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Bruse N, Motos A, van Amstel R, de Bie E, Kooistra EJ, Jansen A, van Lier D, Kennedy J, Schwarzkopf D, Thomas-Rüddel D, Bermejo-Martin JF, Barbe F, de Keizer NF, Bauer M, van der Hoeven JG, Torres A, Seymour C, van Vught L, Pickkers P, Kox M. Clinical phenotyping uncovers heterogeneous associations between corticosteroid treatment and survival in critically ill COVID-19 patients. Intensive Care Med 2024:10.1007/s00134-024-07593-3. [PMID: 39186112 DOI: 10.1007/s00134-024-07593-3] [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: 02/27/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024]
Abstract
PURPOSE Disease heterogeneity in coronavirus disease 2019 (COVID-19) may render the current one-size-fits-all treatment approach suboptimal. We aimed to identify and immunologically characterize clinical phenotypes among critically ill COVID-19 patients, and to assess heterogeneity of corticosteroid treatment effect. METHODS We applied consensus k-means clustering on 21 clinical parameters obtained within 24 h after admission to the intensive care unit (ICU) from 13,279 COVID-19 patients admitted to 82 Dutch ICUs from February 2020 to February 2022. Derived phenotypes were reproduced in 6225 COVID-19 ICU patients from Spain (February 2020 to December 2021). Longitudinal immunological characterization was performed in three COVID-19 ICU cohorts from the Netherlands and Germany, and associations between corticosteroid treatment and survival were assessed across phenotypes. RESULTS We derived three phenotypes: COVIDICU1 (43% of patients) consisted of younger patients with the lowest Acute Physiology And Chronic Health Evaluation (APACHE) scores, highest body mass index (BMI), lowest PaO2/FiO2 ratio, and a 90-day in-hospital mortality rate of 18%. COVIDICU2 patients (37%) had the lowest BMI, were older and had higher APACHE scores and mortality rate (24%) than COVIDICU1. Patients with COVIDICU3 (20%) were the eldest with the most comorbidities, the highest APACHE scores, acute kidney injury and metabolic dysregulations, and the highest mortality rate (47%). These patients also displayed the most pronounced inflammatory response. Corticosteroid therapy started at day 5 [2-9] after ICU admission and administered for 5 [3-7] days was associated with an increased risk for 90-day mortality in patients with the COVIDICU1 and COVIDICU2 phenotypes (hazard ratio [HR] 1.59 [1.09-2.31], p = 0.015 and HR 1.79 [1.42-2.26], p < 0.001, respectively), but not in patients with the COVIDICU3 phenotype (HR 1.08 [0.76-1.54], p = 0.654). CONCLUSION Our multinational study identified three distinct clinical COVID-19 phenotypes, each exhibiting marked differences in demographic, clinical, and immunological features, and in the response to late and short-term corticosteroid treatment.
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Affiliation(s)
- Niklas Bruse
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Anna Motos
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rombout van Amstel
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eckart de Bie
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Emma J Kooistra
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Aron Jansen
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Dirk van Lier
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Jason Kennedy
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel Schwarzkopf
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Daniel Thomas-Rüddel
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | | | - Ferran Barbe
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
- Department of Medical Informatics, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care and Digital Health, Amsterdam, The Netherlands
| | - Michael Bauer
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | | | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain.
- Pneumology Service, Respiratory Institute, Hospital Clinic of Barcelona, Barcelona, Spain.
| | - Christopher Seymour
- Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lonneke van Vught
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Matthijs Kox
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands.
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García-García F, Lee DJ, Nieves-Ermecheo M, Bronte O, España PP, Quintana JM, Menéndez R, Torres A, Ruiz Iturriaga LA, Urrutia I. Obtaining patient phenotypes in SARS-CoV-2 pneumonia, and their association with clinical severity and mortality. Pneumonia (Nathan) 2024; 16:12. [PMID: 38915125 DOI: 10.1186/s41479-024-00132-0] [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: 11/28/2023] [Accepted: 04/01/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND There exists consistent empirical evidence in the literature pointing out ample heterogeneity in terms of the clinical evolution of patients with COVID-19. The identification of specific phenotypes underlying in the population might contribute towards a better understanding and characterization of the different courses of the disease. The aim of this study was to identify distinct clinical phenotypes among hospitalized patients with SARS-CoV-2 pneumonia using machine learning clustering, and to study their association with subsequent clinical outcomes as severity and mortality. METHODS Multicentric observational, prospective, longitudinal, cohort study conducted in four hospitals in Spain. We included adult patients admitted for in-hospital stay due to SARS-CoV-2 pneumonia. We collected a broad spectrum of variables to describe exhaustively each case: patient demographics, comorbidities, symptoms, physiological status, baseline examinations (blood analytics, arterial gas test), etc. For the development and internal validation of the clustering/phenotype models, the dataset was split into training and test sets (50% each). We proposed a sequence of machine learning stages: feature scaling, missing data imputation, reduction of data dimensionality via Kernel Principal Component Analysis (KPCA), and clustering with the k-means algorithm. The optimal cluster model parameters -including k, the number of phenotypes- were chosen automatically, by maximizing the average Silhouette score across the training set. RESULTS We enrolled 1548 patients, each of them characterized by 92 clinical attributes (d=109 features after variable encoding). Our clustering algorithm identified k=3 distinct phenotypes and 18 strongly informative variables: Phenotype A (788 cases [50.9% prevalence] - age ∼ 57, Charlson comorbidity ∼ 1, pneumonia CURB-65 score ∼ 0 to 1, respiratory rate at admission ∼ 18 min-1, FiO2 ∼ 21%, C-reactive protein CRP ∼ 49.5 mg/dL [median within cluster]); phenotype B (620 cases [40.0%] - age ∼ 75, Charlson ∼ 5, CURB-65 ∼ 1 to 2, respiration ∼ 20 min-1, FiO2 ∼ 21%, CRP ∼ 101.5 mg/dL); and phenotype C (140 cases [9.0%] - age ∼ 71, Charlson ∼ 4, CURB-65 ∼ 0 to 2, respiration ∼ 30 min-1, FiO2 ∼ 38%, CRP ∼ 152.3 mg/dL). Hypothesis testing provided solid statistical evidence supporting an interaction between phenotype and each clinical outcome: severity and mortality. By computing their corresponding odds ratios, a clear trend was found for higher frequencies of unfavourable evolution in phenotype C with respect to B, as well as more unfavourable in phenotype B than in A. CONCLUSION A compound unsupervised clustering technique (including a fully-automated optimization of its internal parameters) revealed the existence of three distinct groups of patients - phenotypes. In turn, these showed strong associations with the clinical severity in the progression of pneumonia, and with mortality.
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Affiliation(s)
| | - Dae-Jin Lee
- School of Science & Technology, IE University, Madrid, Madrid, Spain
| | - Mónica Nieves-Ermecheo
- Biocruces Bizkaia Health Research Institute, Barakaldo, Basque Country, Spain
- Respiratory Service, Galdakao-Usansolo University Hospital, Galdakao, Basque Country, Spain
| | - Olaia Bronte
- Respiratory Service, Galdakao-Usansolo University Hospital, Galdakao, Basque Country, Spain
| | - Pedro Pablo España
- Respiratory Service, Galdakao-Usansolo University Hospital, Galdakao, Basque Country, Spain
| | - José María Quintana
- Research Unit, Galdakao-Usansolo University Hospital, Galdakao, Basque Country, Spain
| | - Rosario Menéndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Valencian Community, Spain
| | - Antoni Torres
- Pneumology Department, Hospital Clínic of Barcelona, Barcelona, Catalonia, Spain
| | | | - Isabel Urrutia
- Respiratory Service, Galdakao-Usansolo University Hospital, Galdakao, Basque Country, Spain
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Rodríguez A, Gómez J, Franquet Á, Trefler S, Díaz E, Sole-Violán J, Zaragoza R, Papiol E, Suberviola B, Vallverdú M, Jimenez-Herrera M, Albaya-Moreno A, Canabal Berlanga A, Del Valle Ortíz M, Carlos Ballesteros J, López Amor L, Sancho Chinesta S, de Alba-Aparicio M, Estella A, Martín-Loeches I, Bodi M. Applicability of an unsupervised cluster model developed on first wave COVID-19 patients in second/third wave critically ill patients. Med Intensiva 2024; 48:326-340. [PMID: 38462398 DOI: 10.1016/j.medine.2024.02.006] [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: 12/19/2023] [Accepted: 02/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To validate the unsupervised cluster model (USCM) developed during the first pandemic wave in a cohort of critically ill patients from the second and third pandemic waves. DESIGN Observational, retrospective, multicentre study. SETTING Intensive Care Unit (ICU). PATIENTS Adult patients admitted with COVID-19 and respiratory failure during the second and third pandemic waves. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Collected data included demographic and clinical characteristics, comorbidities, laboratory tests and ICU outcomes. To validate our original USCM, we assigned a phenotype to each patient of the validation cohort. The performance of the classification was determined by Silhouette coefficient (SC) and general linear modelling. In a post-hoc analysis we developed and validated a USCM specific to the validation set. The model's performance was measured using accuracy test and area under curve (AUC) ROC. RESULTS A total of 2330 patients (mean age 63 [53-82] years, 1643 (70.5%) male, median APACHE II score (12 [9-16]) and SOFA score (4 [3-6]) were included. The ICU mortality was 27.2%. The USCM classified patients into 3 clinical phenotypes: A (n = 1206 patients, 51.8%); B (n = 618 patients, 26.5%), and C (n = 506 patients, 21.7%). The characteristics of patients within each phenotype were significantly different from the original population. The SC was -0.007 and the inclusion of phenotype classification in a regression model did not improve the model performance (0.79 and 0.78 ROC for original and validation model). The post-hoc model performed better than the validation model (SC -0.08). CONCLUSION Models developed using machine learning techniques during the first pandemic wave cannot be applied with adequate performance to patients admitted in subsequent waves without prior validation.
