892911 PMCID: PMC11173117 DOI: 10.3390/jcm13113201] [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: 04/22/2024] [Revised: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: This study aimed to explore the influence of hypoxia, inflammation, and erythropoiesis on hepcidin and other iron status parameters in non-anaemic COVID-19 patients admitted to the emergency unit before the introduction of therapeutic interventions. Methods: Ninety-six COVID-19 patients and 47 healthy subjects were recruited. Patients were subdivided into hypoxic or normoxic groups and, after follow-up, into mild and moderate, severe or critical disease severity groups. Iron, unsaturated iron-binding capacity (UIBC), ferritin, C-reactive protein (CRP), and interleukin 6 (IL-6) were measured on automatic analysers. ELISA kits were used for hepcidin and erythropoietin (EPO) determination. We calculated total iron-binding capacity (TIBC) and ratios of hepcidin with parameters of iron metabolism (ferritin/hepcidin, hepcidin/iron), inflammation (hepcidin/CRP, hepcidin/IL-6), and erythropoietic activity (hepcidin/EPO). Results: Hepcidin, ferritin, EPO, CRP, IL-6, ferritin/hepcidin, and hepcidin/iron were increased, while UIBC, TIBC, hepcidin/CRP, and hepcidin/IL-6 were decreased in hypoxic compared to normoxic patients as well as in patients with severe or critical disease compared to those with mild and moderate COVID-19. Regarding predictive parameters of critical COVID-19 occurrence, in multivariable logistic regression analysis, a combination of EPO and ferritin/hepcidin showed very good diagnostic performances and correctly classified 88% of cases, with an AUC of 0.838 (0.749-0.906). Conclusions: The hypoxic signal in our group of patients was not strong enough to overcome the stimulating effect of inflammation on hepcidin expression. EPO and ferritin/hepcidin might help to identify on-admission COVID-19 patients at risk of developing a critical form of the disease.
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Affiliation(s)
- Katarina Gugo
- Medical Laboratory Diagnostic Division, University Hospital of Split, Soltanska 1, 21000 Split, Croatia;
- Department of Health Studies, University of Split, Rudera Boskovica 35, 21000 Split, Croatia;
| | - Leida Tandara
- Medical Laboratory Diagnostic Division, University Hospital of Split, Soltanska 1, 21000 Split, Croatia;
- Department of Medical Chemistry and Biochemistry, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Gordana Juricic
- Department of Laboratory Diagnostics, General Hospital Pula, Santoriova 24a, 52100 Pula, Croatia;
| | - Mirela Pavicic Ivelja
- Department of Health Studies, University of Split, Rudera Boskovica 35, 21000 Split, Croatia;
- Department of Infectious Diseases, University Hospital of Split, Soltanska 1, 21000 Split, Croatia
| | - Lada Rumora
- Department of Medical Biochemistry and Haematology, University of Zagreb Faculty of Pharmacy and Biochemistry, A. Kovacica 1, 10000 Zagreb, Croatia;
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Vásquez-Gómez J, Gutierrez-Gutierrez L, Miranda-Cuevas P, Ríos-Florez L, Casas-Condori L, Gumiel M, Castillo-Retamal M. O 2 Saturation Predicted the ICU Stay of COVID-19 Patients in a Hospital at Altitude: A Low-Cost Tool for Post-Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:641. [PMID: 38674287 PMCID: PMC11052252 DOI: 10.3390/medicina60040641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/04/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Patients at high altitudes with COVID-19 may experience a decrease in their partial oxygen saturation (PO2S) levels. The objective was to assess the association between PO2S and intensive care unit (ICU) stay in patients at high altitudes with COVID-19. Materials and Methods: Clinical records of 69 COVID-19 patients (36% women) admitted to the ICU were analyzed. Median values were considered for intra-group categories ("≤11 days" and ">11 days" in the ICU) and for PO2S height categories ("<90%" and "≥90%"). Logistic regression and linear regression models adjusted for confounding variables were used. Results: Patients with >11 days in the ICU had 84% lower odds of having a PO2S ≥ 90% (OR: 0.16 [CI: 0.02, 0.69], p = 0.005) compared to those with ≤11 days in the ICU. An increase in PO2S by 1% reduced ICU stay by 0.22 days (β: -0.22 [CI: -0.33, -0.11], p < 0.001), potentially leading to a reduction of up to 1.44 days. Conclusions: PO2S is a crucial factor in estimating ICU stays for COVID-19 patients at high altitudes and serves as an accessible and cost-effective measure. It should be used in infected patients to complement the prognosis of post-pandemic ICU stay.
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Affiliation(s)
- Jaime Vásquez-Gómez
- Centro de Investigación de Estudios Avanzados del Maule (CIEAM), Universidad Católica del Maule, Talca 3460000, Chile;
- Laboratorio de Rendimiento Humano, Universidad Católica del Maule, Talca 3460000, Chile
| | - Lucero Gutierrez-Gutierrez
- Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad Privada Franz Tamayo, La Paz 4780, Bolivia; (L.G.-G.); (P.M.-C.); (L.R.-F.); (L.C.-C.)
| | - Pablo Miranda-Cuevas
- Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad Privada Franz Tamayo, La Paz 4780, Bolivia; (L.G.-G.); (P.M.-C.); (L.R.-F.); (L.C.-C.)
| | - Luis Ríos-Florez
- Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad Privada Franz Tamayo, La Paz 4780, Bolivia; (L.G.-G.); (P.M.-C.); (L.R.-F.); (L.C.-C.)
| | - Luz Casas-Condori
- Facultad de Ciencias de la Salud, Carrera de Medicina, Universidad Privada Franz Tamayo, La Paz 4780, Bolivia; (L.G.-G.); (P.M.-C.); (L.R.-F.); (L.C.-C.)
| | - Marcia Gumiel
- Coordinación de Investigación, Universidad Privada Franz Tamayo, La Paz 4780, Bolivia;
| | - Marcelo Castillo-Retamal
- Laboratorio de Rendimiento Humano, Universidad Católica del Maule, Talca 3460000, Chile
- Departamento de Ciencias de la Actividad Física, Universidad Católica del Maule, Talca 3460000, Chile
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Bertilacchi MS, Piccarducci R, Celi A, Germelli L, Romei C, Bartholmai B, Barbieri G, Giacomelli C, Martini C. Blood oxygenation state in COVID-19 patients: Unexplored role of 2,3-bisphosphoglycerate. Biomed J 2024:100723. [PMID: 38583585 DOI: 10.1016/j.bj.2024.100723] [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: 11/28/2023] [Revised: 03/16/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND COVID-19 reduces lung functionality causing a decrease of blood oxygen levels (hypoxemia) often related to a decreased cellular oxygenation (hypoxia). Besides lung injury, other factors are implicated in the regulation of oxygen availability such as pH, partial arterial carbon dioxide tension (PaCO2), temperature, and erythrocytic 2,3-bisphosphoglycerate (2,3-BPG) levels, all factors affecting hemoglobin saturation curve. However, few data are currently available regarding the 2,3-BPG modulation in SARS-CoV-2 affected patients at the hospital admission. MATERIAL AND METHODS Sixty-eight COVID-19 patients were enrolled at hospital admission. The lung involvement was quantified using chest-Computer Tomography (CT) analysed with automatic software (CALIPER). Haemoglobin concentrations, glycemia, and routine analysis were evaluated in the whole blood, while partial arterial oxygen tension (PaO2), PaCO2, pH, and HCO3- were assessed by arterial blood gas analysis. 2,3-BPG levels were assessed by specific immunoenzymatic assays in RBCs. RESULTS A higher percentage of interstitial lung disease (ILD) and vascular pulmonary-related structure (VRS) volume on chest-CT quantified with CALIPER had been found in COVID-19 patients with a worse disease outcome (R = 0.4342; and R = 0.3641, respectively). Furthermore, patients with lower PaO2 showed an imbalanced acid-base equilibrium (pH, p = 0.0208; PaCO2, p = 0.0496) and a higher 2,3-BPG levels (p = 0.0221). The 2,3-BPG levels were also lower in patients with metabolic alkalosis (p = 0.0012 vs. no alkalosis; and p = 0.0383 vs. respiratory alkalosis). CONCLUSIONS Overall, the data reveal a different pattern of activation of blood oxygenation compensatory mechanisms reflecting a different course of the COVID-19 disease specifically focusing on 2,3-BPG modulation.
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Affiliation(s)
| | | | - Alessandro Celi
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, 56126, Italy
| | | | - Chiara Romei
- Department of Radiology, Pisa University Hospital, Pisa, Italy.
| | - Brian Bartholmai
- Division of Radiology, Mayo Clinic Rochester, Rochester, MN, USA
| | - Greta Barbieri
- Department of Emergency Medicine Department, Pisa University Hospital, Italy
| | | | - Claudia Martini
- Department of Pharmacy, University of Pisa, 56126, Pisa, Italy
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Mettler SK, Charoenngam N, Jaroenlapnopparat A, Tern C, Xanthavanij N, Economidou S, Strand MJ, Hobbs BD, Moll M, Cho MH. Clinical factors associated with racial differences in the prevalence of occult hypoxemia: a retrospective case-control study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.28.24305036. [PMID: 38585762 PMCID: PMC10996744 DOI: 10.1101/2024.03.28.24305036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Recent studies showed that Black patients more often have falsely normal oxygen saturation on pulse oximetry compared to White patients. However, whether the racial differences in occult hypoxemia are mediated by other clinical differences is unknown. Methods We conducted a retrospective case-control study utilizing two large ICU databases (eICU and MIMIC-IV). We defined occult hypoxemia as oxygen saturation on pulse oximetry within 92-98% despite oxygen saturation on arterial blood gas below 90%. We assessed associations of commonly measured clinical factors with occult hypoxemia using multivariable logistic regression and conducted mediation analysis of the racial effect. Results Among 24,641 patients, there were 1,855 occult hypoxemia cases and 23,786 controls. In both datasets, Black patients were more likely to have occult hypoxemia (unadjusted odds ratio 1.66 [95%-CI: 1.41-1.95] in eICU and 2.00 [95%-CI: 1.22-3.14] in MIMIC-IV). In multivariable models, higher respiratory rate, PaCO2 and creatinine as well as lower hemoglobin were associated with increased odds of occult hypoxemia. Differences in the commonly measured clinical markers accounted for 9.2% and 44.4% of the racial effect on occult hypoxemia in eICU and MIMIC-IV, respectively. Conclusion Clinical differences, in addition to skin tone, might mediate some of the racial differences in occult hypoxemia.
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Affiliation(s)
- Sofia K. Mettler
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Mount Auburn Hospital, Cambridge, MA, United States
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Nipith Charoenngam
- Mount Auburn Hospital, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
- Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | | | - Courtney Tern
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Nutchapon Xanthavanij
- Mount Auburn Hospital, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sofia Economidou
- Mount Auburn Hospital, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Matthew J. Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, Colorado, United States
| | - Brian D. Hobbs
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Matthew Moll
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, West Roxbury, MA, United States
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, MA, United States
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Martínez-Gómez LE, Martinez-Armenta C, Tusie-Luna T, Vázquez-Cárdenas P, Vidal-Vázquez RP, Ramírez-Hinojosa JP, Gómez-Martín D, Vargas-Alarcón G, Posadas-Sánchez R, Fragoso JM, de la Peña A, Rodríguez-Pérez JM, Mata-Miranda MM, Vázquez-Zapién GJ, Martínez-Cuazitl A, Martínez-Ruiz FDJ, Zayago-Angeles DM, Ramos-Tavera L, Méndez-Aguilera A, Camacho-Rea MDC, Ordoñez-Sánchez ML, Segura-Kato Y, Suarez-Ahedo C, Olea-Torres J, Herrera-López B, Pineda C, Martínez-Nava GA, López-Reyes A. The fatal contribution of serine protease-related genetic variants to COVID-19 outcomes. Front Immunol 2024; 15:1335963. [PMID: 38601158 PMCID: PMC11004237 DOI: 10.3389/fimmu.2024.1335963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction Serine proteases play a critical role during SARS-CoV-2 infection. Therefore, polymorphisms of transmembrane protease serine 2 (TMPRSS2) and serpine family E member 1 (SERPINE1) could help to elucidate the contribution of variability to COVID-19 outcomes. Methods To evaluate the genetic variants of the genes previously associated with COVID-19 outcomes, we performed a cross-sectional study in which 1536 SARS-CoV-2-positive participants were enrolled. TMPRSS2 (rs2070788, rs75603675, rs12329760) and SERPINE1 (rs2227631, rs2227667, rs2070682, rs2227692) were genotyped using the Open Array Platform. The association of polymorphisms with disease outcomes was determined by logistic regression analysis adjusted for covariates (age, sex, hypertension, type 2 diabetes, and obesity). Results According to our codominant model, the GA genotype of rs2227667 (OR=0.55; 95% CI = 0.36-0.84; p=0.006) and the AG genotype of rs2227667 (OR=0.59; 95% CI = 0.38-0.91; p=0.02) of SERPINE1 played a protective role against disease. However, the rs2227692 T allele and TT genotype SERPINE1 (OR=1.45; 95% CI = 1.11-1.91; p=0.006; OR=2.08; 95% CI = 1.22-3.57; p=0.007; respectively) were associated with a decreased risk of death. Similarly, the rs75603675 AA genotype TMPRSS2 had an OR of 1.97 (95% CI = 1.07-3.6; p=0.03) for deceased patients. Finally, the rs2227692 T allele SERPINE1 was associated with increased D-dimer levels (OR=1.24; 95% CI = 1.03-1.48; p=0.02). Discussion Our data suggest that the rs75603675 TMPRSS2 and rs2227692 SERPINE1 polymorphisms are associated with a poor outcome. Additionally, rs2227692 SERPINE1 could participate in hypercoagulable conditions in critical COVID-19 patients, and this genetic variant could contribute to the identification of new pharmacological targets and treatment strategies to block the inhibition of TMPRSS2 entry into SARS-CoV-2.