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Affiliation(s)
- Alejandro Rodríguez
- Critical Care Department - Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Universidad Rovira & Virgili/Institut d'Investigació Sanitaria Pere Virigili/CIBERES, Tarragona, Spain.
| | - Josep Gómez
- Technical Secretary - Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Álvaro Franquet
- Technical Secretary - Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Sandra Trefler
- Critical Care Department - Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Emili Díaz
- Critical Care Department - Hospital Parc Tauli, Sabadell, Spain
| | - Jordi Sole-Violán
- Critical Care Department - Hospital Universitario Dr. Negrin/Universidad Fernando Pessoa, Las Palmas de Gran Canaria, Spain
| | - Rafael Zaragoza
- Critical Care Department - Hospital Dr. Peset, Valencia, Spain
| | - Elisabeth Papiol
- Critical Care Department - Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Borja Suberviola
- Critical Care Department - Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Montserrat Vallverdú
- Critical Care Department - Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Antonio Albaya-Moreno
- Critical Care Department - Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | | | - Lucía López Amor
- Critical Care Department - Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Angel Estella
- Critical Care Department - Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - Ignacio Martín-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
| | - María Bodi
- Critical Care Department - Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Universidad Rovira & Virgili/Institut d'Investigació Sanitaria Pere Virigili/CIBERES, Tarragona, Spain
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Bai WH, Yang JJ, Liu Z, Ning WS, Mao Y, Zhou CL, Cheng L. Development and validation of a nomogram for predicting in-hospital survival rates of patients with COVID-19. Heliyon 2024; 10:e31380. [PMID: 38803927 PMCID: PMC11129089 DOI: 10.1016/j.heliyon.2024.e31380] [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: 07/22/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
Objective Our aim was to develop and validate a nomogram for predicting the in-hospital 14-day (14 d) and 28-day (28 d) survival rates of patients with coronavirus disease 2019 (COVID-19). Methods Clinical data of patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from December 2022 to February 2023 and the north campus of Shanghai Ninth People's Hospital from April 2022 to June 2022 were collected. A total of 408 patients from Renmin Hospital of Wuhan University were selected as the training cohort, and 151 patients from Shanghai Ninth People's Hospital were selected as the verification cohort. Independent variables were screened using Cox regression analysis, and a nomogram was constructed using R software. The prediction accuracy of the nomogram was evaluated using the receiver operating characteristic (ROC) curve, C-index, and calibration curve. Decision curve analysis was used to evaluate the clinical application value of the model. The nomogram was externally validated using a validation cohort. Result In total, 559 patients with severe/critical COVID-19 were included in this study, of whom 179 (32.02 %) died. Multivariate Cox regression analysis showed that age >80 years [hazard ratio (HR) = 1.539, 95 % confidence interval (CI): 1.027-2.306, P = 0.037], history of diabetes (HR = 1.741, 95 % CI: 1.253-2.420, P = 0.001), high APACHE II score (HR = 1.083, 95 % CI: 1.042-1.126, P < 0.001), sepsis (HR = 2.387, 95 % CI: 1.707-3.338, P < 0.001), high neutrophil-to-lymphocyte ratio (NLR) (HR = 1.010, 95 % CI: 1.003-1.017, P = 0.007), and high D-dimer level (HR = 1.005, 95 % CI: 1.001-1.009, P = 0.028) were independent risk factors for 14 d and 28 d survival rates, whereas COVID-19 vaccination (HR = 0.625, 95 % CI: 0.440-0.886, P = 0.008) was a protective factor affecting prognosis. ROC curve analysis showed that the area under the curve (AUC) of the 14 d and 28 d hospital survival rates in the training cohort was 0.765 (95 % CI: 0.641-0.923) and 0.814 (95 % CI: 0.702-0.938), respectively, and the AUC of the 14 d and 28 d hospital survival rates in the verification cohort was 0.898 (95 % CI: 0.765-0.962) and 0.875 (95 % CI: 0.741-0.945), respectively. The calibration curves of 14 d and 28 d hospital survival showed that the predicted probability of the model agreed well with the actual probability. Decision curve analysis (DCA) showed that the nomogram has high clinical application value. Conclusion In-hospital survival rates of patients with COVID-19 were predicted using a nomogram, which will help clinicians in make appropriate clinical decisions.
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Affiliation(s)
- Wen-Hui Bai
- Department of Hepatobiliary Surgery, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430200, China
| | - Jing-Jing Yang
- Department of Critical Care Medicine, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430200, China
| | - Zhou Liu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430000, China
| | - Wan-Shan Ning
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China
| | - Yong Mao
- Department of Vascular Surgery, North Campus of Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 201900, China
| | - Chen-Liang Zhou
- Department of Critical Care Medicine, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430200, China
| | - Li Cheng
- Department of Critical Care Medicine, Eastern Campus, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430200, China
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Ramón A, Bas A, Herrero S, Blasco P, Suárez M, Mateo J. Personalized Assessment of Mortality Risk and Hospital Stay Duration in Hospitalized Patients with COVID-19 Treated with Remdesivir: A Machine Learning Approach. J Clin Med 2024; 13:1837. [PMID: 38610602 PMCID: PMC11013017 DOI: 10.3390/jcm13071837] [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: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Despite advancements in vaccination, early treatments, and understanding of SARS-CoV-2, its impact remains significant worldwide. Many patients require intensive care due to severe COVID-19. Remdesivir, a key treatment option among viral RNA polymerase inhibitors, lacks comprehensive studies on factors associated with its effectiveness. Methods: We conducted a retrospective study in 2022, analyzing data from 252 hospitalized COVID-19 patients treated with remdesivir. Six machine learning algorithms were compared to predict factors influencing remdesivir's clinical benefits regarding mortality and hospital stay. Results: The extreme gradient boost (XGB) method showed the highest accuracy for both mortality (95.45%) and hospital stay (94.24%). Factors associated with worse outcomes in terms of mortality included limitations in life support, ventilatory support needs, lymphopenia, low albumin and hemoglobin levels, flu and/or coinfection, and cough. For hospital stay, factors included vaccine doses, lung density, pulmonary radiological status, comorbidities, oxygen therapy, troponin, lactate dehydrogenase levels, and asthenia. Conclusions: These findings underscore XGB's effectiveness in accurately categorizing COVID-19 patients undergoing remdesivir treatment.
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Affiliation(s)
- Antonio Ramón
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Andrés Bas
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
| | - Santiago Herrero
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
| | - Pilar Blasco
- Department of Pharmacy, University General Hospital, 46014 Valencia, Spain; (A.R.); (A.B.); (S.H.); (P.B.)
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Miguel Suárez
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
- Department of Gastroenterology, Virgen de la Luz Hospital, 16002 Cuenca, Spain
| | - Jorge Mateo
- Medical Analysis Expert Group, Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
- Medical Analysis Expert Group, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
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Bhavani SV, Robichaux C, Verhoef PA, Churpek MM, Coopersmith CM. Using Trajectories of Bedside Vital Signs to Identify COVID-19 Subphenotypes. Chest 2024; 165:529-539. [PMID: 37748574 PMCID: PMC10925543 DOI: 10.1016/j.chest.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajectory model in a multicenter cohort of patients hospitalized with COVID-19 and to evaluate the clinical characteristics and outcomes of the resulting subphenotypes. RESEARCH QUESTION Can the trajectory of routine bedside vital signs identify COVID-19 subphenotypes with distinct clinical characteristics and outcomes? STUDY DESIGN AND METHODS The study included adult patients admitted with COVID-19 to four academic hospitals in the Emory Healthcare system between March 1, 2020, and May 31, 2022. Using a validated group-based trajectory model, we classified patients into previously defined vital sign trajectories using oral temperature, heart rate, respiratory rate, and systolic and diastolic BP measured in the first 8 h of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. Heterogeneity of treatment effect to tocilizumab was evaluated. RESULTS The 7,065 patients with hospitalized COVID-19 were classified into four subphenotypes: group A (n = 1,429, 20%)-high temperature, heart rate, respiratory rate, and hypotensive; group B (1,454, 21%)-high temperature, heart rate, respiratory rate, and hypertensive; group C (2,996, 42%)-low temperature, heart rate, respiratory rate, and normotensive; and group D (1,186, 17%)-low temperature, heart rate, respiratory rate, and hypotensive. Groups A and D had higher ORs of mechanical ventilation, vasopressors, and 30-day inpatient mortality (P < .001). On comparing patients receiving tocilizumab (n = 55) with those who met criteria for tocilizumab but were admitted before its use (n = 461), there was significant heterogeneity of treatment effect across subphenotypes in the association of tocilizumab with 30-day mortality (P = .001). INTERPRETATION By using bedside vital signs available in even low-resource settings, we found novel subphenotypes associated with distinct manifestations of COVID-19, which could lead to preemptive and targeted treatments.
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Affiliation(s)
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Philip A Verhoef
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI; Hawaii Permanente Medical Group, Honolulu, HI
| | | | - Craig M Coopersmith
- Emory Critical Care Center, Atlanta, GA; Department of Surgery, Emory University, Atlanta, GA
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7
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Giacobbe DR, Di Maria E, Tagliafico AS, Bavastro M, Trombetta CS, Marelli C, Di Meco G, Cattardico G, Mora S, Signori A, Vena A, Mikulska M, Dentone C, Bruzzone B, Bignotti B, Orsi A, Robba C, Ball L, Brunetti I, Battaglini D, Di Biagio A, Sormani MP, Pelosi P, Giacomini M, Icardi G, Bassetti M. External validation of unsupervised COVID-19 clinical phenotypes and their prognostic impact. Ann Med 2023; 55:2195204. [PMID: 37052252 PMCID: PMC10116925 DOI: 10.1080/07853890.2023.2195204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Hospitalized patients with coronavirus disease 2019 (COVID-19) can be classified into different clinical phenotypes based on their demographic, clinical, radiology, and laboratory features. We aimed to validate in an external cohort of hospitalized COVID-19 patients the prognostic value of a previously described phenotyping system (FEN-COVID-19) and to assess the reproducibility of phenotypes development as a secondary analysis. METHODS Patients were classified in phenotypes A, B or C according to the severity of oxygenation impairment, inflammatory response, hemodynamic and laboratory tests according to the FEN-COVID-19 method. RESULTS Overall, 992 patients were included in the study, and 181 (18%), 757 (76%) and 54 (6%) of them were assigned to the FEN-COVID-19 phenotypes A, B, and C, respectively. An association with mortality was observed for phenotype C vs. A (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.81-5.30, p < 0.001) and for phenotype C vs. B (HR 2.20, 95% CI 1.50-3.23, p < 0.001). A non-statistically significant trend towards higher mortality was also observed for phenotype B vs. A (HR 1.41; 95% CI 0.92-2.15, p = 0.115). By means of cluster analysis, three different phenotypes were also identified in our cohort, with an overall similar gradient in terms of prognostic impact to that observed when patients were assigned to FEN-COVID-19 phenotypes. CONCLUSIONS The prognostic impact of FEN-COVID-19 phenotypes was confirmed in our external cohort, although with less difference in mortality between phenotypes A and B than in the original study.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emilio Di Maria
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- University Unit of Medical Genetics, Galliera Hospital, Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Martina Bavastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Carlo Simone Trombetta
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cristina Marelli
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gabriele Di Meco
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Greta Cattardico
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Alessio Signori
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Dentone
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bignotti
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Robba
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lorenzo Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maria Pia Sormani
- Section of Biostatistics, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Giacomini
- Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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8
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Jiménez-Cortegana C, Salamanca E, Palazón-Carrión N, Sánchez-Jiménez F, Pérez-Pérez A, Vilariño-García T, Fuentes S, Martín S, Jiménez M, Galván R, Rodríguez-Chacón C, Sánchez-Mora C, Moreno-Mellado E, Gutiérrez-Gutiérrez B, Álvarez N, Sosa A, Garnacho-Montero J, de la Cruz-Merino L, Rodríguez-Baño J, Sánchez-Margalet V. Circulating myeloid-derived suppressor cells may be a useful biomarker in the follow-up of unvaccinated COVID-19 patients after hospitalization. Front Immunol 2023; 14:1266659. [PMID: 38035104 PMCID: PMC10685891 DOI: 10.3389/fimmu.2023.1266659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
SARS-CoV-2 infection is the cause of the disease named COVID-19, a major public health challenge worldwide. Differences in the severity, complications and outcomes of the COVID-19 are intriguing and, patients with similar baseline clinical conditions may have very different evolution. Myeloid-derived suppressor cells (MDSCs) have been previously found to be recruited by the SARS-CoV-2 infection and may be a marker of clinical evolution in these patients. We have studied 90 consecutive patients admitted in the hospital before the vaccination program started in the general population, to measure MDSCs and lymphocyte subpopulations at admission and one week after to assess the possible association with unfavorable outcomes (dead or Intensive Care Unit admission). We analyzed MDSCs and lymphocyte subpopulations by flow cytometry. In the 72 patients discharged from the hospital, there were significant decreases in the monocytic and total MDSC populations measured in peripheral blood after one week but, most importantly, the number of MDSCs (total and both monocytic and granulocytic subsets) were much higher in the 18 patients with unfavorable outcome. In conclusion, the number of circulating MDSCs may be a good marker of evolution in the follow-up of unvaccinated patients admitted in the hospital with the diagnosis of COVID-19.
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Affiliation(s)
- Carlos Jiménez-Cortegana
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Elena Salamanca
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Palazón-Carrión
- Clinical Oncology Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Flora Sánchez-Jiménez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Antonio Pérez-Pérez
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Teresa Vilariño-García
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Sandra Fuentes
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Salomón Martín
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Marta Jiménez
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Raquel Galván
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | | | - Catalina Sánchez-Mora
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Elisa Moreno-Mellado
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Gutiérrez-Gutiérrez
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Nerissa Álvarez
- Intensive Care Unit, Virgen Macarena University Hospital, Seville, Spain
| | - Alberto Sosa
- Intensive Care Unit, Virgen Macarena University Hospital, Seville, Spain
| | | | - Luis de la Cruz-Merino
- Clinical Oncology Service, Virgen Macarena University Hospital, University of Seville, Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and, Microbiology and Preventive Medicine Unit, Virgen Macarena University Hospital/Departments of Medicine and Microbiology, University of Seville/Biomedicine Institute of Seville (IBiS), Seville, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Sánchez-Margalet
- Department of Medical Biochemistry and Molecular Biology, School of Medicine, Virgen Macarena University Hospital, University of Seville, Seville, Spain
- Department of Laboratory Medicine, Virgen Macarena University Hospital, Seville, Spain
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9
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Loucera C, Carmona R, Esteban-Medina M, Bostelmann G, Muñoyerro-Muñiz D, Villegas R, Peña-Chilet M, Dopazo J. Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments. Virol J 2023; 20:226. [PMID: 37803348 PMCID: PMC10559601 DOI: 10.1186/s12985-023-02195-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
PURPOSE Despite the extensive vaccination campaigns in many countries, COVID-19 is still a major worldwide health problem because of its associated morbidity and mortality. Therefore, finding efficient treatments as fast as possible is a pressing need. Drug repurposing constitutes a convenient alternative when the need for new drugs in an unexpected medical scenario is urgent, as is the case with COVID-19. METHODS Using data from a central registry of electronic health records (the Andalusian Population Health Database), the effect of prior consumption of drugs for other indications previous to the hospitalization with respect to patient outcomes, including survival and lymphocyte progression, was studied on a retrospective cohort of 15,968 individuals, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. RESULTS Covariate-adjusted hazard ratios and analysis of lymphocyte progression curves support a significant association between consumption of 21 different drugs and better patient survival. Contrarily, one drug, furosemide, displayed a significant increase in patient mortality. CONCLUSIONS In this study we have taken advantage of the availability of a regional clinical database to study the effect of drugs, which patients were taking for other indications, on their survival. The large size of the database allowed us to control covariates effectively.
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Affiliation(s)
- Carlos Loucera
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
| | - Rosario Carmona
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain
| | - Marina Esteban-Medina
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
| | - Gerrit Bostelmann
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información. Servicio Andaluz de Salud, Sevilla, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información. Servicio Andaluz de Salud, Sevilla, Spain
| | - María Peña-Chilet
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain
| | - Joaquín Dopazo
- Computational Medicine Platform, Andalusian Public Foundation Progress and Health-FPS, Sevilla, Spain.
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, Sevilla, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS. Hospital Virgen del Rocio, Sevilla, Spain.
- FPS/ELIXIR-ES, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, Sevilla, Spain.
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10
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Carpio C, Qasem A, Buño A, Borobia AM, Arnalich F, Rey V, Lázaro T, Mariscal P, Laorden D, Salgueiro G, Moreno A, Peiró C, Lorenzo Ó, Álvarez-Sala R. Krebs von den Lungen-6 (KL-6) Levels in Post-COVID Follow-Up: Differences According to the Severity of COVID-19. J Clin Med 2023; 12:6299. [PMID: 37834944 PMCID: PMC10573402 DOI: 10.3390/jcm12196299] [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: 08/30/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
To evaluate KL-6 levels in medium-term post-COVID and to compare them in three groups categorised by the severity of COVID-19, we conducted a real-world, retrospective, cohort study. Data from the COVID-19 episode and follow-up during the post-COVID phase were extracted from the COVID@HULP and POSTCOVID@HULP databases, respectively. For the post-COVID period we included demographics, medical history, symptoms, quality of life, physical activity, anxiety and depression status and laboratory results. Patients were categorised into three groups based on the severity of COVID-19: Group 1 (inpatient critical), Group 2 (inpatient non-critical) and Group 3 (hospitalised at home). KL-6 was measured during the follow-up of the three groups. In all, 802 patients were included (Group 1 = 59; Group 2 = 296; Group 3 = 447 patients). The median age was 59 years (48-70), and 362 (45.2%) were males. At admission, fibrinogen and ferritin levels were lower in Group 3 than in the other groups (p < 0.001). Follow-up data were obtained 124 days (97-149) after the diagnosis of COVID-19. The median levels of fibrinogen, ferritin and KL-6 at follow-up were 336 mg/dL (276-413), 80.5 ng/mL (36-174.3) and 326 U/mL (240.3-440.3), respectively. KL-6 levels were lower in Group 3 than in the other groups (298 U/mL (231.5-398) vs. 381.5 U/mL (304-511.8) (Group 1) and 372 U/mL (249-483) (Group 2) (p < 0.001)). KL-6 was associated with ferritin (p < 0.001), fibrinogen (p < 0.001), D-dimer (p < 0.001) and gamma-glutamyl transferase (p < 0.001). KL-6 levels are less elevated at medium-term post-COVID follow-up in patients with mild COVID-19 than in those with moderate or severe disease. KL-6 is associated with systemic inflammatory, hepatic enzyme and thrombosis biomarkers.