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Affiliation(s)
- Laura Edith Martínez-Gómez
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Carlos Martinez-Armenta
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Teresa Tusie-Luna
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador, Zubirán, Mexico City, Mexico
- Instituto de Investigaciones Biomédicas Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paola Vázquez-Cárdenas
- Centro de Innovación Médica Aplicada, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Rosa P. Vidal-Vázquez
- Centro de Innovación Médica Aplicada, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Juan P. Ramírez-Hinojosa
- Centro de Innovación Médica Aplicada, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
| | - Diana Gómez-Martín
- Department of Immunology and Rheumatology, Departamento de Inmunogenética, Departamento de Nutrición Animal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Secretaría de Salud, Mexico City, Mexico
| | - Gilberto Vargas-Alarcón
- Departamento de Biología Molecular y Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rosalinda Posadas-Sánchez
- Departamento de Biología Molecular y Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Manuel Fragoso
- Departamento de Biología Molecular y Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Aurora de la Peña
- Departamento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - José Manuel Rodríguez-Pérez
- Departamento de Biología Molecular y Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Mónica M. Mata-Miranda
- Laboratorio de Biología Celular y Tisular, Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Mexico City, Mexico
| | - Gustavo J. Vázquez-Zapién
- Laboratorio de Biología Celular y Tisular, Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Mexico City, Mexico
| | - Adriana Martínez-Cuazitl
- Laboratorio de Biología Celular y Tisular, Laboratorio de Embriología, Escuela Médico Militar, Universidad del Ejército y Fuerza Aérea, Mexico City, Mexico
| | - Felipe de J. Martínez-Ruiz
- Nuevo Hospital General Delegación Regional Sur de la Ciudad de México Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Dulce M. Zayago-Angeles
- Nuevo Hospital General Delegación Regional Sur de la Ciudad de México Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Luis Ramos-Tavera
- Department of Immunology and Rheumatology, Departamento de Inmunogenética, Departamento de Nutrición Animal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Secretaría de Salud, Mexico City, Mexico
| | - Alberto Méndez-Aguilera
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - María del C. Camacho-Rea
- Department of Immunology and Rheumatology, Departamento de Inmunogenética, Departamento de Nutrición Animal, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Secretaría de Salud, Mexico City, Mexico
| | - María L. Ordoñez-Sánchez
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador, Zubirán, Mexico City, Mexico
| | - Yayoi Segura-Kato
- Unidad de Biología Molecular y Medicina Genómica, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador, Zubirán, Mexico City, Mexico
| | - Carlos Suarez-Ahedo
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Jessel Olea-Torres
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Brígida Herrera-López
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Carlos Pineda
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Gabriela A. Martínez-Nava
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
| | - Alberto López-Reyes
- Laboratorio de Gerociencias, Dirección General, Departamento de Reconstrucción Articular, Laboratorio Facilitador, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Secretaría de Salud, Mexico City, Mexico
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Zhang S, Ji J, Gao S, Yang S, Song Z, Li J, Liu J. Association between SpO 2 and the risk of death in elderly T2DM patients with cerebral infarction: a retrospective cohort study. Front Neurol 2024; 15:1344000. [PMID: 38533418 PMCID: PMC10964770 DOI: 10.3389/fneur.2024.1344000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/26/2024] [Indexed: 03/28/2024] Open
Abstract
Objective This study aimed to evaluate the SpO2 (transcutaneous oxygen saturation) -mortality link in elderly T2DM (diabetes mellitus type 2) patients with cerebral infarction and identify their optimal SpO2 range. Methods In this investigation, we employed a comprehensive approach. Initially, we screened the MIMIC-IV database, identifying elderly T2DM patients with cerebral infarction, utilizing specific ICD-9 and ICD-10 codes. We then harnessed the power of restricted cubic splines to craft a visual representation of the correlation between SpO2 and 1-year mortality. To enhance our analysis, we harnessed Cox multivariate regression, allowing us to compute adjusted hazard ratios (HR) accompanied by 95% confidence intervals (CIs). Additionally, we crafted Cumulative Mortality Curve analyses, augmenting our study by engaging in rigorous subgroup analyses, stratifying our observations based on pertinent covariates. Results In this study, 448 elderly T2DM patients with cerebral infarction were included. Within 1-year post-discharge, 161 patients (35.94%) succumbed. Employing Restricted Cubic Spline analysis, a statistically significant U-shaped non-linear relationship between admission ICU SpO2 levels and 1-year mortality was observed (P-value < 0.05). Further analysis indicated that both low and high SpO2 levels increased the mortality risk. Cox multivariate regression analysis, adjusting for potential confounding factors, confirmed the association of low (≤94.5%) and high SpO2 levels (96.5-98.5%) with elevated 1-year mortality risk, particularly notably high SpO2 levels (>98.5%) [HR = 2.06, 95% CI: 1.29-3.29, P-value = 0.002]. The cumulative mortality curves revealed the following SpO2 subgroups from high to low cumulative mortality at the 365th day: normal levels (94.5% < SpO2 ≤ 96.5%), low levels (SpO2 ≤ 94.5%), high levels (96.5% < SpO2 ≤ 98.5%), and notably high levels (>98.5%). Subgroup analysis demonstrated no significant interaction between SpO2 and grouping variables, including Sex, Age, Congestive heart failure, Temperature, and ICU length of stay (LOS-ICU; P-values for interaction were >0.05). Conclusions Striking an optimal balance is paramount, as fixating solely on lower SpO2 limits or neglecting high SpO2 levels may contribute to increased mortality rates. To mitigate mortality risk in elderly T2DM patients with cerebral infarction, we recommend maintaining SpO2 levels within the range of 94.5-96.5%.
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Affiliation(s)
- Shuo Zhang
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Jiaqi Ji
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Siqi Gao
- School of Basic Medical Sciences, North China University of Science and Technology, Tangshan, China
| | - Shu Yang
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Zeyi Song
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Jianmin Li
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Junjie Liu
- College of Clinical Medicine, North China University of Science and Technology, Tangshan, China
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Kim M, Hwang J, Grist JT, Abueid G, Yoon SH, Grau V, Fraser E, Gleeson FV. Functional Impairment in Small Airways Associated With the Breathlessness Symptoms in Long-Coronavirus Disease. J Thorac Imaging 2024; 39:79-85. [PMID: 37889567 DOI: 10.1097/rti.0000000000000748] [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: 10/28/2023]
Abstract
PURPOSE This study aimed to determine the association between functional impairment in small airways and symptoms of dyspnea in patients with Long-coronavirus disease (COVID), using imaging and computational modeling analysis. PATIENTS AND METHODS Thirty-four patients with Long-COVID underwent thoracic computed tomography and hyperpolarized Xenon-129 magnetic resonance imaging (HP Xe MRI) scans. Twenty-two answered dyspnea-12 questionnaires. We used a computed tomography-based full-scale airway network (FAN) flow model to simulate pulmonary ventilation. The ventilation distribution projected on a coronal plane and the percentage lobar ventilation modeled in the FAN model were compared with the HP Xe MRI data. To assess the ventilation heterogeneity in small airways, we calculated the fractal dimensions of the impaired ventilation regions in the HP Xe MRI and FAN models. RESULTS The ventilation distribution projected on a coronal plane showed an excellent resemblance between HP Xe MRI scans and FAN models (structure similarity index: 0.87 ± 0.04). In both the image and the model, the existence of large clustered ventilation defects was not identifiable regardless of dyspnea severity. The percentage lobar ventilation of the HP Xe MRI and FAN model showed a strong correlation (ρ = 0.63, P < 0.001). The difference in the fractal dimension of impaired ventilation zones between the low and high dyspnea-12 score groups was significant (HP Xe MRI: 1.97 [1.89 to 2.04] and 2.08 [2.06 to 2.14], P = 0.005; FAN: 2.60 [2.59 to 2.64] and 2.64 [2.63 to 2.65], P = 0.056). CONCLUSIONS This study has identified a potential association of small airway functional impairment with breathlessness in Long-COVID, using fractal analysis of HP Xe MRI scans and FAN models.
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Affiliation(s)
- Minsuok Kim
- School of Mechanical, Electrical, and Manufacturing Engineering, Loughborough University, Loughborough
| | - Jeongeun Hwang
- Department of Engineering Science, Institute of Biomedical Engineering, Oxford e-Research Centre
- Department of Medical IT Engineering, Soonchunhyang University, Chungcheonnam-do
| | - James T Grist
- Department of Physiology, Anatomy, and Genetics
- Department of Radiology
- Oxford Centre for Clinical MR Research, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Vicente Grau
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine
| | - Emily Fraser
- Oxford Interstitial Lung Disease Service, The Churchill Hospital
| | - Fergus V Gleeson
- Department of Oncology, University of Oxford
- Department of Radiology
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12
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May L, Chu CF, Zielinski CE. Single-Cell RNA Sequencing Reveals HIF1A as a Severity-Sensitive Immunological Scar in Circulating Monocytes of Convalescent Comorbidity-Free COVID-19 Patients. Cells 2024; 13:300. [PMID: 38391913 PMCID: PMC10886588 DOI: 10.3390/cells13040300] [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: 12/22/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
COVID-19, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by a wide range of clinical symptoms and a poorly predictable disease course. Although in-depth transcriptomic investigations of peripheral blood samples from COVID-19 patients have been performed, the detailed molecular mechanisms underlying an asymptomatic, mild or severe disease course, particularly in patients without relevant comorbidities, remain poorly understood. While previous studies have mainly focused on the cellular and molecular dissection of ongoing COVID-19, we set out to characterize transcriptomic immune cell dysregulation at the single-cell level at different time points in patients without comorbidities after disease resolution to identify signatures of different disease severities in convalescence. With single-cell RNA sequencing, we reveal a role for hypoxia-inducible factor 1-alpha (HIF1A) as a severity-sensitive long-term immunological scar in circulating monocytes of convalescent COVID-19 patients. Additionally, we show that circulating complexes formed by monocytes with either T cells or NK cells represent a characteristic cellular marker in convalescent COVID-19 patients irrespective of their preceding symptom severity. Together, these results provide cellular and molecular correlates of recovery from COVID-19 and could help in immune monitoring and in the design of new treatment strategies.
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Affiliation(s)
- Lilly May
- Leibniz Institute for Natural Products Research and Infection Biology, Department of Infection Immunology, 07745 Jena, Germany; (L.M.); (C.-F.C.)
- Center for Translational Cancer Research (TranslaTUM) & Institute of Virology, Technical University of Munich, 81675 Munich, Germany
| | - Chang-Feng Chu
- Leibniz Institute for Natural Products Research and Infection Biology, Department of Infection Immunology, 07745 Jena, Germany; (L.M.); (C.-F.C.)
- Center for Translational Cancer Research (TranslaTUM) & Institute of Virology, Technical University of Munich, 81675 Munich, Germany
| | - Christina E. Zielinski
- Leibniz Institute for Natural Products Research and Infection Biology, Department of Infection Immunology, 07745 Jena, Germany; (L.M.); (C.-F.C.)
- Center for Translational Cancer Research (TranslaTUM) & Institute of Virology, Technical University of Munich, 81675 Munich, Germany
- Department of Microbiology, Friedrich Schiller University, 07743 Jena, Germany
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Bastidas-Goyes AR, Tuta-Quintero E, Aguilar MF, Mora AV, Aponte HC, Villamizar JM, Galeano S, Mejia P, Muñoz M, Paredes S, Pumarejo D, Barragan MDM. Performance of oxygenation indices and risk scores to predict invasive mechanical ventilation and mortality in COVID-19. BMC Pulm Med 2024; 24:68. [PMID: 38308270 PMCID: PMC10835882 DOI: 10.1186/s12890-023-02807-8] [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: 08/08/2023] [Accepted: 12/07/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Information on the performance of oxygenation indices (OIs) and risk scores in patients requiring invasive mechanical ventilation (IMV) is limited. We determine the performance of the OIs and risk scores in hospitalized patients with COVID-19 to predict the requirement of IMV and death at 28 days after admission. METHODS A retrospective study of diagnostic tests in patients admitted to the emergency department, hospitalization, and intensive care unit diagnosed with COVID-19. The receiver operating characteristic curve (ROC-curve) were built with the OIs and risk scores to predict IMV and mortality. RESULTS A total of 1402 subjects entered the final analysis, of whom 19.5% (274/1402) received IMV and 23.0% (323/1402) died at 28 days. The ROC-curve of the delta PaO2/FiO2 ratio for the requirement of IMV and mortality at 28-day was 0.589 (95% CI: 0.546-0.632) and 0.567 (95% CI: 0.526-0.608), respectively. PaO2/FiO2 ≤ 300 shows a ROC curve of 0.669 (95% CI: 0.628-0.711) to predict IMV. PaO2/FiO2 ≤ 300 and 4 C mortality score in mortality at 28 days showed an ROC-curve of 0.624 (95% CI: 0.582-0.667) and 0.706 (95% CI: 0.669-0.742), respectively. CONCLUSION PaO2/FiO2 ≤ 300, 4 C mortality score ≥ 8, SOFA score ≥ 4 y SaO2/FiO2 ≤ 300 were weak predictors of the IMV requirement from admission, and 4 C mortality score ≥ 8 was weak predictors of the mortality from admission in patients with pulmonary involvement by COVID-19.
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Affiliation(s)
- Alirio R Bastidas-Goyes
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia.
| | - Eduardo Tuta-Quintero
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria F Aguilar
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Angélica V Mora
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | | | - Jesus M Villamizar
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Susana Galeano
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Paola Mejia
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria Muñoz
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Sara Paredes
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Doris Pumarejo
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
| | - Maria Del Mar Barragan
- School of Medicine, Internal Medicine Department, Universidad de La Sabana, Km 7, Northern highway. Chía, Chía, Cundinamarca 140013, Colombia
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AlShehhi A, Almansoori TM, Alsuwaidi AR, Alblooshi H. Utilizing machine learning for survival analysis to identify risk factors for COVID-19 intensive care unit admission: A retrospective cohort study from the United Arab Emirates. PLoS One 2024; 19:e0291373. [PMID: 38206939 PMCID: PMC10783720 DOI: 10.1371/journal.pone.0291373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The current situation of the unprecedented COVID-19 pandemic leverages Artificial Intelligence (AI) as an innovative tool for addressing the evolving clinical challenges. An example is utilizing Machine Learning (ML) models-a subfield of AI that take advantage of observational data/Electronic Health Records (EHRs) to support clinical decision-making for COVID-19 cases. This study aimed to evaluate the clinical characteristics and risk factors for COVID-19 patients in the United Arab Emirates utilizing EHRs and ML for survival analysis models. METHODS We tested various ML models for survival analysis in this work we trained those models using a different subset of features extracted by several feature selection methods. Finally, the best model was evaluated and interpreted using goodness-of-fit based on calibration curves,Partial Dependence Plots and concordance index. RESULTS The risk of severe disease increases with elevated levels of C-reactive protein, ferritin, lactate dehydrogenase, Modified Early Warning Score, respiratory rate and troponin. The risk also increases with hypokalemia, oxygen desaturation and lower estimated glomerular filtration rate and hypocalcemia and lymphopenia. CONCLUSION Analyzing clinical data using AI models can provide vital information for clinician to measure the risk of morbidity and mortality of COVID-19 patients. Further validation is crucial to implement the model in real clinical settings.
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Affiliation(s)
- Aamna AlShehhi
- Biomedical Engineering Department,College of Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hiba Alblooshi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Sivagurunathan N, Calivarathan L. SARS-CoV-2 Infection to Premature Neuronal Aging and Neurodegenerative Diseases: Is there any Connection with Hypoxia? CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:431-448. [PMID: 37073650 DOI: 10.2174/1871527322666230418114446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 04/20/2023]
Abstract
The pandemic of coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, has become a global concern as it leads to a spectrum of mild to severe symptoms and increases death tolls around the world. Severe COVID-19 results in acute respiratory distress syndrome, hypoxia, and multi- organ dysfunction. However, the long-term effects of post-COVID-19 infection are still unknown. Based on the emerging evidence, there is a high possibility that COVID-19 infection accelerates premature neuronal aging and increases the risk of age-related neurodegenerative diseases in mild to severely infected patients during the post-COVID period. Several studies correlate COVID-19 infection with neuronal effects, though the mechanism through which they contribute to the aggravation of neuroinflammation and neurodegeneration is still under investigation. SARS-CoV-2 predominantly targets pulmonary tissues and interferes with gas exchange, leading to systemic hypoxia. The neurons in the brain require a constant supply of oxygen for their proper functioning, suggesting that they are more vulnerable to any alteration in oxygen saturation level that results in neuronal injury with or without neuroinflammation. We hypothesize that hypoxia is one of the major clinical manifestations of severe SARS-CoV-2 infection; it directly or indirectly contributes to premature neuronal aging, neuroinflammation, and neurodegeneration by altering the expression of various genes responsible for the survival of the cells. This review focuses on the interplay between COVID-19 infection, hypoxia, premature neuronal aging, and neurodegenerative diseases and provides a novel insight into the molecular mechanisms of neurodegeneration.
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Affiliation(s)
- Narmadhaa Sivagurunathan
- Molecular Pharmacology & Toxicology Laboratory, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur - 610005, Tamil Nadu, India
| | - Latchoumycandane Calivarathan
- Molecular Pharmacology & Toxicology Laboratory, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur - 610005, Tamil Nadu, India
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Kalra A, Wilcox C, Holmes SD, Tonna JE, Jeong IS, Rycus P, Anders MM, Zaaqoq AM, Lorusso R, Brodie D, Keller SP, Kim BS, Whitman GJR, Cho SM. Characterizing the Racial Discrepancy in Hypoxemia Detection in VV-ECMO: An ELSO Registry Analysis. RESEARCH SQUARE 2023:rs.3.rs-3617237. [PMID: 38014220 PMCID: PMC10680917 DOI: 10.21203/rs.3.rs-3617237/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Importance Skin pigmentation influences peripheral oxygen saturation (SpO2) measured by pulse oximetry compared to the arterial saturation of oxygen (SaO2) measured via arterial blood gas analysis. However, data on SpO2-SaO2 discrepancy are limited in venovenous-extracorporeal membrane oxygenation (VV-ECMO) patients. Objective To determine whether there is racial/ethnical discrepancy between SpO2 and SaO2 in patients receiving VV-ECMO. We hypothesized VV-ECMO cannulation, in addition to race/ethnicity, accentuates the SpO2-SaO2 discrepancy due to significant hemolysis. Design Retrospective cohort study of the Extracorporeal Life Support Organization Registry from 1/2018-5/2023. Setting International, multicenter registry study including over 500 ECMO centers. Participants Adults (≥ 18 years) supported with VV-ECMO with concurrently measured SpO2 and SaO2 measurements. Exposure Race/ethnicity and ECMO cannulation. Main outcomes and measures Occult hypoxemia (SaO2 ≤ 88% with SpO2 ≥ 92%) was our primary outcome. Multivariable logistic regressions were performed to examine whether race/ethnicity was associated with occult hypoxemia in pre-ECMO and on-ECMO SpO2-SaO2 calculations. Covariates included age, sex, temporary mechanical circulatory support, pre-vasopressors, and pre-inotropes for pre-ECMO analysis, plus single-lumen versus double-lumen cannulation, hemolysis, hyperbilirubinemia, ECMO pump flow rate, and on-ECMO 24h lactate for on-ECMO analysis. Results Of 13,171 VV-ECMO patients (median age = 48.6 years, 66% male), there were 7,772 (59%) White, 2,114 (16%) Hispanic, 1,777 (14%) Black, and 1,508 (11%) Asian patients. The frequency of on-ECMO occult hypoxemia was 2.0% (N = 233). Occult hypoxemia was more common in Black and Hispanic versus White patients (3.1% versus 1.7%, P < 0.001 and 2.5% versus 1.7%, P = 0.025, respectively).In multivariable logistic regression, Black patients were at higher risk of pre-ECMO occult hypoxemia versus White patients (adjusted odds ratio [aOR] = 1.55, 95% confidence interval [CI] = 1.18-2.02, P = 0.001). For on-ECMO occult hypoxemia, Black patients (aOR = 1.79, 95%CI = 1.16-2.75, P = 0.008) and Hispanic patients (aOR = 1.71, 95%CI = 1.15-2.55, P = 0.008) had higher risk versus White patients. Furthermore, higher pump flow rate (aOR = 1.29, 95%CI = 1.08-1.55, P = 0.005) and higher on-ECMO 24h lactate (aOR = 1.06, 95%CI = 1.03-1.10, P < 0.001) significantly increased the risk of on-ECMO occult hypoxemia. Conclusions and Relevance Hispanic and Black VV-ECMO patients experienced occult hypoxemia more than White patients. SaO2 should be carefully monitored during ECMO support for Black and Hispanic patients especially for those with high pump flow and lactate values at risk for occult hypoxemia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Bo Soo Kim
- Johns Hopkins University School of Medicine
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Rhys GH, Wakeling T, Moore JP, Subbe CP. Exercise testing to guide safe discharge from hospital in COVID-19: a scoping review to identify candidate tests. BMJ Open 2023; 13:e068169. [PMID: 37907292 PMCID: PMC10619037 DOI: 10.1136/bmjopen-2022-068169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 08/20/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES We aimed to identify exercise tests that have been validated to support a safe discharge to home in patients with or without COVID-19. STUDY DESIGN Scoping review, using PRISMA-ScR reporting standards. Medline, PubMed, AMED, Embase, CINAHL and LitCovid databases were searched between 16 and 22 February 2021, with studies included from any publication date up to and including the search date. INTERVENTION Short exercise tests. PRIMARY OUTCOME MEASURES Safe discharge from hospital, readmission rate, length of hospital stay, mortality. Secondary outcomes measures: safety, feasibility and reliability. RESULTS Of 1612 original records screened, 19 studies were included in the analysis. These used a variety of exercise tests in patients with chronic obstructive pulmonary disease, suspected pulmonary embolism and pneumocystis carinii pneumonia, heart failure or critical illness. Only six studies had examined patients with COVID-19, of these two were still recruiting to evaluate the 1 min sit-to-stand test and the 40-steps test. There was heterogeneity in patient populations, tests used and outcome measures. Few exercise tests have been validated to support discharge decisions. There is currently no support for short exercise tests for triage of care in patients with COVID-19. CONCLUSIONS Further research is needed to aid clinical decision-making at discharge from hospital.
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Affiliation(s)
- Gwenllian Haf Rhys
- Medicine, Ysbyty Gwynedd, Bangor, UK
- School of Psychology and Sport Science, Bangor University, Bangor, UK
| | | | - Jonathan P Moore
- School of Psychology and Sport Science, Bangor University, Bangor, UK
| | - Christian Peter Subbe
- Acute Medicine, Ysbyty Gwynedd, Bangor, UK
- North Wales Medical School, Bangor University, Bangor, UK
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Oh S, Lee K. The new combination of oxygen saturation with age shock index predicts the outcome of COVID-19 pneumonia. SAGE Open Med 2023; 11:20503121231203683. [PMID: 37846368 PMCID: PMC10576920 DOI: 10.1177/20503121231203683] [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: 05/17/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023] Open
Abstract
Introduction Emergency departments around the world have been struggling to deal with patients with COVID-19 and presumed COVID-19. Triaging patients who need further medical support is the key matter to emergency physicians as the delay of proper treatment may worsen the results. The aim of this study was to validate the ability of age shock index and hypoxia-age-shock index at the time of presentation to the emergency department to predict case fatality in patients with COVID-19 pneumonia. Methods We only included patients who had COVID-19-associated pneumonia who needed in-hospital treatment. The vital signs and oxygen saturation used in the study were collected, especially from the triage sector, before patients were given supplemental oxygen. Results A total of 241 patients enrolled in the study. The case fatality rate was 27%. The median age of the study samples was 78 (66-86) years with 133 male and 108 female patients. Hypoxia-age-shock index showed the best performance in analysis (odds ratio 15.1, 95% confidence interval: 5.1-44.4; adjusted odds ratio 8.6, 95% confidence interval: 2.8-26.8). Conclusion The hypoxia-age-shock index was a strong predictor for in-hospital mortality of COVID-19 pneumonia. Furthermore, when it was compared with age shock index, hypoxia-age-shock index showed better performance in predicting fatality of the disease.
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Affiliation(s)
- Sangyeop Oh
- Department of Emergency Medicine, Myongi Hospital, Gyeonggi, South Korea
| | - Kyoungmi Lee
- Department of Emergency Medicine, Myongi Hospital, Gyeonggi, South Korea
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Paciorek M, Bieńkowski C, Kowalska JD, Skrzat-Klapaczyńska A, Bednarska A, Krogulec D, Cholewińska G, Kowalski J, Podlasin R, Ropelewska-Łącka K, Wasilewski P, Boros PW, Martusiewicz-Boros MM, Pulik P, Pihowicz A, Horban A. Hospital Admission Factors Independently Affecting the Risk of Mortality of COVID-19 Patients. J Clin Med 2023; 12:6264. [PMID: 37834907 PMCID: PMC10573469 DOI: 10.3390/jcm12196264] [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: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION COVID-19 is a disease characterized by high in-hospital mortality, which seems to be dependent on many predisposing factors. OBJECTIVES The aim of this study was to analyze the clinical symptoms, abnormalities in the results of laboratory tests, and coexisting chronic diseases that independently affected the risk of in-hospital mortality in patients with COVID-19. PATIENTS AND METHODS We analyzed the records of patients with COVID-19 who were hospitalized from 6 March 2020 to 30 November 2021. RESULTS Out of the entire group of 2138 patients who were analyzed, 12.82% died during hospitalization. In-hospital mortality was independently associated with older age (OR 1.53, 95% CI 1.20-1.97); lower arterial blood oxygen saturation (OR 0.95, 95% CI 0.92-0.99); the presence of a neoplasm (OR 4.45, 95% CI 2.01-9.62), a stomach ulcer (OR 3.35, 95% CI 0.94-11.31), and dementia (OR 3.40, 95% CI 1.36-8.26); a higher score on the SOFA scale (OR 1.73, 95% CI 1.52-1.99); higher lactate dehydrogenase (LDH) (OR 1.08, 95% CI 1.05-1.12); higher N-terminal pro-brain natriuretic peptide (NT pro BNP) (OR 1.06, 95% CI 1.01-1.11); and lower total bilirubin in blood concentration (OR 0.94, 95% CI 0.90-0.99). CONCLUSIONS We found that low oxygen saturation, old age, and the coexistence of cancer, gastric ulcers, and dementia syndrome were variables that independently increased mortality during hospitalization due to COVID-19. Moreover, we found that decreased platelet count and bilirubin concentration and increased levels of LDH and NT-proBNP were laboratory test results that independently indicated a higher risk of mortality. We also confirmed the usefulness of the SOFA scale in predicting treatment results. The ability to identify mortality risk factors on admission to hospital will facilitate both adjusting the intensity of treatment and the monitoring of patients infected with SARS-CoV-2.
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Affiliation(s)
- Marcin Paciorek
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Carlo Bieńkowski
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Justyna Dominika Kowalska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Agnieszka Bednarska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Dominika Krogulec
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Grażyna Cholewińska
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Jacek Kowalski
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Regina Podlasin
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Katarzyna Ropelewska-Łącka
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Piotr Wasilewski
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
- Department of Infectious Diseases, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-815 Warsaw, Poland
| | - Piotr W. Boros
- Lung Pathophysiology Department, National TB & Lung Diseases Research Institute, 01-138 Warsaw, Poland;
| | | | - Piotr Pulik
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Andrzej Pihowicz
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
| | - Andrzej Horban
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-001 Warsaw, Poland; (M.P.); (J.D.K.); (A.S.-K.); (A.B.); (D.K.); (A.H.)
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland; (G.C.); (J.K.); (R.P.); (K.R.-Ł.); (P.W.); (P.P.); (A.P.)
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Navuluri N, Lagat DK, Birgen E, Kitur S, Kussin PS, Murdoch DM, Thielman NM, Parish A, Green CL, MacIntyre N, Egger JR, Wools-Kaloustian K, Que LG. Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study. BMJ Open 2023; 13:e072111. [PMID: 37723111 PMCID: PMC10510888 DOI: 10.1136/bmjopen-2023-072111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya, with a focus on chronic hypoxaemia. DESIGN Single-centre, prospective cohort study. SETTING National tertiary referral hospital in Eldoret, Kenya between September 2019 and April 2022. PARTICIPANTS Adults (age ≥18 years) admitted to general medicine wards. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was proportion of patients who were hypoxaemic (oxygen saturation, SpO2 ≤88%) on admission. Secondary outcomes were proportion of patients with hypoxaemia on admission who had hypoxaemia resolution, hospital discharge, transfer, or death among those with unresolved hypoxaemia or chronic hypoxaemia. Patients remaining hypoxaemic for ≤3 days after admission were enrolled into an additional cohort to determine chronic hypoxaemia. Chronic hypoxaemia was defined as an SpO2 ≤ 88% at either 1-month post-discharge follow-up or, for patients who died prior to follow-up, a documented SpO2 ≤88% during a previous hospital discharge or outpatient visit within the last 6 months. RESULTS We screened 4104 patients (48.5% female, mean age 49.4±19.4 years), of whom 23.8% were hypoxaemic on admission. Hypoxaemic patients were significantly older and more predominantly female than normoxaemic patients. Among those hypoxaemic on admission, 33.9% had resolution of their hypoxaemia as inpatients, 55.6% had unresolved hypoxaemia (31.0% died before hospital discharge, 13.3% were alive on discharge and 11.4% were transferred) and 10.4% were lost to follow-up. The prevalence of chronic hypoxaemia was 2.1% in the total screened population, representing 8.8% of patients who were hypoxaemic on admission. Chronic hypoxaemia was determined at 1-month post-discharge among 59/86 patients and based on prior documentation among 27/86 patients. CONCLUSION Hypoxaemia is highly prevalent among adults admitted to a general medicine ward at a national referral hospital in Kenya. Nearly 1 in 11 patients who are hypoxaemic on admission are chronically hypoxaemic.