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Affiliation(s)
- Carlos Carpio
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Ana Qasem
- Clinical Analytics Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Antonio Buño
- Clinical Analytics Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Alberto M. Borobia
- Clinical Pharmacology Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.M.B.); (V.R.)
| | - Francisco Arnalich
- Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.A.); (G.S.); (A.M.)
| | - Vega Rey
- Clinical Pharmacology Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (A.M.B.); (V.R.)
| | - Teresa Lázaro
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Pablo Mariscal
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Daniel Laorden
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
| | - Giorgina Salgueiro
- Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.A.); (G.S.); (A.M.)
| | - Alberto Moreno
- Internal Medicine Department, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, 28049 Madrid, Spain; (F.A.); (G.S.); (A.M.)
| | - Concepción Peiró
- Pharmacology Department. Universidad Autónoma de Madrid, IdiPAZ, 28049 Madrid, Spain;
| | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular pathology, IIS, Fundación Jiménez Díaz, CIBERDEM, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Rodolfo Álvarez-Sala
- Pneumology Department, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Universidad Autónoma de Madrid, 28046 Madrid, Spain; (T.L.); (P.M.); (D.L.); (R.Á.-S.)
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11
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Gonzaga A, Andreu E, Hernández-Blasco LM, Meseguer R, Al-Akioui-Sanz K, Soria-Juan B, Sanjuan-Gimenez JC, Ferreras C, Tejedo JR, Lopez-Lluch G, Goterris R, Maciá L, Sempere-Ortells JM, Hmadcha A, Borobia A, Vicario JL, Bonora A, Aguilar-Gallardo C, Poveda JL, Arbona C, Alenda C, Tarín F, Marco FM, Merino E, Jaime F, Ferreres J, Figueira JC, Cañada-Illana C, Querol S, Guerreiro M, Eguizabal C, Martín-Quirós A, Robles-Marhuenda Á, Pérez-Martínez A, Solano C, Soria B. Rationale for combined therapies in severe-to-critical COVID-19 patients. Front Immunol 2023; 14:1232472. [PMID: 37767093 PMCID: PMC10520558 DOI: 10.3389/fimmu.2023.1232472] [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: 05/31/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
An unprecedented global social and economic impact as well as a significant number of fatalities have been brought on by the coronavirus disease 2019 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute SARS-CoV-2 infection can, in certain situations, cause immunological abnormalities, leading to an anomalous innate and adaptive immune response. While most patients only experience mild symptoms and recover without the need for mechanical ventilation, a substantial percentage of those who are affected develop severe respiratory illness, which can be fatal. The absence of effective therapies when disease progresses to a very severe condition coupled with the incomplete understanding of COVID-19's pathogenesis triggers the need to develop innovative therapeutic approaches for patients at high risk of mortality. As a result, we investigate the potential contribution of promising combinatorial cell therapy to prevent death in critical patients.
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Affiliation(s)
- Aitor Gonzaga
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
| | - Etelvina Andreu
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Applied Physics Department, Miguel Hernández University, Elche, Spain
| | | | - Rut Meseguer
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Clinic University Hospital, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA) Health Research Institute, Valencia, Spain
| | - Karima Al-Akioui-Sanz
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Bárbara Soria-Juan
- Réseau Hospitalier Neuchâtelois, Hôpital Pourtalès, Neuchâtel, Switzerland
| | | | - Cristina Ferreras
- Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, Madrid, Spain
| | - Juan R. Tejedo
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Seville, Spain
- Biomedical Research Network for Diabetes and Related Metabolic Diseases-Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) of the Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Guillermo Lopez-Lluch
- University Pablo de Olavide, Centro Andaluz de Biología del Desarrollo - Consejo Superior de Investigaciones Científicas (CABD-CSIC), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Sevilla, Spain
| | - Rosa Goterris
- Clinic University Hospital, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA) Health Research Institute, Valencia, Spain
| | - Loreto Maciá
- Nursing Department, University of Alicante, Alicante, Spain
| | - Jose M. Sempere-Ortells
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Biotechnology Department, University of Alicante, Alicante, Spain
| | - Abdelkrim Hmadcha
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Seville, Spain
- Biosanitary Research Institute (IIB-VIU), Valencian International University (VIU), Valencia, Spain
| | - Alberto Borobia
- Clinical Pharmacology Department, La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, IdiPAz, Madrid, Spain
| | - Jose L. Vicario
- Transfusion Center of the Autonomous Community of Madrid, Madrid, Spain
| | - Ana Bonora
- Health Research Institute Hospital La Fe, Valencia, Spain
| | | | - Jose L. Poveda
- Health Research Institute Hospital La Fe, Valencia, Spain
| | - Cristina Arbona
- Valencian Community Blood Transfusion Center, Valencia, Spain
| | - Cristina Alenda
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Fabian Tarín
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Francisco M. Marco
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Immunology Department, Dr. Balmis General University Hospital, Alicante, Spain
| | - Esperanza Merino
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, Miguel Hernández University, Elche, Spain
- Infectious Diseases Unit, Dr. Balmis General University Hospital, Alicante, Spain
| | - Francisco Jaime
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Ferreres
- Intensive Care Service, Hospital Clinico Universitario, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Valencia, Spain
| | | | | | | | - Manuel Guerreiro
- Department of Hematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Cristina Eguizabal
- Research Unit, Basque Center for Blood Transfusion and Human Tissues, Galdakao, Spain
- Cell Therapy, Stem Cells and Tissues Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | | | | | - Antonio Pérez-Martínez
- Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, Madrid, Spain
- Department of Pediatrics, Faculty of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Valencia, Spain
| | - Bernat Soria
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Institute of Bioengineering, Miguel Hernández University, Elche, Spain
- Biomedical Research Network for Diabetes and Related Metabolic Diseases-Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) of the Carlos III Health Institute (ISCIII), Madrid, Spain
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12
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Bassetti M, Brucci G, Vena A, Giacobbe DR. Use of antibiotics in hospitalized patients with COVID-19: evolving concepts in a highly dynamic antimicrobial stewardship scenario. Expert Opin Pharmacother 2023; 24:1679-1684. [PMID: 37466425 DOI: 10.1080/14656566.2023.2239154] [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: 05/15/2023] [Revised: 06/23/2023] [Accepted: 07/18/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Excessive use of antibiotics has been frequently reported in hospitalized patients with COVID-19 worldwide, compared to the actual number of bacterial co-infections or super-infections. AREAS COVERED In this perspective, we discuss the current literature on the use of antibiotics and antimicrobial stewardship interventions in hospitalized patients with COVID-19. A search was conducted in PubMed up to March 2023. EXPERT OPINION The COVID-19 pandemic has witnessed an excessive use of antibiotics in hospitals worldwide, especially before the advent of COVID-19 vaccination, although according to the most recent data there is still an important disproportion between the prevalence of antibiotic use and that of proven bacterial coinfection or superinfections. An important reduction in the prevalence of antibiotic use in COVID-19 patients reported in the literature, from 70-100% to 50-60%, has been observed after successful vaccination campaigns, likely related to the reduced median disease severity of hospitalized COVID-19 patients and some successful interventions of antimicrobial and diagnostic stewardship. However, the disproportion between antibiotic use and the prevalence of bacterial infections (4-6%) is still uncomfortable from an antimicrobial stewardship perspective and requires further attention.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Giorgia Brucci
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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13
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Charkoftaki G, Aalizadeh R, Santos-Neto A, Tan WY, Davidson EA, Nikolopoulou V, Wang Y, Thompson B, Furnary T, Chen Y, Wunder EA, Coppi A, Schulz W, Iwasaki A, Pierce RW, Cruz CSD, Desir GV, Kaminski N, Farhadian S, Veselkov K, Datta R, Campbell M, Thomaidis NS, Ko AI, Thompson DC, Vasiliou V. An AI-powered patient triage platform for future viral outbreaks using COVID-19 as a disease model. Hum Genomics 2023; 17:80. [PMID: 37641126 PMCID: PMC10463861 DOI: 10.1186/s40246-023-00521-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023] Open
Abstract
Over the last century, outbreaks and pandemics have occurred with disturbing regularity, necessitating advance preparation and large-scale, coordinated response. Here, we developed a machine learning predictive model of disease severity and length of hospitalization for COVID-19, which can be utilized as a platform for future unknown viral outbreaks. We combined untargeted metabolomics on plasma data obtained from COVID-19 patients (n = 111) during hospitalization and healthy controls (n = 342), clinical and comorbidity data (n = 508) to build this patient triage platform, which consists of three parts: (i) the clinical decision tree, which amongst other biomarkers showed that patients with increased eosinophils have worse disease prognosis and can serve as a new potential biomarker with high accuracy (AUC = 0.974), (ii) the estimation of patient hospitalization length with ± 5 days error (R2 = 0.9765) and (iii) the prediction of the disease severity and the need of patient transfer to the intensive care unit. We report a significant decrease in serotonin levels in patients who needed positive airway pressure oxygen and/or were intubated. Furthermore, 5-hydroxy tryptophan, allantoin, and glucuronic acid metabolites were increased in COVID-19 patients and collectively they can serve as biomarkers to predict disease progression. The ability to quickly identify which patients will develop life-threatening illness would allow the efficient allocation of medical resources and implementation of the most effective medical interventions. We would advocate that the same approach could be utilized in future viral outbreaks to help hospitals triage patients more effectively and improve patient outcomes while optimizing healthcare resources.