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Affiliation(s)
- Neelima Navuluri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - David K Lagat
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Elcy Birgen
- Duke Global Health Institute, Durham, North Carolina, USA
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sylvia Kitur
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peter S Kussin
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David M Murdoch
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan M Thielman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neil MacIntyre
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph R Egger
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Loretta G Que
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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21
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Hori M, Yasuda K, Takahashi H, Aoi T, Mori Y, Tsujita M, Shirasawa Y, Kondo C, Hashimoto T, Koyama H, Morozumi K, Maruyama S. The Impact of Liver Chemistries on Respiratory Failure among Hemodialysis Patients with COVID-19 during the Omicron Wave. Intern Med 2023; 62:2617-2625. [PMID: 37407459 PMCID: PMC10569926 DOI: 10.2169/internalmedicine.2115-23] [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: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Although the coronavirus disease 2019 (COVID-19) Omicron variant causes less severe symptoms than previous variants, early indicators for respiratory failure are needed in hemodialysis patients, who have a higher mortality rate than the general population. Liver chemistries are known to reflect the severity of COVID-19 in the general population. This study explored the early indicators for worsened respiratory failure based on patient characteristics, including liver chemistries. Methods This retrospective study included 117 patients admitted for COVID-19 during the Omicron wave. Respiratory failure was defined as oxygen requirement during treatment. Information on the symptoms and clinical characteristics, including liver chemistries [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], at admission was collected. Results Thirty-five patients (29.9%) required oxygen supply during treatment. In the multivariate logistic regression analyses, AST [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.00-1.13, p=0.029], ALT (OR 1.09, 95% CI 1.02-1.18, p=0.009), and moderate COVID-19 illness (Model including AST, OR 6.95, 95% CI 2.23-23.17, p<0.001; Model including ALT, OR 7.19, 95% CI 2.21-25.22, p=0.001) were independent predictors for respiratory failure. Based on the cutoff values determined by the receiver operating characteristic curve, higher AST (≥23 IU/L) and ALT levels (≥14 IU/L) were also independently associated with respiratory failure (higher AST: 64.3% vs. 18.8%, OR 3.44, 95% CI 1.08-11.10, p=0.035; higher ALT: 48.8% vs. 19.7%, OR 4.23, 95% CI 1.34-14.52, p=0.013, respectively). Conclusion The measurement of AST and ALT levels at baseline may help predict oxygen requirement in hemodialysis patients with COVID-19.
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Affiliation(s)
- Mayuko Hori
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Kaoru Yasuda
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Hiroshi Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Japan
| | - Tomonori Aoi
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Yoshiko Mori
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Makoto Tsujita
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | | | - Chika Kondo
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Takashi Hashimoto
- Department of General Internal Medicine, Masuko Memorial Hospital, Japan
| | - Hiroichi Koyama
- Department of General Internal Medicine, Masuko Memorial Hospital, Japan
| | - Kunio Morozumi
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
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Genena SESR, Fadhil MM, Mansour MM, Attwa AHM, Khalil MMIM. Expression pattern of long non-coding RNAs MALAT1 and MEG3 in COVID-19 patients. J Gene Med 2023; 25:e3532. [PMID: 37209019 DOI: 10.1002/jgm.3532] [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: 09/01/2022] [Revised: 03/24/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND COVID-19 is a novel infectious disease for which no specific treatment exists. It is likely that a combination of genetic and non-genetic factors predispose to it. Expression levels of genes that are involved in the interaction with SARS-CoV-2 or the host response are thought to play a role in disease susceptibility and severity. It is crucial to explore biomarkers for disease severity and outcome. Herein, we studied the expression levels and effects of long non-coding metastasis-associated lung adenocarcinoma transcript 1 (lnc-MALAT1) and long non-coding maternally expressed gene 3 (lnc-MEG3) in COVID-19 patients. The study enrolled 35 hospitalized and 35 non-hospitalized COVID-19 patients, and 35 healthy controls. A chest computed tomography (CT) scan, complete blood count (CBC), ferritin, C-reactive protein (CRP), D-dimer and analysis of lnc-MALAT1 and lnc-MEG3 expression were done. RESULTS There was a significant relation between ferritin, CRP, D-dimer levels, oxygen saturation, CT-CORADS score and disease severity. Lnc-MALAT1 was significantly higher but lnc-MEG3 was significantly lower in patients vs. controls, and in hospitalized vs. non-hospitalized patients. Elevated MALAT1 and reduced MEG3 levels were significantly associated with more elevated ferritin, CRP, D-dimer levels, lower oxygen saturation, higher CT-CORADS score and poor survival. Moreover, MALAT1 and MEG3 levels displayed higher sensitivity and specificity as predictors of COVID-19 severity compared with other prognostic biochemical markers such as ferritin, CRP, and D-dimer. CONCLUSIONS MALAT1 levels are higher, whereas MEG3 levels are lower in COVID-19 patients. Both are linked to disease severity and mortality and could emerge as predictive biomarkers for COVID-19 severity and therapeutic targets.
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Affiliation(s)
- Shaimaa El Sayed Ramadan Genena
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
| | - Maher Mishaal Fadhil
- Department of Zoology Physiology, Faculty of Science, Menoufia University, Menoufia Governorate, Egypt
| | - Manal Monir Mansour
- Department of Clinical Pathology, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
| | - Asrar Helal Mahrous Attwa
- Department of Chest disease and Tuberculosis, Faculty of Medicine, Menoufia University, Menoufia Governorate, Egypt
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Klein A, Bastard M, Hemat H, Singh S, Muniz B, Manangama G, Alayyan A, Tamanna AH, Barakzaie B, Popal N, Kakar MAZ, Poulet E, Finger F. Factors associated with adverse outcomes among patients hospitalized at a COVID-19 treatment center in Herat, Afghanistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001687. [PMID: 37619213 PMCID: PMC10449473 DOI: 10.1371/journal.pgph.0001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/30/2023] [Indexed: 08/26/2023]
Abstract
Though many studies on COVID have been published to date, data on COVID-19 epidemiology, symptoms, risk factors and severity in low- and middle-income countries (LMICS), such as Afghanistan are sparse. To describe clinical characteristics, severity, and outcomes of patients hospitalized in the MSF COVID-19 treatment center (CTC) in Herat, Afghanistan and to assess risk factors associated with severe outcomes. 1113 patients were included in this observational study between June 2020 and April 2022. Descriptive analysis was performed on clinical characteristics, complications, and outcomes of patients. Univariate description by Cox regression to identify risk factors for an adverse outcome was performed. Adverse outcome was defined as death or transfer to a level 3 intensive care located at another health facility. Finally, factors identified were included in a multivariate Cox survival analysis. A total of 165 patients (14.8%) suffered from a severe disease course, with a median time of 6 days (interquartile range: 2-11 days) from admission to adverse outcome. In our multivariate model, we identified male gender, age over 50, high O2 flow administered during admission, lymphopenia, anemia and O2 saturation < = 93% during the first three days of admission as predictors for a severe disease course (p<0.05). Our analysis concluded in a relatively low rate of adverse outcomes of 14.8%. This is possibly related to the fact that the resources at an MSF-led facility are higher, in terms of human resources as well as supply of drugs and biomedical equipment, including oxygen therapy devices, compared to local hospitals. Predictors for severe disease outcomes were found to be comparable to other settings.
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Aritonovic Pribakovic J, Peric M, Milenkovic A, Janicevic A, Hadzistevic S, Ilic A, Stojanovic-Tasic M, Bulatovic K, Rasic D, Mitic J. Importance of Demographic and Clinical Features in Evaluating the Severity of COVID-19 in Hospitalized Patients: A Serbian Retrospective Study in the First Pandemic Year. J Clin Med 2023; 12:4638. [PMID: 37510752 PMCID: PMC10380436 DOI: 10.3390/jcm12144638] [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: 05/10/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study is to determine the demographic and initial clinical characteristics of patients with COVID-19 and their importance in evaluating the severity of the disease. A retrospective study included patients suffering from COVID-19 who were hospitalized at The Department of Infectious Disease of the Clinical Hospital Center Pristina-Gracanica from the beginning of the pandemic until the end of 2020. We compared the symptoms of the disease, radiographic findings of pneumonia, laboratory parameters, duration of symptoms before admission, the difference in the need for certain therapies, and the presence of comorbidities between non-severe and severe groups of patients. Patients with a severe disease were statistically significantly older. Hypertension was significantly associated with severe clinical conditions. Radiographic findings of bilateral pneumonia on admission were much more frequent among the severe group, and these patients' need for oxygen support was significantly higher. Lower neutrophil and higher lymphocyte counts were statistically significant in the non-severe group. Biochemical parameters at admission also showed statistical significance between the examined groups. Based on our research, we can conclude that a complete overview of the patient, including demographic and laboratory parameters as perhaps the most significant attributes, can help doctors in the timely clinical assessment of patients and, thus, in the timely application of adequate therapeutic protocols in the treatment of COVID-19.
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Affiliation(s)
- Jelena Aritonovic Pribakovic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
- Clinical Hospital Center Pristina, 38205 Gracanica, Serbia
| | - Milica Peric
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Aleksandra Milenkovic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
- Clinical Hospital Center Pristina, 38205 Gracanica, Serbia
| | | | - Snezana Hadzistevic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Aleksandra Ilic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Mirjana Stojanovic-Tasic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Kristina Bulatovic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
- Clinical Hospital Center Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
| | - Dragisa Rasic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
- Clinical Hospital Center Pristina, 38205 Gracanica, Serbia
| | - Jadranka Mitic
- Faculty of Medicine in Pristina, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia
- Clinical Hospital Center Pristina, 38205 Gracanica, Serbia
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Shahdad A, Fadaee Aghdam N, Goli S, Binesh E, Nourian J, Khajeh M. Effect of transcutaneous electrical nerve stimulation of acupoints on respiratory outcomes of COVID-19 patients with moderate pulmonary involvement: A parallel randomized clinical trial. Health Sci Rep 2023; 6:e1427. [PMID: 37492271 PMCID: PMC10363792 DOI: 10.1002/hsr2.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
Background and aims Experiencing respiratory symptoms, especially dyspnea and decreased oxygen saturation (SpO2) level in patients with coronavirus disease 2019 (COVID-19) is associated with increased mortality. The present study was conducted to investigate the effect of transcutaneous electrical nerve stimulation of acupoints (Acu-TENS) on the respiratory outcomes of COVID-19 patients with moderate pulmonary involvement. Methods In these three-blind parallel randomized clinical trials, 84 patients with COVID-19 admitted to a referral hospital were selected by the convenience sampling method. Participants were randomly assigned to Acu-TENS (n = 42) and control (n = 42) groups. The Acu-TENS group received Acu-TENS over the EX-B1 (Dingchuan) acupuncture point for 45 min for four consecutive days, while participants in the control group received no intervention. Participants' respiratory outcomes, including oxygen saturation, vital signs, and the severity of dyspnea, were evaluated before and after each intervention on four consecutive days. In addition, the need for mechanical ventilation on Days 4, 8, and 12 and the disease's outcome (death or survival) were recorded in SPSS software version 16, and finally, data were analyzed using an independent samples t-test. Results SpO2, the number of patients without the need for mechanical ventilation, and patient survival after the intervention were significantly higher in the Acu-TENS group compared with the control group (<0.001). However, respiratory rate, heart rate, and the severity of dyspnea after the intervention were not significantly different between the two groups (p > 0.05). Conclusion The use of Acu-TENS could improve SpO2 as a respiratory outcome of patients with COVID-19 with moderate pulmonary involvement and it can be used as a therapeutic intervention.
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Affiliation(s)
- Amin Shahdad
- Student Research Committee, Nursing and Midwifery SchoolShahroud University of Medical SciencesShahroudIran
| | - Nasrin Fadaee Aghdam
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Shahrbanoo Goli
- Department of Epidemiology, School of Public HealthShahroud University of Medical SciencesShahroudIran
| | - Ehsan Binesh
- Clinical Research Development Unit, Imam Hossein HospitalShahroud University of Medical SciencesShahroudIran
| | - Javad Nourian
- Clinical Research Development Unit, Imam Hossein HospitalShahroud University of Medical SciencesShahroudIran
| | - Mahboobeh Khajeh
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
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Bojti I, Przewosnik AS, Luxenburger H, Hofmann M, Neumann-Haefelin C, Esser JS, Siegel PM, Maier A, Kovacs SB, Kardos L, Csanádi Z, Rieder M, Duerschmied D, Lother A, Bode C, Szabó GT, Czuriga D. Decreased level of serum NT-proCNP associates with disease severity in COVID-19. Respir Res 2023; 24:174. [PMID: 37386635 PMCID: PMC10311835 DOI: 10.1186/s12931-023-02469-4] [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: 07/18/2022] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND C-type natriuretic peptide (CNP) is an endothelium-derived paracrine molecule with an important role in vascular homeostasis. In septic patients, the serum level of the amino-terminal propeptide of CNP (NT-proCNP) shows a strong positive correlation with inflammatory biomarkers and, if elevated, correlates with disease severity and indicates a poor outcome. It is not yet known whether NT-proCNP also correlates with the clinical outcome of patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the current study, we aimed to determine possible changes in the NT-proCNP levels of patients with coronavirus disease 2019 (COVID-19), with special regard to disease severity and outcome. METHODS In this retrospective analysis, we determined the serum level of NT-proCNP in hospitalized patients with symptoms of upper respiratory tract infection, using their blood samples taken on admission, stored in a biobank. The NT-proCNP levels of 32 SARS-CoV-2 positive and 35 SARS-CoV-2 negative patients were measured to investigate possible correlation with disease outcome. SARS-CoV-2 positive patients were then divided into two groups based on their need for intensive care unit treatment (severe and mild COVID-19). RESULTS The NT-proCNP was significantly different in the study groups (e.g. severe and mild COVID-19 and non-COVID-19 patients), but showed inverse changes compared to previous observations in septic patients: lowest levels were detected in critically ill COVID-19 patients, while highest levels in the non-COVID-19 group. A low level of NT-proCNP on admission was significantly associated with severe disease outcome. CONCLUSIONS Low-level NT-proCNP on hospital admission is associated with a severe COVID-19 disease course. The pathomechanism underlying this observation remains to be elucidated, while future studies in larger patient cohorts are necessary to confirm these observations and reveal therapeutic importance. Trial registration DRKS00026655 Registered 26. November 2021.