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Affiliation(s)
- Georgia Charkoftaki
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Reza Aalizadeh
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Zografou, 15771, Greece
| | - Alvaro Santos-Neto
- São Carlos Institute of Chemistry, University of São Paulo, São Carlos, SP, 13566-590, Brazil
| | - Wan Ying Tan
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Internal Medicine Residency Program, Department of Internal Medicine, Norwalk Hospital, Norwalk, CT, USA
| | - Emily A Davidson
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, CT, USA
| | - Varvara Nikolopoulou
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Zografou, 15771, Greece
| | - Yewei Wang
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Brian Thompson
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Tristan Furnary
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ying Chen
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Elsio A Wunder
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Institute Gonçalo Moniz, Fundação Oswaldo Cruz, Brazilian Ministry of Health, Salvador, Brazil
| | - Andreas Coppi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Wade Schulz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
- Howard Hughes Medical Institute, MD, Chevy Chase, USA
| | - Richard W Pierce
- Department of Pediatrics , Yale School of Medicine, New Haven, CT, USA
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Gary V Desir
- Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
| | - Naftali Kaminski
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shelli Farhadian
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, USA
| | - Kirill Veselkov
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London, UK
| | - Rupak Datta
- Veterans Affairs Connecticut Healthcare System, CT, West Haven, USA
- Department of Internal Medicine, Yale School of Medicine, CT, New Haven, USA
| | - Melissa Campbell
- Department of Pediatrics, Division of Pediatric Infectious Diseases, School of Medicine, Duke University, NC, Durham, USA
| | - Nikolaos S Thomaidis
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
- Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, Athens, Zografou, 15771, Greece
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Institute Gonçalo Moniz, Fundação Oswaldo Cruz, Brazilian Ministry of Health, Salvador, Brazil
- Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA
| | - David C Thompson
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Vasilis Vasiliou
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.
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Papathanakos G, Andrianopoulos I, Xenikakis M, Papathanasiou A, Koulenti D, Blot S, Koulouras V. Clinical Sepsis Phenotypes in Critically Ill Patients. Microorganisms 2023; 11:2165. [PMID: 37764009 PMCID: PMC10538192 DOI: 10.3390/microorganisms11092165] [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] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis, defined as the life-threatening dysregulated host response to an infection leading to organ dysfunction, is considered as one of the leading causes of mortality worldwide, especially in intensive care units (ICU). Moreover, sepsis remains an enigmatic clinical syndrome, with complex pathophysiology incompletely understood and a great heterogeneity both in terms of clinical expression, patient response to currently available therapeutic interventions and outcomes. This heterogeneity proves to be a major obstacle in our quest to deliver improved treatment in septic critical care patients; thus, identification of clinical phenotypes is absolutely necessary. Although this might be seen as an extremely difficult task, nowadays, artificial intelligence and machine learning techniques can be recruited to quantify similarities between individuals within sepsis population and differentiate them into distinct phenotypes regarding not only temperature, hemodynamics or type of organ dysfunction, but also fluid status/responsiveness, trajectories in ICU and outcome. Hopefully, we will eventually manage to determine both the subgroup of septic patients that will benefit from a therapeutic intervention and the correct timing of applying the intervention during the disease process.
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Affiliation(s)
- Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Ioannis Andrianopoulos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QL 4029, Australia;
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Stijn Blot
- Department of Internal Medicine & Pediatrics, Ghent University, 9000 Ghent, Belgium;
| | - Vasilios Koulouras
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
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15
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Li D, Xu M, Hooper AT, Rofail D, Mohammadi KA, Chen Y, Ali S, Norton T, Weinreich DM, Musser BJ, Hamilton JD, Geba GP. Casirivimab + imdevimab accelerates symptom resolution linked to improved COVID-19 outcomes across susceptible antibody and risk profiles. Sci Rep 2023; 13:12784. [PMID: 37550377 PMCID: PMC10406852 DOI: 10.1038/s41598-023-39681-7] [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: 12/21/2022] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
Severe, protracted symptoms are associated with poor outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In a placebo-controlled study of casirivimab and imdevimab (CAS + IMD) in persons at high risk of severe coronavirus disease 2019 (COVID-19; n = 3816), evolution of individual symptoms was assessed for resolution patterns across risk factors, and baseline SARS-CoV-2-specific antibody responses against S1 and N domains. CAS + IMD versus placebo provided statistically significant resolution for 17/23 symptoms, with greater response linked to absence of endogenous anti-SARS-CoV-2 immunoglobulin (Ig)G, IgA, or specific neutralizing antibodies at baseline, or high baseline viral load. Resolution of five key symptoms (onset days 3-5)-dyspnea, cough, feeling feverish, fatigue, and loss of appetite-independently correlated with reduced hospitalization and death (hazard ratio range: 0.31-0.56; P < 0.001-0.043), and was more rapid in CAS + IMD-treated patients lacking robust early antibody responses. Those who seroconverted late still benefited from treatment. Thus, highly neutralizing COVID-19-specific antibodies provided by CAS + IMD treatment accelerated key symptom resolution associated with hospitalization and death in those at high risk for severe disease as well as in those lacking early, endogenous neutralizing antibody responses.
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Affiliation(s)
- Dateng Li
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Meng Xu
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Andrea T Hooper
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Diana Rofail
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Kusha A Mohammadi
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Yiziying Chen
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Shazia Ali
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Thomas Norton
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - David M Weinreich
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Bret J Musser
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Jennifer D Hamilton
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA
| | - Gregory P Geba
- Global Development, Regeneron Pharmaceuticals, Inc., 777 Old Saw Mill River Road, Tarrytown, NY, 10591, USA.
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16
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Faucheux L, Bassolli de Oliveira Alves L, Chevret S, Rocha V. Comparison of characteristics and laboratory tests of COVID-19 hematological patients from France and Brazil during the pre-vaccination period: identification of prognostic profiles for survival. Hematol Transfus Cell Ther 2023; 45:306-316. [PMID: 35673599 PMCID: PMC9159977 DOI: 10.1016/j.htct.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/29/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION COVID-19 disease presentation is heterogeneous, from asymptomatic up to severe life-threatening forms. Getting further insights into patients with specific diseases is of particular interest. We aimed to identify profiles of hematology patients hospitalized with COVID-19 that would be associated with survival and to assess the differences between cohorts METHODS: A binational cohort of 263 patients with COVID-19 and hematological disease was studied in Paris, France and São Paulo, Brazil. Patient profiles were based on age, comorbidities, biological measurements, COVID-19 symptoms and hematological disease characteristics. A semi-supervised learning method with a survival endpoint was first used, following which, a classifier was identified to allow the classification of patients using only baseline information MAIN RESULTS: Two profiles of patients were identified, one being young patients with few comorbidities and low C-reactive protein (CRP), D-dimers, lactate dehydrogenase (LDH) and creatinine levels, and the other, older patients, with several comorbidities and high levels of the 4 biology markers. The profiles were strongly associated with survival (p < 0.0001), even after adjusting for age (p = 0.0002). The 30-day survival rate was 77.1% in the first profiles, versus 46.7% in the second. The Brazilian analysis emphasized the importance of age, while the French focused on the comorbidities CONCLUSION: This analysis showed the importance of CRP, LHD and creatinine in the COVID-19 presentation and prognosis, whatever the geographic origin of the patients.
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Affiliation(s)
- Lilith Faucheux
- Hôpital Saint Louis, Université de Paris, Paris, France; Université de Paris, INSERM U976, Paris, France.
| | | | | | - Vanderson Rocha
- Hospital das Clinicas, Faculty of Medicine, Universidade de São Paulo (HCFM-USP), São Paulo, SP, Brazil; Churchill Hospital, Oxford University, Oxford, UK
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17
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Aranda J, Loureiro-Amigo J, Murgadella A, Vàzquez N, Feria L, Muñoz M, Padulles A, Abelenda G, Garcia-Vidal C, Tuset M, Albanell M, Boix-Palop L, Sanmartí-Martínez N, Gómez-Zorrilla S, Echeverria-Esnal D, Rodriguez-Alarcón A, Borjabad B, Coloma A, Carratalà J, Oriol I. Changing Trends in the Global Consumption of Treatments Used in Hospitalized Patients for COVID-19: A Time Series Multicentre Study. Antibiotics (Basel) 2023; 12:antibiotics12050809. [PMID: 37237712 DOI: 10.3390/antibiotics12050809] [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: 03/11/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
AIM To analyze trends in the prescription of COVID-19 treatments for hospitalized patients during the pandemic. METHODS Multicenter, ecological, time-series study of aggregate data for all adult patients with COVID-19 treated in five acute-care hospitals in Barcelona, Spain, between March 2020 and May 2021. Trends in the monthly prevalence of drugs used against COVID-19 were analyzed by the Mantel-Haenszel test. RESULTS The participating hospitals admitted 22,277 patients with COVID-19 during the study period, reporting an overall mortality of 10.8%. In the first months of the pandemic, lopinavir/ritonavir and hydroxychloroquine were the most frequently used antivirals, but these fell into disuse and were replaced by remdesivir in July 2020. By contrast, the trend in tocilizumab use varied, first peaking in April and May 2020, declining until January 2021, and showing a discrete upward trend thereafter. Regarding corticosteroid use, we observed a notable upward trend in the use of dexamethasone 6 mg per day from July 2020. Finally, there was a high prevalence of antibiotics use, especially azithromycin, in the first three months, but this decreased thereafter. CONCLUSIONS Treatment for patients hospitalized with COVID-19 evolved with the changing scientific evidence during the pandemic. Initially, multiple drugs were empirically used that subsequently could not demonstrate clinical benefit. In future pandemics, stakeholders should strive to promote the early implementation of adaptive randomized clinical trials.
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Affiliation(s)
- Judit Aranda
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Jose Loureiro-Amigo
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Anna Murgadella
- Pharmacy Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Núria Vàzquez
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Lucía Feria
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Miriam Muñoz
- Pharmacy Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain
| | - Ariadna Padulles
- Pharmacy Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Gabriela Abelenda
- Infectious Diseases Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain
| | - Carol Garcia-Vidal
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Montse Tuset
- Pharmacy Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Marta Albanell
- Pharmacy Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Department, Hospital Mútua de Terrassa, 08221 Terrassa, Spain
| | | | - Sílvia Gómez-Zorrilla
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) (Center Associated with the Universitat Pompeu Fabra), 08003 Barcelona, Spain
| | - Daniel Echeverria-Esnal
- Pharmacy Department, Hospital del Mar, Parc De Salut Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) (Center Associated with the Universitat Pompeu Fabra), 08003 Barcelona, Spain
| | - Alicia Rodriguez-Alarcón
- Pharmacy Department, Hospital del Mar, Parc De Salut Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) (Center Associated with the Universitat Pompeu Fabra), 08003 Barcelona, Spain
| | - Beatriz Borjabad
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Ana Coloma
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Jordi Carratalà
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Department, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain
- Clinical Science Department, Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
| | - Isabel Oriol
- Infectious Diseases Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Clinical Science Department, Faculty of Medicine, University of Barcelona, 08036 Barcelona, Spain
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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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Zhang HP, Sun YL, Wang YF, Yazici D, Azkur D, Ogulur I, Azkur AK, Yang ZW, Chen XX, Zhang AZ, Hu JQ, Liu GH, Akdis M, Akdis CA, Gao YD. Recent developments in the immunopathology of COVID-19. Allergy 2023; 78:369-388. [PMID: 36420736 PMCID: PMC10108124 DOI: 10.1111/all.15593] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
There has been an important change in the clinical characteristics and immune profile of Coronavirus disease 2019 (COVID-19) patients during the pandemic thanks to the extensive vaccination programs. Here, we highlight recent studies on COVID-19, from the clinical and immunological characteristics to the protective and risk factors for severity and mortality of COVID-19. The efficacy of the COVID-19 vaccines and potential allergic reactions after administration are also discussed. The occurrence of new variants of concerns such as Omicron BA.2, BA.4, and BA.5 and the global administration of COVID-19 vaccines have changed the clinical scenario of COVID-19. Multisystem inflammatory syndrome in children (MIS-C) may cause severe and heterogeneous disease but with a lower mortality rate. Perturbations in immunity of T cells, B cells, and mast cells, as well as autoantibodies and metabolic reprogramming may contribute to the long-term symptoms of COVID-19. There is conflicting evidence about whether atopic diseases, such as allergic asthma and rhinitis, are associated with a lower susceptibility and better outcomes of COVID-19. At the beginning of pandemic, the European Academy of Allergy and Clinical Immunology (EAACI) developed guidelines that provided timely information for the management of allergic diseases and preventive measures to reduce transmission in the allergic clinics. The global distribution of COVID-19 vaccines and emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with reduced pathogenic potential dramatically decreased the morbidity, severity, and mortality of COVID-19. Nevertheless, breakthrough infection remains a challenge for disease control. Hypersensitivity reactions (HSR) to COVID-19 vaccines are low compared to other vaccines, and these were addressed in EAACI statements that provided indications for the management of allergic reactions, including anaphylaxis to COVID-19 vaccines. We have gained a depth knowledge and experience in the over 2 years since the start of the pandemic, and yet a full eradication of SARS-CoV-2 is not on the horizon. Novel strategies are warranted to prevent severe disease in high-risk groups, the development of MIS-C and long COVID-19.
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Affiliation(s)
- Huan-Ping Zhang
- Department of Allergology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuan-Li Sun
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan-Fen Wang
- Department of Pediatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Dilek Azkur
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ahmet Kursat Azkur
- Department of Virology, Faculty of Veterinary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Zhao-Wei Yang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Xue Chen
- Department of Allergology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Ai-Zhi Zhang
- Intensive Care Unit, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jia-Qian Hu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guang-Hui Liu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Wong JM, Volkman HR, Adams LE, Oliveras García C, Martinez-Quiñones A, Perez-Padilla J, Bertrán-Pasarell J, Sainz de la Peña D, Tosado-Acevedo R, Santiago GA, Muñoz-Jordán JL, Torres-Velásquez BC, Lorenzi O, Sánchez-González L, Rivera-Amill V, Paz-Bailey G. Clinical Features of COVID-19, Dengue, and Influenza among Adults Presenting to Emergency Departments and Urgent Care Clinics-Puerto Rico, 2012-2021. Am J Trop Med Hyg 2023; 108:107-114. [PMID: 36410319 PMCID: PMC9833087 DOI: 10.4269/ajtmh.22-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/27/2022] [Indexed: 11/23/2022] Open
Abstract
Dengue and influenza are pathogens of global concern and cause febrile illness similar to COVID-19. We analyzed data from an enhanced surveillance system operating from three emergency departments and an urgent care clinic in Puerto Rico to identify clinical features predictive of influenza or dengue compared with COVID-19. Participants with fever or respiratory symptoms and aged ≥18 years enrolled May 2012-January 2021 with dengue, influenza, or SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction were included. We calculated adjusted odds ratios (aORs) and 95% CIs using logistic regression to assess clinical characteristics of participants with COVID-19 compared to those with dengue or influenza, adjusting for age, subregion, and days from illness onset to presentation for clinical care. Among 13,431 participants, we identified 2,643 with dengue (N = 303), influenza (N = 2,064), or COVID-19 (N = 276). We found differences in days from onset to presentation among influenza (2 days [interquartile range: 1-3]), dengue (3 days [2-4]), and COVID-19 cases (4 days [2-7]; P < 0.001). Cough (aOR: 0.12 [95% CI: 0.07-0.19]) and shortness of breath (0.18 [0.08-0.44]) were less common in dengue compared with COVID-19. Facial flushing (20.6 [9.8-43.5]) and thrombocytopenia (24.4 [13.3-45.0]) were more common in dengue. Runny nose was more common in influenza compared with COVID-19 (8.3 [5.8-12.1]). In summary, cough, shortness of breath, facial flushing, and thrombocytopenia helped distinguish between dengue and COVID-19. Although few features distinguished influenza from COVID-19, presentation > 4 days after symptom onset suggests COVID-19. These findings may assist clinicians making time-sensitive decisions regarding triage, isolation, and management while awaiting pathogen-specific testing.
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Affiliation(s)
- Joshua M. Wong
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | - Laura E. Adams
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
| | | | | | | | | | | | | | | | | | | | - Olga Lorenzi
- Centers for Disease Control and Prevention, San Juan, Puerto Rico
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Sprockel Díaz JJ, Torres Tobar LA, Rodríguez Acosta MJ. Aplicación de la calculadora de probabilidad fenotípica FEN-COVID en pacientes hospitalizados por COVID-19 en una población latinoamericana. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introducción: la variabilidad del comportamiento clínico del COVID-19 puede ser uno de los determinantes que limitan la toma de decisiones terapéuticas. Se busca clasificar a pacientes latinoamericanos hospitalizados mediante la herramienta FEN-COVID para la identificación de fenotipos clínicos y determinar su asociación con mortalidad e ingreso a la unidad de cuidado intensivo (UCI). Métodos: estudio observacional de cohorte retrospectivo, que incluyó adultos hospitalizados en dos centros de tercer nivel de atención con COVID-19 confirmado entre septiembre 2020 y marzo 2021. A cada paciente seleccionado se asignó un fenotipo aplicando la calculadora FEN-COVID. Se llevó a cabo un análisis multivariado para documentar las asociaciones entre el fenotipo, las complicaciones hospitalarias y los desenlaces clínicos. Resultados: se identificaron 126 pacientes hospitalizados por COVID-19, edad promedio de 58 años, 45 mujeres (35.7%), 23% diabéticos, 45% hipertensos y 20% obesos. 108 (85.7%) fueron del fenotipo B y 18 (14.2%) fenotipo C. Aunque en este último los desenlaces fueron peores (requerimiento de UCI 77.8% vs 45.4% y mortalidad 66% vs 22%, OR 1.408, IC95% 3.191-5.243, p <0.007), esta asociación no se mantuvo en el análisis multivariado con OR 1.110 (IC95% 0.780 - 1.581, p de 0.555) Conclusión: los fenotipos identificados a partir de FEN-COVID parecen discriminar un subgrupo de pacientes que ostenta el peor comportamiento clínico, aunque no tuvo representación del fenotipo más leve. El análisis bivariado documentó asociación con la muerte o ingreso a UCI que no se mantuvo en el modelo multivariado.
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22
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Fiedler L, Motloch LJ, Jirak P, Gumerov R, Davtyan P, Gareeva D, Lakman I, Tataurov A, Lasinova G, Pavlov V, Hauptmann L, Kopp K, Hoppe UC, Lichtenauer M, Pistulli R, Dieplinger AM, Zagidullin N. Investigation of hs-TnI and sST-2 as Potential Predictors of Long-Term Cardiovascular Risk in Patients with Survived Hospitalization for COVID-19 Pneumonia. Biomedicines 2022; 10:2889. [PMID: 36359409 PMCID: PMC9687975 DOI: 10.3390/biomedicines10112889] [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: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: COVID-19 survivors reveal an increased long-term risk for cardiovascular disease. Biomarkers like troponins and sST-2 improve stratification of cardiovascular risk. Nevertheless, their prognostic value for identifying long-term cardiovascular risk after having survived COVID-19 has yet to be evaluated. Methods: In this single-center study, admission serum biomarkers of sST-2 and hs-TnI in a single cohort of 251 hospitalized COVID-19 survivors were evaluated. Concentrations were correlated with major cardiovascular events (MACE) defined as cardiovascular death and/or need for cardiovascular hospitalization during follow-up after hospital discharge [FU: 415 days (403; 422)]. Results: MACE was a frequent finding during FU with an incidence of 8.4% (cardiovascular death: 2.8% and/or need for cardiovascular hospitalization: 7.2%). Both biomarkers were reliable indicators of MACE (hs-TnI: sensitivity = 66.7% & specificity = 65.7%; sST-2: sensitivity = 33.3% & specificity = 97.4%). This was confirmed in a multivariate proportional-hazards analysis: besides age (HR = 1.047, 95% CI = 1.012−1.084, p = 0.009), hs-TnI (HR = 4.940, 95% CI = 1.904−12.816, p = 0.001) and sST-2 (HR = 10.901, 95% CI = 4.509−29.271, p < 0.001) were strong predictors of MACE. The predictive value of the model was further improved by combining both biomarkers with the factor age (concordance index hs-TnI + sST2 + age = 0.812). Conclusion: During long-term FU, hospitalized COVID-19 survivors, hs-TnI and sST-2 at admission, were strong predictors of MACE, indicating both proteins to be involved in post-acute sequelae of COVID-19.