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Affiliation(s)
- Istvan Bojti
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Anne-Sophie Przewosnik
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hendrik Luxenburger
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maike Hofmann
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II (Gastroenterology, Hepatology, Endocrinology and Infectious Diseases), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jennifer S Esser
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Patrick M Siegel
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Maier
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarolta Bojtine Kovacs
- IMM-PACT, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Section of Molecular Hematology, Department of Medicine I, Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Laszlo Kardos
- Clinical Department of Infectious Diseases, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanádi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marina Rieder
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Achim Lother
- Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Interdisciplinary Medical Intensive Care, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology, University Heart Center, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabor Tamas Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Beck NS, Song S, Park T, Hong SH, Jeong-Eun J, Kim KH, Im JI, Hong SY. Clinical features of COVID-19 among patients with end-stage renal disease on hemodialysis in the context of high vaccination coverage during the omicron surge period: a retrospective cohort study. BMC Nephrol 2023; 24:191. [PMID: 37370006 DOI: 10.1186/s12882-023-03219-w] [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: 02/05/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND We determined the clinical presentation and outcomes of the Omicron variant of severe acute respiratory syndrome coronavirus 2 infection in hemodialysis patients and identified the risk factors for severe coronavirus disease (COVID-19) and mortality in the context of high vaccination coverage. METHODS This was a retrospective cohort study involving hemodialysis patients who were vaccinated against COVID-19 during March-September 2022, when the Omicron variant was predominant, and the COVID-19 vaccination rate was high. The proportion of people with severe COVID-19 or mortality was evaluated using univariate logistic regression. RESULTS Eighty-three (78.3%) patients had asymptomatic/mild symptoms, 10 (9.4%) had moderate symptoms, and 13 (12.3%) had severe symptoms. Six (5.7%) patients required intensive care admission, two (1.9%) required mechanical ventilation, and one (0.9%) was kept on high-flow nasal cannula. Of the five (4.7%) mortality cases, one was directly attributed to COVID-19 and four to pre-existing comorbidities. Risk factors for both severe COVID-19 and mortality were advanced age; number of comorbidities; cardiovascular diseases; increased levels of aspartate transaminase, lactate dehydrogenase, blood urea nitrogen/creatinine ratio, brain natriuretic peptide, and red cell distribution; and decreased levels of hematocrit and albumin. Moreover, the number of COVID-19 vaccinations wasa protective factor against both severe disease and mortality. CONCLUSIONS Clinical features of hemodialysis patients during the Omicron surge with high COVID-19 vaccination coverage were significant for low mortality. The risk features for severe COVID-19 or mortality were similar to those in the pre-Omicron period in the context of low vaccination coverage.
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Affiliation(s)
- Nam-Seon Beck
- Department of Pediatrics, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Soomin Song
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - Taesung Park
- Department of Statistics, Seoul National University, Seoul, South Korea
| | - So-Hyeon Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ewha Woman's University, School of Medicine, Seoul, South Korea
| | - Jang Jeong-Eun
- Department of Nursing, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Kyoung-Hwan Kim
- Department of Family Medicine, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Joung-Il Im
- Department of Orthopedic Surgery, Chung-Ang Jeil Hospital, Chungbuk, South Korea
| | - Sae-Yong Hong
- Department of Nephrology, Chung-angJeil General Hospital, 24 Jungang-Bukro, Jincheon County, Chungbuk, 27832, South Korea.
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28
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Stămăteanu LO, Miftode IL, Pleșca CE, Dorneanu OS, Roșu MF, Miftode ID, Obreja M, Miftode EG. Symptoms, Treatment, and Outcomes of COVID-19 Patients Coinfected with Clostridioides difficile: Single-Center Study from NE Romania during the COVID-19 Pandemic. Antibiotics (Basel) 2023; 12:1091. [PMID: 37508187 PMCID: PMC10375993 DOI: 10.3390/antibiotics12071091] [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: 05/23/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 07/30/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has brought new challenges across medical disciplines, particularly in infectious disease medicine. In Romania, the incidence of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) infection increased dramatically since March 2020 until March 2022. Antibiotic administration for pulmonary superinfections in COVID-19 intensified and, consequently, increased rates of Clostridioides difficile infection (CDI) were hypothesized. We conducted a single-center, retrospective, observational study on patients from North-Eastern Romania to assess clinical characteristics and outcomes of COVID-19 and Clostridioides difficile (CD) coinfection, and to identify risk factors for CDI in COVID-19 patients. The study enrolled eighty-six CDI and COVID-19 coinfected patients admitted during March 2020-February 2021 (mean age 59.14 years, 53.49% men, 67.44% urban residents) and a group of eighty-six COVID-19 patients. On admission, symptoms were more severe in mono-infected patients, while coinfected patients associated a more intense acute inflammatory syndrome. The main risk factors for severe COVID-19 were smoking, diabetes mellitus, and antibiotic administration. Third generation cephalosporins (55%) and carbapenems (24%) were the main antibiotics used, and carbapenems were significantly associated with severe COVID-19 in patients coinfected with CD during hospitalization. Coinfection resulted in longer hospitalization and poorer outcomes. The extensive use of antibiotics in COVID-19, particularly carbapenems, contributed substantially to CD coinfection.
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Affiliation(s)
- Lidia Oana Stămăteanu
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
| | - Ionela Larisa Miftode
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
| | - Claudia Elena Pleșca
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
| | - Olivia Simona Dorneanu
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
| | - Manuel Florin Roșu
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
- Department of Intensive Care Unit, Infectious Diseases Clinical Hospital, 700115 Iași, Romania
| | - Ioana Diandra Miftode
- Department of Radiology, "St. Spiridon" Emergency Clinical Hospital, 700111 Iași, Romania
| | - Maria Obreja
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
| | - Egidia Gabriela Miftode
- Department of Internal Medicine II, Faculty of Medicine, University of Medicine and Pharmacy Gr. T. Popa, 700115 Iași, Romania
- "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
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29
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Molano-Franco D, Viruez-Soto A, Gomez M, Beltran E, Villabon M, Sosa A, Ortiz L, Orozco E, Hurtado A, Sanchez L, Arias-Reyes C, Soliz J, Masclans JR. Impact of High-Flow Nasal Cannula Use in Subjects With COVID-19 ARDS at High Altitudes: Clinical Presentation and Prognostic Factors. Respir Care 2023; 69:respcare.10839. [PMID: 37311630 PMCID: PMC10753611 DOI: 10.4187/respcare.10839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) reduces the need for intubation in adult subject with acute respiratory failure. Changes in hypobaric hypoxemia have not been studied for subject with an HFNC in ICUs at altitudes > 2,600 m above sea level. In this study, we investigated the efficacy of HFNC treatment in subjects with COVID-19 at high altitudes. We hypothesized that progressive hypoxemia and the increase in breathing frequency associated with COVID-19 in high altitudes affect the success of HFNC therapy and may also influence the performance of the traditionally used predictors of success and failure. METHODS This was a prospective cohort study of subjects >18 y with a confirmed diagnosis of COVID-19-induced ARDS requiring HFNC who were admitted to the ICU. Subjects were followed up during the 28 d of HFNC treatment or until failure. RESULTS One hundred and eight subjects were enrolled. At admission to the ICU, FIO2 delivery between 0.5-0.8 (odds ratio 0.38 [95% CI 0.17-0.84]) was associated with a better response to HFNC therapy than oxygen delivery on admission between 0.8-1.0 (odds ratio 3.58 [95% CI 1.56-8.22]). This relationship continued during follow-ups at 2, 6, 12, and 24 h, with a progressive increase in the risk of failure (odds ratio 24 h 13.99 [95% CI 4.32-45.26]). A new cutoff for the ratio of oxygen saturation (ROX) index (ROX ≥ 4.88) after 24 h of HFNC administration was demonstrated to be the best predictor of success (odds ratio 11.0 [95% CI 3.3-47.0]). CONCLUSIONS High-altitude subjects treated with HFNC for COVID-19 showed a high risk of respiratory failure and progressive hypoxemia when FIO2 requirements were > 0.8 after 24 h of treatment. In these subjects, personalized management should include continuous monitoring of individual clinical conditions (such as oxygenation indices, with cutoffs adapted to those corresponding to high-altitude cities).
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Affiliation(s)
- Daniel Molano-Franco
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia.
| | - Antonio Viruez-Soto
- Intensive Care Unit, Hospital del Norte and Hospital Agramont of El Alto City, Research Center GIMIA, La Paz, Bolivia
| | - Mario Gomez
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Edgar Beltran
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Mario Villabon
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Angela Sosa
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Leidy Ortiz
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Estefania Orozco
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Alejandra Hurtado
- Intensive Care Unit Hospital de San José, Foundation University of Health Sciences, CIMCA Research Centre, Bogotá, Colombia
| | - Lida Sanchez
- Université Laval, Faculté de Médecine, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada
| | - Christian Arias-Reyes
- Université Laval, Faculté de Médecine, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; and Brain Research Center, High-Altitude Research Foundation, La Paz, Bolivia
| | - Jorge Soliz
- Université Laval, Faculté de Médecine, Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; and Brain Research Center, High-Altitude Research Foundation, La Paz, Bolivia
| | - Joan R Masclans
- Critical Care Department, Hospital del Mar de Barcelona, Spain; and Grupo de Investigación en Patología Crítica, IMIM, Departamento de Medicina y Ciéncias de la Vida (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
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30
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Swenson KE, Hardin CC. Pathophysiology of Hypoxemia in COVID-19 Lung Disease. Clin Chest Med 2023; 44:239-248. [PMID: 37085217 PMCID: PMC9682047 DOI: 10.1016/j.ccm.2022.11.007] [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] [Indexed: 11/24/2022]
Abstract
As the pandemic has progressed, our understanding of hypoxemia in coronavirus disease 2019 (COVID-19) lung disease has become more nuanced, although much remains to be understood. In this article, we review ventilation-perfusion mismatching in COVID-19 and the evidence to support various biologic theories offered in explanation. In addition, the relationship between hypoxemia and other features of severe COVID-19 lung disease such as respiratory symptoms, radiographic abnormalities, and pulmonary mechanics is explored. Recognizing and understanding hypoxemia in COVID-19 lung disease remains essential for risk stratification, prognostication, and choice of appropriate treatments in severe COVID-19.
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Affiliation(s)
- Kai E Swenson
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA.
| | - Charles C Hardin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Bulfinch 148, 55 Fruit Street, Boston, MA 02114, USA
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31
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Baik SM, Hong KS, Park DJ. Deep learning approach for early prediction of COVID-19 mortality using chest X-ray and electronic health records. BMC Bioinformatics 2023; 24:190. [PMID: 37161395 PMCID: PMC10169101 DOI: 10.1186/s12859-023-05321-0] [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: 03/06/2023] [Accepted: 05/05/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND An artificial-intelligence (AI) model for predicting the prognosis or mortality of coronavirus disease 2019 (COVID-19) patients will allow efficient allocation of limited medical resources. We developed an early mortality prediction ensemble model for COVID-19 using AI models with initial chest X-ray and electronic health record (EHR) data. RESULTS We used convolutional neural network (CNN) models (Inception-ResNet-V2 and EfficientNet) for chest X-ray analysis and multilayer perceptron (MLP), Extreme Gradient Boosting (XGBoost), and random forest (RF) models for EHR data analysis. The Gradient-weighted Class Activation Mapping and Shapley Additive Explanations (SHAP) methods were used to determine the effects of these features on COVID-19. We developed an ensemble model (Area under the receiver operating characteristic curve of 0.8698) using a soft voting method with weight differences for CNN, XGBoost, MLP, and RF models. To resolve the data imbalance, we conducted F1-score optimization by adjusting the cutoff values to optimize the model performance (F1 score of 0.77). CONCLUSIONS Our study is meaningful in that we developed an early mortality prediction model using only the initial chest X-ray and EHR data of COVID-19 patients. Early prediction of the clinical courses of patients is helpful for not only treatment but also bed management. Our results confirmed the performance improvement of the ensemble model achieved by combining AI models. Through the SHAP method, laboratory tests that indicate the factors affecting COVID-19 mortality were discovered, highlighting the importance of these tests in managing COVID-19 patients.
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Affiliation(s)
- Seung Min Baik
- Division of Critical Care Medicine, Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyung Sook Hong
- Division of Critical Care Medicine, Department of Surgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dong Jin Park
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Korea.
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Lu LW, Quek SY, Lu SP, Chen JH. Potential Benefits of Omega-3 Polyunsaturated Fatty Acids (N3PUFAs) on Cardiovascular Health Associated with COVID-19: An Update for 2023. Metabolites 2023; 13:metabo13050630. [PMID: 37233671 DOI: 10.3390/metabo13050630] [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: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
The accumulating literature demonstrates that omega-3 polyunsaturated fatty acid (n-3 polyunsaturated fatty acid, N3PUFA) can be incorporated into the phospholipid bilayer of cell membranes in the human body to positively affect the cardiovascular system, including improving epithelial function, decreasing coagulopathy, and attenuating uncontrolled inflammatory responses and oxidative stress. Moreover, it has been proven that the N3PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are precursors of some potent endogenous bioactive lipid mediators that mediate some favorable effects attributed to their parent substances. A dose-response relationship between increased EPA and DHA intake and reduced thrombotic outcomes has been reported. The excellent safety profile of dietary N3PUFAs makes them a prospective adjuvant treatment for people exposed to a higher risk of cardiovascular problems associated with COVID-19. This review presented the potential mechanisms that might contribute to the beneficial effects of N3PUFA and the optimal form and dose applied.