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Affiliation(s)
- Lukas Fiedler
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, 2700 Wiener Neustadt, Austria
| | - Lukas J. Motloch
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Peter Jirak
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Ruslan Gumerov
- Department of Internal Diseases, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
| | - Paruir Davtyan
- Department of Internal Diseases, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
| | - Diana Gareeva
- Department of Internal Diseases, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
| | - Irina Lakman
- Department of Internal Diseases, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
- Scientific Laboratory for the Socio-Economic Region Problems Investigation, Ufa University of Science and Technology, Zaki Validi Str. 32, 450076 Ufa, Russia
| | - Alexandr Tataurov
- Department of Biomedical Engineering, Ufa University of Science and Technology, Zaki Validi Str. 32, 450076 Ufa, Russia
| | - Gulnaz Lasinova
- Department of Internal Diseases, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
| | - Valentin Pavlov
- Department of Urology, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
| | - Laurenz Hauptmann
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kristen Kopp
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Uta C. Hoppe
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Michael Lichtenauer
- University Clinic for Internal Medicine II, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, 48149 Muenster, Germany
| | - Anna-Maria Dieplinger
- Nursing Science Program, Institute for Nursing Science and Practice, Paracelsus Medical University, 5020 Salzburg, Austria
- Medical Faculty, Johannes Kepler University Linz, 4040 Linz, Austria
| | - Naufal Zagidullin
- Department of Internal Diseases, Bashkir State Medical University, Lenin Str. 3, 450008 Ufa, Russia
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23
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Tami A, van der Gun BTF, Wold KI, Vincenti-González MF, Veloo ACM, Knoester M, Harmsma VPR, de Boer GC, Huckriede ALW, Pantano D, Gard L, Rodenhuis-Zybert IA, Upasani V, Smit J, Dijkstra AE, de Haan JJ, van Elst JM, van den Boogaard J, O’ Boyle S, Nacul L, Niesters HGM, Friedrich AW. The COVID HOME study research protocol: Prospective cohort study of non-hospitalised COVID-19 patients. PLoS One 2022; 17:e0273599. [PMID: 36327223 PMCID: PMC9632784 DOI: 10.1371/journal.pone.0273599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Guidelines on COVID-19 management are developed as we learn from this pandemic. However, most research has been done on hospitalised patients and the impact of the disease on non-hospitalised and their role in transmission are not yet well understood. The COVID HOME study conducts research among COVID-19 patients and their family members who were not hospitalised during acute disease, to guide patient care and inform public health guidelines for infection prevention and control in the community and household. METHODS An ongoing prospective longitudinal observational study of COVID-19 outpatients was established in March 2020 at the beginning of the COVID-19 pandemic in the Netherlands. Laboratory confirmed SARS-CoV-2 infected individuals of all ages that did not merit hospitalisation, and their household (HH) members, were enrolled after written informed consent. Enrolled participants were visited at home within 48 hours after initial diagnosis, and then weekly on days 7, 14 and 21 to obtain clinical data, a blood sample for biochemical parameters/cytokines and serological determination; and a nasopharyngeal/throat swab plus urine, stool and sperm or vaginal secretion (if consenting) to test for SARS-CoV-2 by RT-PCR (viral shedding) and for viral culturing. Weekly nasopharyngeal/throat swabs and stool samples, plus a blood sample on days 0 and 21 were also taken from HH members to determine whether and when they became infected. All participants were invited to continue follow-up at 3-, 6-, 12- and 18-months post-infection to assess long-term sequelae and immunological status.
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Affiliation(s)
- Adriana Tami
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bernardina T. F. van der Gun
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin I. Wold
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - María F. Vincenti-González
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alida C. M. Veloo
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein Knoester
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Valerie P. R. Harmsma
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerolf C. de Boer
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anke L. W. Huckriede
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniele Pantano
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lilli Gard
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Izabela A. Rodenhuis-Zybert
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vinit Upasani
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jolanda Smit
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Akkelies E. Dijkstra
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jacco J. de Haan
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jip M. van Elst
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Shennae O’ Boyle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luis Nacul
- Department of Clinical Research, Faculty of Medicine and London School of Hygiene and Tropical Medicine, University of British Columbia, Vancouver, Canada
| | - Hubert G. M. Niesters
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Alex W. Friedrich
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Gustani-Buss EG, Buss CE, Cavalli LR, Panis C, Tuon FF, Telles JP, Follador FAC, Wendt GW, Lucio LC, Ferreto LED, de Oliveira IM, Carraro E, David LE, Simão ANC, Boldt ABW, Luiza Petzl-Erler M, Silva WA, Figueiredo DLA. Cross-sectional study for COVID-19-related mortality predictors in a Brazilian state-wide landscape: the role of demographic factors, symptoms and comorbidities. BMJ Open 2022; 12:e056801. [PMID: 36253047 PMCID: PMC9577275 DOI: 10.1136/bmjopen-2021-056801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The Brazilian state of Paraná has suffered from COVID-19 effects, understanding predictors of increased mortality in health system interventions prevent hospitalisation of patients. We selected the best models to evaluate the association of death with demographic characteristics, symptoms and comorbidities based on three levels of clinical severity for COVID-19: non-hospitalised, hospitalised non-ICU ward and ICU ward. DESIGN Cross-sectional survey using binomial mixed models. SETTING COVID-19-positive cases diagnosed by reverse transcription-PCR of municipalities located in Paraná State. PATIENTS Cases of anonymous datasets of electronic medical records from 1 April 2020 to 31 December 2020. PRIMARY AND SECONDARY OUTCOME MEASURES The best prediction factors were chosen based on criteria after a stepwise analysis using multicollinearity measure, lower Akaike information criterion and goodness-of-fit χ2 tests from univariate to multivariate contexts. RESULTS Male sex was associated with increased mortality among non-hospitalised patients (OR 1.76, 95% CI 1.47 to 2.11) and non-ICU patients (OR 1.22, 95% CI 1.05 to 1.43) for symptoms and for comorbidities (OR 1.89, 95% CI 1.59 to 2.25, and OR 1.30, 95% CI 1.11 to 1.52, respectively). Higher mortality occurred in patients older than 35 years in non-hospitalised (for symptoms: OR 4.05, 95% CI 1.55 to 10.54; and for comorbidities: OR 3.00, 95% CI 1.24 to 7.27) and in hospitalised over 40 years (for symptoms: OR 2.72, 95% CI 1.08 to 6.87; and for comorbidities: OR 2.66, 95% CI 1.22 to 5.79). Dyspnoea was associated with increased mortality in non-hospitalised (OR 4.14, 95% CI 3.45 to 4.96), non-ICU (OR 2.41, 95% CI 2.04 to 2.84) and ICU (OR 1.38, 95% CI 1.10 to 1.72) patients. Neurological disorders (OR 2.16, 95% CI 1.35 to 3.46), neoplastic (OR 3.22, 95% CI 1.75 to 5.93) and kidney diseases (OR 2.13, 95% CI 1.36 to 3.35) showed the majority of increased mortality for ICU as well in the three levels of severity jointly with heart disease, diabetes and CPOD. CONCLUSIONS These findings highlight the importance of the predictor's assessment for the implementation of public healthcare policy in response to the COVID-19 pandemic, mainly to understand how non-pharmaceutical measures could mitigate the virus impact over the population.
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Affiliation(s)
- Emanuele Gustani Gustani-Buss
- Bioinformatics Laboratory, Institute for Cancer Research, IPEC, Guarapuava, Brazil
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
| | - Carlos E Buss
- Bioinformatics Laboratory, Institute for Cancer Research, IPEC, Guarapuava, Brazil
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- MindFlow Genomics, Guarapuava, Brazil
| | - Luciane R Cavalli
- Postgraduate Program in Biotechnology Applied to Child and Adolescent Health at FPP, Faculdades Pequeno Príncipe, Curitiba, Brazil
| | - Carolina Panis
- Laboratory of Tumor Biology, Western Paraná State University-UNIOESTE, Cascavel, Brazil
| | - Felipe F Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Joao P Telles
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Franciele A C Follador
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Guilherme W Wendt
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Léia C Lucio
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Lirane E D Ferreto
- Department of Life Sciences,Postgraduate Program in Applied Health Sciences, Western Paraná State University-UNIOESTE, Francisco Beltrão, Brazil
| | - Isabela M de Oliveira
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Institute for Cancer Research IPEC, Guarapuava, Brazil
| | - Emerson Carraro
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Virology Laboratory, Midwestern Parana State University-UNICENTRO, Guarapuava, Brazil
| | - Lualis E David
- Virology Laboratory, Midwestern Parana State University-UNICENTRO, Guarapuava, Brazil
| | - Andréa N C Simão
- Laboratory of Research in Applied Immunology, Department of Pathology, Clinical Analysis and Toxicology, State University of Londrina-UEL, Londrina, Brazil
| | - Angelica B W Boldt
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Postgraduate Program in Genetics, Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná-UFPR, Curitiba, Brazil
| | - Maria Luiza Petzl-Erler
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Postgraduate Program in Genetics, Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná-UFPR, Curitiba, Brazil
| | - Wilson A Silva
- Institute for Cancer Research IPEC, Guarapuava, Brazil
- Ribeirão Preto Medical School and Center for Cell-Based Therapy (CEPID/FAPESP), University of São Paulo (USP), Ribeirão Preto, Brazil
| | - David L A Figueiredo
- New Arrangements for Research and Innovation - Genomics-Novos Arranjos de Pesquisa e Inovação - Genômica (NAPI-Genômica), Araucária Foundation - FAAP-PR, Curitiba, Parana, Brazil
- Institute for Cancer Research IPEC, Guarapuava, Brazil
- Department of Medicine, Midwestern Paraná State University-UNICENTRO, Guarapuava, Brazil
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25
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Aranda J, Oriol I, Feria L, Abelenda G, Rombauts A, Simonetti AF, Catalano C, Pallarès N, Martín M, Vàzquez N, Vall-Llosera E, Rhyman N, Suárez RC, Nogué M, Loureiro-Amigo J, Coloma A, Ceresuela L, Carratalà J. Persistent COVID-19 symptoms 1 year after hospital discharge: A prospective multicenter study. PLoS One 2022; 17:e0275615. [PMID: 36215250 PMCID: PMC9550043 DOI: 10.1371/journal.pone.0275615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To determine the health status and exercise capacity of COVID-19 survivors one year after hospital discharge. METHODS This multicenter prospective study included COVID-19 survivors 12 months after hospital discharge. Participants were randomly selected from a large cohort of COVID-19 patients who had been hospitalized until 15th April 2020. They were interviewed about persistent symptoms, underwent a physical examination, chest X-ray, and a 6-minute walk test (6MWT). A multivariate analysis was performed to determine the risk factors for persistent dyspnea. RESULTS Of the 150 patients included, 58% were male and the median age was 63 (IQR 54-72) years. About 82% reported ≥1 symptoms and 45% had not recovered their physical health. The multivariate regression analysis revealed that the female sex, chronic obstructive pulmonary disease, and smoking were independent risk factors for persistent dyspnea. Approximately 50% completed less than 80% of the theoretical distance on the 6MWT. Only 14% had an abnormal X-ray, showing mainly interstitial infiltrates. A third of them had been followed up in outpatient clinics and 6% had undergone physical rehabilitation. CONCLUSION Despite the high rate of survivors of the first wave of the COVID-19 pandemic with persistent symptomatology at 12 months, the follow-up and rehabilitation of these patients has been really poor. Studies focusing on the role of smoking in the persistence of COVID-19 symptoms are lacking.