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Affiliation(s)
- Louise Weiwei Lu
- School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand
| | - Siew-Young Quek
- Food Science, School of Chemical Sciences, The University of Auckland, Auckland 1010, New Zealand
- Riddet Institute, New Zealand Centre of Research Excellence for Food Research, Palmerston North 4474, New Zealand
| | - Shi-Ping Lu
- Pharma New Zealand PNZ Limited, Hamilton 3210, New Zealand
| | - Jie-Hua Chen
- Institute for Innovative Development of Food Industry, Shenzhen University, Shenzhen 518060, China
- Shenzhen Key Laboratory of Marine Microbiome Engineering, Institute for Advanced Study, Shenzhen University, Shenzhen 518060, China
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Mwine P, Atuhaire I, Ahirirwe SR, Nansikombi HT, Senyange S, Elayeete S, Masanja V, Asio A, Komakech A, Nampeera R, Nsubuga EJ, Nakamya P, Kwiringira A, Migamba SM, Kwesiga B, Kadobera D, Bulage L, Okello PE, Nabatanzi S, Monje F, Kyamwine IB, Ario AR, Harris JR. Readiness of health facilities to manage individuals infected with COVID-19, Uganda, June 2021. BMC Health Serv Res 2023; 23:441. [PMID: 37143093 PMCID: PMC10159667 DOI: 10.1186/s12913-023-09380-0] [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: 04/09/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic overwhelmed the capacity of health facilities globally, emphasizing the need for readiness to respond to rapid increases in cases. The first wave of COVID-19 in Uganda peaked in late 2020 and demonstrated challenges with facility readiness to manage cases. The second wave began in May 2021. In June 2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19. METHODS Referral hospitals managed severe COVID-19 patients, while lower-level health facilities screened, isolated, and managed mild cases. We assessed 17 of 20 referral hospitals in Uganda and 71 of 3,107 lower-level health facilities, selected using multistage sampling. We interviewed health facility heads in person about case management, coordination and communication and reporting, and preparation for the surge of COVID-19 during first and the start of the second waves of COVID-19, inspected COVID-19 treatment units (CTUs) and other service delivery points. We used an observational checklist to evaluate capacity in infection prevention, medicines, personal protective equipment (PPE), and CTU surge capacity. We used the "ReadyScore" criteria to classify readiness levels as > 80% ('ready'), 40-80% ('work to do'), and < 40% ('not ready') and tailored the assessments to the health facility level. Scores for the lower-level health facilities were weighted to approximate representativeness for their health facility type in Uganda. RESULTS The median (interquartile range (IQR)) readiness scores were: 39% (IQR: 30, 51%) for all health facilities, 63% (IQR: 56, 75%) for referral hospitals, and 32% (IQR: 24, 37%) for lower-level facilities. Of 17 referral facilities, two (12%) were 'ready' and 15 (88%) were in the "work to do" category. Fourteen (82%) had an inadequate supply of medicines, 12 (71%) lacked adequate supply of oxygen, and 11 (65%) lacked space to expand their CTU. Fifty-five (77%) lower-level health facilities were "not ready," and 16 (23%) were in the "work to do" category. Seventy (99%) lower-level health facilities lacked medicines, 65 (92%) lacked PPE, and 53 (73%) lacked an emergency plan for COVID-19. CONCLUSION Few health facilities were ready to manage the second wave of COVID-19 in Uganda during June 2021. Significant gaps existed for essential medicines, PPE, oxygen, and space to expand CTUs. The Uganda Ministry of Health utilized our findings to set up additional COVID-19 wards in hospitals and deliver medicines and PPE to referral hospitals. Adequate readiness for future waves of COVID-19 requires additional support and action in Uganda.
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Affiliation(s)
- Patience Mwine
- Uganda Public Health Fellowship Program, Kampala, Uganda.
| | | | | | | | | | - Sarah Elayeete
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Alice Asio
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Allan Komakech
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | - Rose Nampeera
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | | | | | | | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lillian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Paul E Okello
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Sandra Nabatanzi
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | - Fred Monje
- Uganda Public Health Fellowship Program, Kampala, Uganda
| | | | - Alex R Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Julie R Harris
- United States Centers for Disease Control and Prevention, Kampala, Uganda
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Zhang M, Wu Q, Chen H, Heidari AA, Cai Z, Li J, Md Abdelrahim E, Mansour RF. Whale optimization with random contraction and Rosenbrock method for COVID-19 disease prediction. Biomed Signal Process Control 2023; 83:104638. [PMID: 36741073 PMCID: PMC9889265 DOI: 10.1016/j.bspc.2023.104638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
Coronavirus Disease 2019 (COVID-19), instigated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has hugely impacted global public health. To identify and intervene in critically ill patients early, this paper proposes an efficient, intelligent prediction model based on the machine learning approach, which combines the improved whale optimization algorithm (RRWOA) with the k-nearest neighbor (KNN) classifier. In order to improve the problem that WOA is prone to fall into local optimum, an improved version named RRWOA is proposed based on the random contraction strategy (RCS) and the Rosenbrock method. To verify the capability of the proposed algorithm, RRWOA is tested against nine classical metaheuristics, nine advanced metaheuristics, and seven well-known WOA variants based on 30 IEEE CEC2014 competition functions, respectively. The experimental results in mean, standard deviation, the Friedman test, and the Wilcoxon signed-rank test are considered, proving that RRWOA won first place on 18, 24, and 25 test functions, respectively. In addition, a binary version of the algorithm, called BRRWOA, is developed for feature selection problems. An efficient prediction model based on BRRWOA and KNN classifier is proposed and compared with seven existing binary metaheuristics based on 15 datasets of UCI repositories. The experimental results show that the proposed algorithm obtains the smallest fitness value in eleven datasets and can solve combinatorial optimization problems, indicating that it still performs well in discrete cases. More importantly, the model was compared with five other algorithms on the COVID-19 dataset. The experiment outcomes demonstrate that the model offers a scientific framework to support clinical diagnostic decision-making. Therefore, RRWOA is an effectively improved optimizer with efficient value.
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Affiliation(s)
- Meilin Zhang
- Institute of Big Data and Information Technology, Wenzhou University, Wenzhou 325000, China
| | - Qianxi Wu
- Institute of Big Data and Information Technology, Wenzhou University, Wenzhou 325000, China
| | - Huiling Chen
- Institute of Big Data and Information Technology, Wenzhou University, Wenzhou 325000, China
| | - Ali Asghar Heidari
- Institute of Big Data and Information Technology, Wenzhou University, Wenzhou 325000, China
| | - Zhennao Cai
- Institute of Big Data and Information Technology, Wenzhou University, Wenzhou 325000, China
| | - Jiaren Li
- Wenzhou People's Hospital, Wenzhou, Zhejiang 325099, China
| | - Elsaid Md Abdelrahim
- Faculty of Science, Northern Border University, Arar, Saudi Arabia.,Faculty of Science, Tanta University, Tanta, Egypt
| | - Romany F Mansour
- Department of Mathematics, Faculty of Science, New Valley University, El-Kharga 72511, Egypt
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Yamga E, Mullie L, Durand M, Cadrin-Chenevert A, Tang A, Montagnon E, Chartrand-Lefebvre C, Chassé M. Interpretable clinical phenotypes among patients hospitalized with COVID-19 using cluster analysis. Front Digit Health 2023; 5:1142822. [PMID: 37114183 PMCID: PMC10128042 DOI: 10.3389/fdgth.2023.1142822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/13/2023] [Indexed: 04/29/2023] Open
Abstract
Background Multiple clinical phenotypes have been proposed for coronavirus disease (COVID-19), but few have used multimodal data. Using clinical and imaging data, we aimed to identify distinct clinical phenotypes in patients admitted with COVID-19 and to assess their clinical outcomes. Our secondary objective was to demonstrate the clinical applicability of this method by developing an interpretable model for phenotype assignment. Methods We analyzed data from 547 patients hospitalized with COVID-19 at a Canadian academic hospital. We processed the data by applying a factor analysis of mixed data (FAMD) and compared four clustering algorithms: k-means, partitioning around medoids (PAM), and divisive and agglomerative hierarchical clustering. We used imaging data and 34 clinical variables collected within the first 24 h of admission to train our algorithm. We conducted a survival analysis to compare the clinical outcomes across phenotypes. With the data split into training and validation sets (75/25 ratio), we developed a decision-tree-based model to facilitate the interpretation and assignment of the observed phenotypes. Results Agglomerative hierarchical clustering was the most robust algorithm. We identified three clinical phenotypes: 79 patients (14%) in Cluster 1, 275 patients (50%) in Cluster 2, and 203 (37%) in Cluster 3. Cluster 2 and Cluster 3 were both characterized by a low-risk respiratory and inflammatory profile but differed in terms of demographics. Compared with Cluster 3, Cluster 2 comprised older patients with more comorbidities. Cluster 1 represented the group with the most severe clinical presentation, as inferred by the highest rate of hypoxemia and the highest radiological burden. Intensive care unit (ICU) admission and mechanical ventilation risks were the highest in Cluster 1. Using only two to four decision rules, the classification and regression tree (CART) phenotype assignment model achieved an AUC of 84% (81.5-86.5%, 95 CI) on the validation set. Conclusions We conducted a multidimensional phenotypic analysis of adult inpatients with COVID-19 and identified three distinct phenotypes associated with different clinical outcomes. We also demonstrated the clinical usability of this approach, as phenotypes can be accurately assigned using a simple decision tree. Further research is still needed to properly incorporate these phenotypes in the management of patients with COVID-19.
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Affiliation(s)
- Eric Yamga
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Louis Mullie
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Madeleine Durand
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | | | - An Tang
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Emmanuel Montagnon
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Carl Chartrand-Lefebvre
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
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Boukhalfa Y, Stambouli N, Driss A, Daiki M, Abouda A, Razgallah R, Gharsallah H, Sellami W, Abid R, Hannachi S, Battikh R, Benmoussa M, Mazigh C, Ferjani M, Elgaaied AB, Labbene I. sCXCL16 as a prognostic biomarker for COVID-19 outcome. J Med Virol 2023; 95:e28728. [PMID: 37185869 PMCID: PMC10188208 DOI: 10.1002/jmv.28728] [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: 11/16/2022] [Revised: 03/14/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023]
Abstract
As elevated levels of the soluble CXCL16 (sCXCL16) chemokine have been reported in severe coronavirus disease 2019 (COVID-19) patients, this study examined whether sCXCL16 concentration on the first day of hospitalization predicted death in COVID-19 patients. A total of 76 patients with COVID-19 were admitted to the Military Hospital of Tunis, Tunisia, between October 2020 and April 2021, and later classified as survivors or nonsurvivors based on their outcomes. At admission, the groups were matched by age, gender, comorbidities, and the percentage of patients with moderate conditions. On the first day of admission, serum's sCXCL16 concentrations were measured using a magnetic-bead assay. There was an eightfold increase in serum sCXCL16 levels in the nonsurvivors' group (3661.51 ± 2464.87 pg/mL vs. 454.3 ± 338.07 pg/mL, p < 0.0001). For the optimal cutoff value of sCXCL16 at 2095 pg/mL, we found a 94.6% sensitivity and a 97.4% specificity, with an area under curve of 0.981 (p = 5.03E-08; 95% confidence interval [95% CI]: 0.951-1.0114). Considering the risk of death at a concentration above the threshold, the unadjusted odds ratio was 36 (p < 0.0001). The adjusted odd ratio was estimated at 1.003 (p < 0.0001; 95% CI: 1.002-1.004). Finally, there was a significant difference between survival and nonsurvival groups in leukocyte numbers (p = 0.006), lymphocytes (p = 0.001), polymorphonuclear neutrophils (p = 0.001), and C-reactive protein levels (p = 0.007), except for monocytes (p = 0.881). Based on these results, sCXCL16 level could be used for detecting nonsurvival COVID-19 patients. Therefore, we recommend assessing this marker in hospitalized COVID-19 patients.
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Affiliation(s)
- Yasmine Boukhalfa
- Research Laboratory LR12DN01, Military Hospital of Tunis, Tunis, Tunisia
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
| | - Nejla Stambouli
- Research Unit UR17DN05, Military Hospital of Tunis, Tunis, Tunisia
| | - Adel Driss
- Department of Physiology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Maissa Daiki
- Research Laboratory LR12DN01, Military Hospital of Tunis, Tunis, Tunisia
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
| | - Amal Abouda
- Research Laboratory LR12DN01, Military Hospital of Tunis, Tunis, Tunisia
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
| | - Rabie Razgallah
- Research Unit UR17DN05, Military Hospital of Tunis, Tunis, Tunisia
| | - Hedi Gharsallah
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
- Research Unit UR17DN05, Military Hospital of Tunis, Tunis, Tunisia
| | - Walid Sellami
- Research Laboratory LR12DN01, Military Hospital of Tunis, Tunis, Tunisia
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
| | - Rym Abid
- Department of Infectious Disease, Military Hospital of Tunis, Tunis, Tunisia
| | - Souha Hannachi
- Department of Infectious Disease, Military Hospital of Tunis, Tunis, Tunisia
| | - Riadh Battikh
- Department of Infectious Disease, Military Hospital of Tunis, Tunis, Tunisia
| | | | - Chakib Mazigh
- Department of Biochemistry, Military Hospital of Tunis, Tunis, Tunisia
| | - Mustapha Ferjani
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
| | - Amel B Elgaaied
- Department of Sciences, Tunisian Academy of Sciences, Letters and Art, Beit El Hikma Academy, University of Tunis El Manar, Tunis, Tunisia
| | - Iheb Labbene
- Research Laboratory LR12DN01, Military Hospital of Tunis, Tunis, Tunisia
- Department of Intensive Care, Military Hospital of Tunis, Tunis, Tunisia
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Carboni Bisso I, Ruiz V, Huespe IA, Rosciani F, Cantos J, Lockhart C, Fernández Ceballos I, Las Heras M. Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic. Surgery 2023; 173:944-949. [PMID: 36621447 PMCID: PMC9771743 DOI: 10.1016/j.surg.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Assessment of the efficacy and complications associated with performing bronchoscopy-guided percutaneous tracheostomy in COVID-19 and non-COVID-19 patients. METHODS Prospective observational study conducted between March of 2020 and February of 2022. All adult patients who underwent elective bronchoscopy-guided percutaneous tracheostomy were included. The efficacy of the procedure was evaluated based either on the success rate in the execution or on the need for conversion to open technique. Percutaneous tracheostomy-related complications were registered during the procedure. We performed 6-month follow-up for identifying late complications. RESULTS During the study period, 312 bronchoscopy-guided percutaneous tracheostomies were analyzed. One hundred and eighty-three were performed in COVID-19 patients and 129 among non-COVID-19 patients. Overall, 64.1% (200) of patients were male, with a median age of 66 (interquartile range 54-74), and 65% (205) presented at least 1 comorbidity. Overall, oxygen desaturation was the main complication observed (20.8% [65]), being more frequent in the COVID-19 group occurring in 27.3% (50) with a statistically significant difference versus the non-COVID-19 patients' group (11.6% [15]); P < .01). Major complications such as hypotension, arrhythmias, and pneumothorax were more frequently observed among COVID-19 patients as well but with no significant differences. Percutaneous tracheostomy could be executed quickly and satisfactorily in all the patients with no need for conversion to the open technique. Likewise, no suspension of the procedure was required in any case. During 6-month follow-up, we found an incidence of 0.96% (n = 3) late complications, 2 tracheal granulomas, and 1 ostomal infection. CONCLUSION Bronchoscopy-guided percutaneous tracheostomy can be considered an effective and safe procedure in COVID-19 patients. Nevertheless, it is highly remarkable that in the series under study, a great number of COVID-19 patients presented oxygen desaturation during the procedure.
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Affiliation(s)
| | - Victoria Ruiz
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | | | - Foda Rosciani
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | - Joaquín Cantos
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Marcos Las Heras
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
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Keller GA, Colaianni I, Coria J, Di Girolamo G, Miranda S. Clinical and biochemical short-term effects of hyperbaric oxygen therapy on SARS-Cov-2+ hospitalized patients with hypoxemic respiratory failure. Respir Med 2023; 209:107155. [PMID: 36796547 PMCID: PMC9927797 DOI: 10.1016/j.rmed.2023.107155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Hyperbaric oxygen therapy (HBOT) has been proposed to address COVID-19- associated respiratory failure. However, its biochemical effects are poorly known. METHOD 50 patients with hypoxemic COVID-19 pneumonia were divided into C group (standard care) and H group (standard care plus HBOT). Blood was obtained at t = 0 and t = 5 days. Oxygen saturation (O2 Sat) was followed up. White blood cell (WC) count, lymphocytes (L) and platelets (P) and serum analysis (glucose, urea, creatinine, sodium, potassium, ferritin, D dimer, LDH and CRP) were carried out. Plasma levels of sVCAM, sICAM, sPselectin, SAA and MPO, and of cytokines (IL-1β, IL-1RA, IL-6, TNFα, IFNα, IFNγ, IL-15, VEGF, MIP1α, IL-12p70, IL-2 and IP-10) were measured by multiplex assays. Angiotensin Converting Enzyme 2 (ACE-2) levels were determined by ELISA. RESULTS The average basal O2 Sat was 85 ± 3%. The days needed to reach O2 Sat >90% were: H: 3 ± 1 and C: 5 ± 1 (P < 0,01). At term, H increased WC, L and P counts (all, H vs C: P < 0,01). Also, H diminished D dimer levels (H vs C, P < 0,001) and LDH concentration (H vs C, P < 0.01]. At term, H showed lower levels of sVCAM, sPselectin and SAA than C with respect to basal values (H vs C: ΔsVCAM: P < 0,01; ΔsPselectin: P < 0,05; ΔSAA: P < 0,01). Similarly, H showed diminished levels of TNFα (ΔTNFα: P < 0,05) and increased levels of IL-1RA and VEGF than C respect to basal values (H vs C: ΔIL-1RA and ΔVEGF: P < 0,05). CONCLUSION Patients underwent HBOT improved O2 Sat with lower levels of severity markers (WC and platelets count, D dimer, LDH, SAA). Moreover, HBOT reduced proinflammatory agents (sVCAM, sPselectin, TNFα) and increased anti-inflammatory and pro-angiogenic ones (IL-1RA and VEGF).
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Affiliation(s)
- Guillermo A Keller
- Universidad de Buenos Aires, Facultad de Medicina, Centro de Vigilancia y Seguridad de Medicamentos, Argentina; Hospital General de Agudos Donación Francisco J. Santojanni, Departamento de Urgencias, Argentina
| | - Ivana Colaianni
- Hospital General de Agudos Donación Francisco J. Santojanni, Departamento de Urgencias, Argentina
| | - Javier Coria
- Universidad de Buenos Aires- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional (IATIMET), Argentina
| | - Guillermo Di Girolamo
- Universidad de Buenos Aires- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional (IATIMET), Argentina
| | - Silvia Miranda
- Universidad de Buenos Aires- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional (IATIMET), Argentina.
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Afşin E, Demirkol ME. FACTORS AFFECTING PROGNOSIS AND MORTALITY IN SEVERE COVID-19 PNEUMONIA PATIENTS. Acta Clin Croat 2023; 62:106-114. [PMID: 38304373 PMCID: PMC10829946 DOI: 10.20471/acc.2023.62.01.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/12/2021] [Indexed: 02/03/2024] Open
Abstract
Fatality rate in coronavirus disease 2019 (COVID-19) cases has been reported to be 3.4% worldwide. The aim of this study was to evaluate the factors that determine prognosis and mortality in severe COVID-19 pneumonia patients. Eighty adult patients with severe COVID-19 pneumonia hospitalized and monitored at Izzet Baysal State Hospital (Bolu, Turkey) between August and November 2020 were included in this retrospective single-center study. Demographic and laboratory data, severity of radiological involvement, comorbidities, agents used in treatment, and clinical results were recorded, and data were grouped as survivors and non-survivors. The mean patient age was 67.8±12.6 years. There were 59 (73.8%) male patients. Comorbid diseases were present in 53 (66.3%) patients. There was no significant relationship between patient age, gender, smoking status or presence of comorbidity and mortality (p>0.05). The variables such as pulmonary involvement above 50%, intubation, or ferritin (>434.8 µg/L), troponin I (>14.05 ng/L) and procalcitonin (>0.125 ng/mL) as the sole variables of laboratory data were found to have significant relationship with increased mortality (p<0.05). Mortality was significantly higher in patients using steroid pulse therapy + tocilizumab, steroid pulse therapy + hydroxychloroquine, or solely steroid pulse therapy, while it was significantly lower in patients receiving azithromycin therapy and those in the plasma + steroid pulse therapy group. The severity of pulmonary involvement, intubation, and increase in inflammation markers such as ferritin, troponin and procalcitonin were found to be significantly associated with mortality (p<0.05). Treatment approaches with azithromycin and plasma + steroid pulse therapy were found to reduce mortality.
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Affiliation(s)
- Emine Afşin
- Abant Izzet Baysal University Hospital, Department of Chest Diseases, Bolu, Turkey
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40
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Devaux CA, Lagier JC. Unraveling the Underlying Molecular Mechanism of 'Silent Hypoxia' in COVID-19 Patients Suggests a Central Role for Angiotensin II Modulation of the AT1R-Hypoxia-Inducible Factor Signaling Pathway. J Clin Med 2023; 12:jcm12062445. [PMID: 36983445 PMCID: PMC10056466 DOI: 10.3390/jcm12062445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
A few days after being infected with SARS-CoV-2, a fraction of people remain asymptomatic but suffer from a decrease in arterial oxygen saturation in the absence of apparent dyspnea. In light of our clinical investigation on the modulation of molecules belonging to the renin angiotensin system (RAS) in COVID-19 patients, we propose a model that explains 'silent hypoxia'. The RAS imbalance caused by SARS-CoV-2 results in an accumulation of angiotensin 2 (Ang II), which activates the angiotensin 2 type 1 receptor (AT1R) and triggers a harmful cascade of intracellular signals leading to the nuclear translocation of the hypoxia-inducible factor (HIF)-1α. HIF-1α transactivates many genes including the angiotensin-converting enzyme 1 (ACE1), while at the same time, ACE2 is downregulated. A growing number of cells is maintained in a hypoxic condition that is self-sustained by the presence of the virus and the ACE1/ACE2 ratio imbalance. This is associated with a progressive worsening of the patient's biological parameters including decreased oxygen saturation, without further clinical manifestations. When too many cells activate the Ang II-AT1R-HIF-1α axis, there is a 'hypoxic spillover', which marks the tipping point between 'silent' and symptomatic hypoxia in the patient. Immediate ventilation is required to prevent the 'hypoxic spillover'.
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Affiliation(s)
- Christian Albert Devaux
- Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Microbes Evolution Phylogeny and Infection Laboratory, Aix-Marseille University, 13000 Marseille, France
- Institut Hospitalo-Universitaire-Méditerranée Infection, 13000 Marseille, France
- Centre National de la Recherche Scientifique, 13000 Marseille, France
| | - Jean-Christophe Lagier
- Institut de Recherche pour le Développement, Assistance Publique Hôpitaux de Marseille, Microbes Evolution Phylogeny and Infection Laboratory, Aix-Marseille University, 13000 Marseille, France
- Institut Hospitalo-Universitaire-Méditerranée Infection, 13000 Marseille, France
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Yohannes S, Seam N, Sun J, McAlduff J, Thorne JL, Lara SB, Keller M. Impact of an Early Warning System Protocol, for Patients Admitted to
the Medical Floors with SARS-COV2 Pneumonia, on ICU Admission. Clin Med Insights Circ Respir Pulm Med 2023; 17:11795484231156755. [PMID: 36968975 PMCID: PMC10034308 DOI: 10.1177/11795484231156755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/25/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND COVID-19 placed a significant burden on the global healthcare system. Strain
in critical care capacity has been associated with increased
COVID-19-related ICU mortality. This study evaluates the impact of an early
warning system and response team implemented on medical floors to safely
triage and care for critically ill patients on the floor and preserve ICU
capacity. METHODS We conducted a multicenter, retrospective cohort study, comparing outcomes
between intervention and control hospitals within a US eight-hospital urban
network. Patients hospitalized with COVID-19 pneumonia between April
13th, 2020 and June 19th, 2020 were included in
the study, which was a time of a regional surge of COVID-19 admissions. An
automated, electronic early warning protocol to identify patients with
moderate-severe hypoxemia on the medical floors and implement early
interventions was implemented at one of the eight hospitals (“the
intervention hospital”). RESULTS Among 1024 patients, 403 (39%) were admitted to the intervention hospital and
621 (61%) were admitted to one of the control hospitals. Adjusted for
potential confounders, patients at the intervention hospital were less
likely to be admitted to the ICU (HR = 0.73, 95% CI 0.53, 1.000,
P = .0499) compared to the control hospitals. Patients
admitted from the floors to the ICU at the intervention hospital had shorter
ICU stay (HR for ICU discharge: 1.74; 95% CI 1.21, 2.51,
P = .003). There was no significant difference between
intervention and control hospitals in need for mechanical ventilation (OR =
0.93; 95% CI 0.38, 2.31; P = .88) or hospital mortality (OR
= 0.79; 95% CI 0.52, 1.18; P = .25). CONCLUSION A protocol to conserve ICU beds by implementing an early warning system with
a dedicated response team to manage respiratory distress on the floors
reduced ICU admission and was not associated with worse outcomes compared to
hospitals that managed similar levels of respiratory distress in the
ICU.
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Affiliation(s)
- Seife Yohannes
- Department of Critical Care, MedStar Washington Hospital
Center, Washington DC, USA
- Seife Yohannes, Department of Critical
Care, MedStar Washington Hospital Center, 110 Irving Street NW, Suite 4B42,
Washington DC, 200010, USA.
| | - Nitin Seam
- Clinical Center, National Institutes of
Health, Bethesda, Maryland, USA
| | - Junfeng Sun
- Clinical Center, National Institutes of
Health, Bethesda, Maryland, USA
| | | | | | - Susanne B. Lara
- Department of Critical Care, MedStar Washington Hospital
Center, Washington DC, USA
| | - Michael Keller
- Clinical Center, National Institutes of
Health, Bethesda, Maryland, USA
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Kattner S, Müller J, Glanz K, Manoochehri M, Sylvester C, Vainshtein Y, Berger MM, Brenner T, Sohn K. Identification of two early blood biomarkers ACHE and CLEC12A for improved risk stratification of critically ill COVID-19 patients. Sci Rep 2023; 13:4388. [PMID: 36928077 PMCID: PMC10019437 DOI: 10.1038/s41598-023-30158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023] Open
Abstract
In order to identify biomarkers for earlier prediction of COVID-19 outcome, we collected blood samples from patients with fatal outcomes (non-survivors) and with positive clinical outcomes (survivors) at ICU admission and after seven days. COVID-19 survivors and non-survivors showed significantly different transcript levels for 93 genes in whole blood already at ICU admission as revealed by RNA-Seq. These differences became even more pronounced at day 7, resulting in 290 differentially expressed genes. Many identified genes play a role in the differentiation of hematopoietic cells. For validation, we designed an RT-qPCR assay for C-type lectin domain family 12 member A (CLEC12A) and acetylcholinesterase (ACHE), two transcripts that showed highest potential to discriminate between survivors and non-survivors at both time points. Using our combined RT-qPCR assay we examined 33 samples to accurately predict patient survival with an AUROC curve of 0.931 (95% CI = 0.814-1.000) already at ICU admission. CLEC12A and ACHE showed improved prediction of patient outcomes compared to standard clinical biomarkers including CRP and PCT in combination (AUROC = 0.403, 95% CI = 0.108-0.697) or SOFA score (AUROC = 0.701 95% CI = 0.451-0.951) at day 0. Therefore, analyzing CLEC12A and ACHE gene expression from blood may provide a promising approach for early risk stratification of severely ill COVID-19 patients.
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Affiliation(s)
- Simone Kattner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Jan Müller
- Innovation Field In-Vitro Diagnostics, Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
- Center for Integrative Bioinformatics Vienna (CIBIV), Max Perutz Labs, University of Vienna and Medical University of Vienna, Vienna BioCenter, Vienna, Austria
- Vienna BioCenter PhD Program, Doctoral School of the University of Vienna and Medical University of Vienna, Vienna, Austria
| | - Karolina Glanz
- Innovation Field In-Vitro Diagnostics, Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
| | - Mehdi Manoochehri
- Innovation Field In-Vitro Diagnostics, Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
| | - Caroline Sylvester
- Innovation Field In-Vitro Diagnostics, Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
| | - Yevhen Vainshtein
- Innovation Field In-Vitro Diagnostics, Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany
| | - Marc Moritz Berger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Thorsten Brenner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| | - Kai Sohn
- Innovation Field In-Vitro Diagnostics, Fraunhofer Institute for Interfacial Engineering and Biotechnology IGB, Stuttgart, Germany.
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The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients. Am J Emerg Med 2023; 65:65-70. [PMID: 36586224 PMCID: PMC9773782 DOI: 10.1016/j.ajem.2022.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY OBJECTIVE The coronavirus disease 2019 (COVID-19) outbreak has caused a severe burden on medical professionals, as the rapid disposition of patients is important. Therefore, we aimed to develop a new clinical assessment tool based on the shock index (SI) and age-shock index (ASI). We proposed the hypoxia-age-shock index (HASI) and determined the usability of triage for COVID-19 infected patients in the first scene. METHODS The predictive power for three indexes on mortality, intensive care unit (ICU) admission, and endotracheal intubation rate was evaluated using the receiver operating curve (ROC). We used DeLong's method for comparing the ROCs. RESULTS The area under the curve (AUC) for ROC on mortality for SI, ASI, and HASI were 0.546, 0.771, and 0.773, respectively. The AUC on ICU admission mortality for SI, ASI, and HASI were 0.581, 0.700, and 0.743, respectively. The AUC for intubation for SI, ASI, and HASI were 0.592, 0.708, and 0.757, respectively. The AUC differences between HASI and SI showed statistically significant (P = 0.001) results on mortality, ICU admission, and intubation. Additionally, statistically significant results were found for the AUC difference between the HASI and ASI on ICU admission and intubation (P = 0.001 and P = 0.004, respectively). CONCLUSION HASI can provide a better prediction compared to ASI on ICU admission and endotracheal intubation. HASI was more sensitive in mortality, ICU admission, and intubation prediction than the ASI.
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Xiang M, Wu X, Jing H, Novakovic VA, Shi J. The intersection of obesity and (long) COVID-19: Hypoxia, thrombotic inflammation, and vascular endothelial injury. Front Cardiovasc Med 2023; 10:1062491. [PMID: 36824451 PMCID: PMC9941162 DOI: 10.3389/fcvm.2023.1062491] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
The role of hypoxia, vascular endothelial injury, and thrombotic inflammation in worsening COVID-19 symptoms has been generally recognized. Damaged vascular endothelium plays a crucial role in forming in situ thrombosis, pulmonary dysfunction, and hypoxemia. Thrombotic inflammation can further aggravate local vascular endothelial injury and affect ventilation and blood flow ratio. According to the results of many studies, obesity is an independent risk factor for a variety of severe respiratory diseases and contributes to high mechanical ventilation rate, high mortality, and slow recovery in COVID-19 patients. This review will explore the mechanisms by which obesity may aggravate the acute phase of COVID-19 and delay long COVID recovery by affecting hypoxia, vascular endothelial injury, and thrombotic inflammation. A systematic search of PubMed database was conducted for papers published since January 2020, using the medical subject headings of "COVID-19" and "long COVID" combined with the following keywords: "obesity," "thrombosis," "endothelial injury," "inflammation," "hypoxia," "treatment," and "anticoagulation." In patients with obesity, the accumulation of central fat restricts the expansion of alveoli, exacerbating the pulmonary dysfunction caused by SARS-CoV-2 invasion, inflammatory damage, and lung edema. Abnormal fat secretion and immune impairment further aggravate the original tissue damage and inflammation diffusion. Obesity weakens baseline vascular endothelium function leading to an early injury and pre-thrombotic state after infection. Enhanced procoagulant activity and microthrombi promote early obstruction of the vascular. Obesity also prolongs the duration of symptoms and increases the risk of sequelae after hospital discharge. Persistent viral presence, long-term inflammation, microclots, and hypoxia may contribute to the development of persistent symptoms, suggesting that patients with obesity are uniquely susceptible to long COVID. Early interventions, including supplemental oxygen, comprehensive antithrombotic therapy, and anti-inflammatory drugs, show effectiveness in many studies in the prevention of serious hypoxia, thromboembolic events, and systemic inflammation, and are therefore recommended to reduce intensive care unit admission, mortality, and sequelae.
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Affiliation(s)
- Mengqi Xiang
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Xiaoming Wu
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Haijiao Jing
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Valerie A. Novakovic
- Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States
| | - Jialan Shi
- Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China,Department of Research, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA, United States,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, United States,*Correspondence: Jialan Shi, ,
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45
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Amini N, Mahdavi M, Choubdar H, Abedini A, Shalbaf A, Lashgari R. Automated prediction of COVID-19 mortality outcome using clinical and laboratory data based on hierarchical feature selection and random forest classifier. Comput Methods Biomech Biomed Engin 2023; 26:160-173. [PMID: 35297747 DOI: 10.1080/10255842.2022.2050906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Early prediction of COVID-19 mortality outcome can decrease expiration risk by alerting healthcare personnel to assure efficient resource allocation and treatment planning. This study introduces a machine learning framework for the prediction of COVID-19 mortality using demographics, vital signs, and laboratory blood tests (complete blood count (CBC), coagulation, kidney, liver, blood gas, and general). 41 features from 244 COVID-19 patients were recorded on the first day of admission. In this study, first, the features in each of the eight categories were investigated. Afterward, features that have an area under the receiver operating characteristic curve (AUC) above 0.6 and the p-value criterion from the Wilcoxon rank-sum test below 0.005 were used as selected features for further analysis. Then five feature reduction methods, Forward Feature selection, minimum Redundancy Maximum Relevance, Relieff, Linear Discriminant Analysis, and Neighborhood Component Analysis were utilized to select the best combination of features. Finally, seven classifiers frameworks, random forest (RF), support vector machine, logistic regression (LR), K nearest neighbors, Artifical neural network, bagging, and boosting were used to predict the mortality outcome of COVID-19 patients. The results revealed that the combination of features in CBC and then vital signs had the highest mortality classification parameters, respectively. Furthermore, the RF classifier with hierarchical feature selection algorithms via Forward Feature selection had the highest classification power with an accuracy of 92.08 ± 2.56. Therefore, our proposed method can be confidently used as a valuable assistant prognostic tool to sieve patients with high mortality risks.
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Affiliation(s)
- Nasrin Amini
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Mahdavi
- Institute of Medical Science and Technology (IMSAT), Shahid Beheshti University, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Choubdar
- Institute of Medical Science and Technology (IMSAT), Shahid Beheshti University, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Shalbaf
- Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Lashgari
- Institute of Medical Science and Technology (IMSAT), Shahid Beheshti University, Tehran, Iran
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Choi KJ, Jung SK, Kim KC, Kim EJ. Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study. Acute Crit Care 2023; 38:57-67. [PMID: 36935535 PMCID: PMC10030243 DOI: 10.4266/acc.2022.00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19. METHODS This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group). RESULTS Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039). CONCLUSIONS Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.
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Affiliation(s)
- Keum-Ju Choi
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Soo Kyun Jung
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
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47
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Smail SW, Babaei E, Amin K. Ct, IL-18 polymorphism, and laboratory biomarkers for predicting chemosensory dysfunctions and mortality in COVID-19. Future Sci OA 2023; 9:FSO838. [PMID: 36999046 PMCID: PMC10005086 DOI: 10.2144/fsoa-2022-0082] [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: 12/05/2022] [Accepted: 02/17/2023] [Indexed: 03/11/2023] Open
Abstract
Aim Patients with COVID-19 often experience chemosensory dysfunction. This research intends to uncover the association of RT-PCR Ct value with chemosensory dysfunctions and SpO2. This study also aims to investigate Ct, SpO2, CRP, D-dimer, and -607 IL-18 T/G polymorphism in order to find out predictors of chemosensory dysfunctions and mortality. Materials & methods This study included 120 COVID-19 patients, of which 54 were mild, 40 were severe and 26 were critical. CRP, D-dimer, RT-PCR, and IL-18 polymorphism were evaluated. Results & conclusion: Low Ct was associated with SpO2 dropping and chemosensory dysfunctions. IL-18 T/G polymorphism did not show an association with COVID-19 mortality; conversely, age, BMI, D-dimer and Ct values did.
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Affiliation(s)
- Shukur Wasman Smail
- Department of Biology, College of Science, Salahaddin University-Erbil, Iraq
| | - Esmaeil Babaei
- Department of Biology, School of Natural Sciences, University of Tabriz, Tabriz, Iran
- Department of Pharmacognosy, College of Pharmacy, Hawler Medical University, Erbil, Kurdistan Region, Iraq
| | - Kawa Amin
- College of Medicine, University of Sulaimani, Sulaymaniyah, Iraq
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Association of Lower Antispike Antibody Levels with Mortality in ICU Patients with COVID-19 Disease. Crit Care Res Pract 2023; 2023:4174241. [PMID: 36761157 PMCID: PMC9904915 DOI: 10.1155/2023/4174241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 11/23/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background Though vaccines have been reported as highly efficacious in preventing severe COVID-19 disease, there is emerging data of severe infections, albeit a small number, in vaccinated individuals. We have conducted a retrospective observational study to assess the clinical characteristics, immunological response, and disease outcomes among the vaccinated and unvaccinated patients admitted to the ICU with severe COVID-19 disease. Methods Study Design and Participants. We conducted a retrospective observational study in COVID ICU of a tertiary care hospital. Data were collected from the month of 1 April 2021 to 31 November 2021. All adult patients admitted to the ICU having severe COVID-19 disease were included in the study. Data were collected from the medical records database which included demographics, a clinical course in the ICU, laboratory and radiological parameters, and disease outcomes. In a subset of patients, cell-mediated immunity and S1S2-neutralising antibody assessment was done. Results A total of 419 patients with severe COVID-19 were included in the study. Of the 419 patients, 90 (21.5%) were vaccinated, and 329 (78.5%) were unvaccinated. There was a significantly higher mortality in unvaccinated severe COVID 19 patients as compared to vaccinated severe COVID patients (46.2% vs 34.4%; P < 0.0455). The neutralizing antibody titre was significantly higher in survivors as compared to nonsurvivors (2139.8, SE ± 713.3 vs 471, SE ± 154.4); P < 0.026. Conclusion Our study suggests the association of lower neutralizing antibody levels with mortality in ICU patients admitted with COVID-19 breakthrough infections.
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49
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Sobel JA, Levy J, Almog R, Reiner-Benaim A, Miller A, Eytan D, Behar JA. Descriptive characteristics of continuous oximetry measurement in moderate to severe covid-19 patients. Sci Rep 2023; 13:442. [PMID: 36624254 PMCID: PMC9828367 DOI: 10.1038/s41598-022-27342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
Non-invasive oxygen saturation (SpO2) is a central vital sign used to shape the management of COVID-19 patients. Yet, there have been no report quantitatively describing SpO2 dynamics and patterns in COVID-19 patients using continuous SpO2 recordings. We performed a retrospective observational analysis of the clinical information and 27 K hours of continuous SpO2 high-resolution (1 Hz) recordings of 367 critical and non-critical COVID-19 patients hospitalised at the Rambam Health Care Campus, Haifa, Israel. An absolute SpO2 threshold of 93% most efficiently discriminated between critical and non-critical patients, regardless of oxygen support. Oximetry-derived digital biomarker (OBMs) computed per 1 h monitoring window showed significant differences between groups, notably the cumulative time below 93% SpO2 (CT93). Patients with CT93 above 60% during the first hour of monitoring, were more likely to require oxygen support. Mechanical ventilation exhibited a strong effect on SpO2 dynamics by significantly reducing the frequency and depth of desaturations. OBMs related to periodicity and hypoxic burden were markedly affected, up to several hours before the initiation of the mechanical ventilation. In summary, OBMs, traditionally used in the field of sleep medicine research, are informative for continuous assessment of disease severity and response to respiratory support of hospitalised COVID-19 patients. In conclusion, OBMs may improve risk stratification and therapy management of critical care patients with respiratory impairment.
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Affiliation(s)
- Jonathan A. Sobel
- grid.6451.60000000121102151Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Jeremy Levy
- grid.6451.60000000121102151Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel ,grid.6451.60000000121102151Faculty of Electrical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ronit Almog
- grid.413731.30000 0000 9950 8111Rambam Health Care Campus, Haifa, Israel
| | - Anat Reiner-Benaim
- grid.7489.20000 0004 1937 0511Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben Gurion University of the Negev Beer-Sheva, Beer-Sheva, Israel
| | - Asaf Miller
- grid.413731.30000 0000 9950 8111Rambam Health Care Campus, Haifa, Israel
| | - Danny Eytan
- grid.413731.30000 0000 9950 8111Rambam Health Care Campus, Haifa, Israel
| | - Joachim A. Behar
- grid.6451.60000000121102151Faculty of Biomedical Engineering, Technion, Israel Institute of Technology, Haifa, Israel
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50
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Prataviera F, Hashimoto EM, Ortega EMM, Cordeiro GM, Cancho VG, Vila R. A new flexible regression model with application to recovery probability Covid-19 patients. J Appl Stat 2023; 51:826-844. [PMID: 38524797 PMCID: PMC10956937 DOI: 10.1080/02664763.2022.2163229] [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: 06/17/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
The aim of this study is to propose a generalized odd log-logistic Maxwell mixture model to analyze the effect of gender and age groups on lifetimes and on the recovery probabilities of Chinese individuals with COVID-19. We add new properties of the generalized Maxwell model. The coefficients of the regression and the recovered fraction are estimated by maximum likelihood and Bayesian methods. Further, some simulation studies are done to compare the regressions for different scenarios. Model-checking techniques based on the quantile residuals are addressed. The estimated survival functions for the patients are reported by age range and sex. The simulation study showed that mean squared errors decay toward zero and the average estimates converge to the true parameters when sample size increases. According to the fitted model, there is a significant difference only in the age group on the lifetime of individuals with COVID-19. Women have higher probability of recovering than men and individuals aged ≥ 60 years have lower recovered probabilities than those who aged < 60 years. The findings suggest that the proposed model could be a good alternative to analyze censored lifetime of individuals with COVID-19.
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Affiliation(s)
- F. Prataviera
- Department of Exact Sciences, University of S ao Paulo, Piracicaba, Brazil
| | - E. M. Hashimoto
- Academic Department of Mathematics, Federal University of Technology – Paraná, Londrina, Brazil
| | - E. M. M. Ortega
- Department Exact Sciences, University of São Paulo, Piracicaba, Brazil
| | - G. M. Cordeiro
- Department of Statistics, Federal University of Pernambuco, Recife, Brazil
| | - V. G. Cancho
- Department of Statistics, University of São Paulo, São Carlos, Brazil
| | - R. Vila
- Department of Statistics, University of Brasilia, Brasilia, Brazil
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