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Affiliation(s)
- Judit Aranda
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Isabel Oriol
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL); L’Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Clinical Science Department, University of Barcelona, Barcelona, Spain
| | - Lucía Feria
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Gabriela Abelenda
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Alexander Rombauts
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Natàlia Pallarès
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Martín
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Núria Vàzquez
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Estel Vall-Llosera
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Nicolás Rhyman
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | - Marta Nogué
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Jose Loureiro-Amigo
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Ana Coloma
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Luis Ceresuela
- Consorci Sanitari Integral—Complex Hospitalari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Jordi Carratalà
- Bellvitge Biomedical Research Institute (IDIBELL); L’Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Clinical Science Department, University of Barcelona, Barcelona, Spain
- Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
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Loucera C, Perez-Florido J, Casimiro-Soriguer CS, Ortuño FM, Carmona R, Bostelmann G, Martínez-González LJ, Muñoyerro-Muñiz D, Villegas R, Rodriguez-Baño J, Romero-Gomez M, Lorusso N, Garcia-León J, Navarro-Marí JM, Camacho-Martinez P, Merino-Diaz L, de Salazar A, Viñuela L, Lepe JA, Garcia F, Dopazo J. Assessing the Impact of SARS-CoV-2 Lineages and Mutations on Patient Survival. Viruses 2022; 14:1893. [PMID: 36146700 PMCID: PMC9500738 DOI: 10.3390/v14091893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES More than two years into the COVID-19 pandemic, SARS-CoV-2 still remains a global public health problem. Successive waves of infection have produced new SARS-CoV-2 variants with new mutations for which the impact on COVID-19 severity and patient survival is uncertain. METHODS A total of 764 SARS-CoV-2 genomes, sequenced from COVID-19 patients, hospitalized from 19th February 2020 to 30 April 2021, along with their clinical data, were used for survival analysis. RESULTS A significant association of B.1.1.7, the alpha lineage, with patient mortality (log hazard ratio (LHR) = 0.51, C.I. = [0.14,0.88]) was found upon adjustment by all the covariates known to affect COVID-19 prognosis. Moreover, survival analysis of mutations in the SARS-CoV-2 genome revealed 27 of them were significantly associated with higher mortality of patients. Most of these mutations were located in the genes coding for the S, ORF8, and N proteins. CONCLUSIONS This study illustrates how a combination of genomic and clinical data can provide solid evidence for the impact of viral lineage on patient survival.
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Affiliation(s)
- Carlos Loucera
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
| | - Javier Perez-Florido
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
| | - Carlos S. Casimiro-Soriguer
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
| | - Francisco M. Ortuño
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
- Department of Computer Architecture and Computer Technology, University of Granada, 18011 Granada, Spain
| | - Rosario Carmona
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
| | - Gerrit Bostelmann
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
| | - L. Javier Martínez-González
- GENYO, Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, 18016 Granada, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, 41001 Sevilla, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, 41001 Sevilla, Spain
| | - Jesus Rodriguez-Baño
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla, C. San Fernando, 4, 41004 Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), ISCIII, 28029 Madrid, Spain
| | - Manuel Romero-Gomez
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla, C. San Fernando, 4, 41004 Sevilla, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Nicola Lorusso
- Dirección General de Salud Pública, Consejería de Salud y Familias, Junta de Andalucía, 41020 Sevilla, Spain
| | - Javier Garcia-León
- Departamento de Metafísica y Corrientes Actuales de la Filosofía, Ética y Filosofía Política, Universidad de Sevilla, 41004 Sevilla, Spain
| | - Jose M. Navarro-Marí
- Servicio de Microbiología, Hospital Virgen de las Nieves, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
| | - Pedro Camacho-Martinez
- Servicio de Microbiología, Unidad Clínica Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Laura Merino-Diaz
- Servicio de Microbiología, Unidad Clínica Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | - Adolfo de Salazar
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), ISCIII, 28029 Madrid, Spain
- Servicio de Microbiología, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | - Laura Viñuela
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), ISCIII, 28029 Madrid, Spain
- Servicio de Microbiología, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | | | - Jose A. Lepe
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), ISCIII, 28029 Madrid, Spain
- Servicio de Microbiología, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | - Federico Garcia
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), ISCIII, 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, 18012 Granada, Spain
- Servicio de Microbiología, Hospital Universitario San Cecilio, 18016 Granada, Spain
| | - Joaquin Dopazo
- Bioinformatics Area, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
- Institute of Biomedicine of Seville, IBiS, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Sevilla, Spain
- FPS/ELIXIR-ES, Andalusian Public Foundation Progress and Health-FPS, 41013 Sevilla, Spain
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Ramón A, Zaragozá M, Torres AM, Cascón J, Blasco P, Milara J, Mateo J. Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab. J Clin Med 2022; 11:jcm11164729. [PMID: 36012968 PMCID: PMC9410189 DOI: 10.3390/jcm11164729] [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: 07/04/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 11/16/2022] Open
Abstract
Among the IL-6 inhibitors, tocilizumab is the most widely used therapeutic option in patients with SARS-CoV-2-associated severe respiratory failure (SRF). The aim of our study was to provide evidence on predictors of poor outcome in patients with COVID-19 treated with tocilizumab, using machine learning (ML) techniques. We conducted a retrospective study, analyzing the clinical, laboratory and sociodemographic data of patients admitted for severe COVID-19 with SRF, treated with tocilizumab. The extreme gradient boost (XGB) method had the highest balanced accuracy (93.16%). The factors associated with a worse outcome of tocilizumab use in terms of mortality were: baseline situation at the start of tocilizumab treatment requiring invasive mechanical ventilation (IMV), elevated ferritin, lactate dehydrogenase (LDH) and glutamate-pyruvate transaminase (GPT), lymphopenia, and low PaFi [ratio between arterial oxygen pressure and inspired oxygen fraction (PaO2/FiO2)] values. The factors associated with a worse outcome of tocilizumab use in terms of hospital stay were: baseline situation at the start of tocilizumab treatment requiring IMV or supplemental oxygen, elevated levels of ferritin, glutamate-oxaloacetate transaminase (GOT), GPT, C-reactive protein (CRP), LDH, lymphopenia, and low PaFi values. In our study focused on patients with severe COVID-19 treated with tocilizumab, the factors that were weighted most strongly in predicting worse clinical outcome were baseline status at the start of tocilizumab treatment requiring IMV and hyperferritinemia.
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Affiliation(s)
- Antonio Ramón
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Marta Zaragozá
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Ana María Torres
- Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Joaquín Cascón
- Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
| | - Pilar Blasco
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
| | - Javier Milara
- Department of Pharmacy, General University Hospital, 46014 Valencia, Spain
- Department of Pharmacology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain
- Centre for Biomedical Research Network on Respiratory Diseases (CIBERES), Health Institute Carlos III, 28029 Madrid, Spain
- Correspondence:
| | - Jorge Mateo
- Institute of Technology, University of Castilla-La Mancha, 16002 Cuenca, Spain
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Greenwood D, Taverner T, Adderley NJ, Price MJ, Gokhale K, Sainsbury C, Gallier S, Welch C, Sapey E, Murray D, Fanning H, Ball S, Nirantharakumar K, Croft W, Moss P. Machine learning of COVID-19 clinical data identifies population structures with therapeutic potential. iScience 2022; 25:104480. [PMID: 35665240 PMCID: PMC9153184 DOI: 10.1016/j.isci.2022.104480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/07/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Clinical outcomes for patients with COVID-19 are heterogeneous and there is interest in defining subgroups for prognostic modeling and development of treatment algorithms. We obtained 28 demographic and laboratory variables in patients admitted to hospital with COVID-19. These comprised a training cohort (n = 6099) and two validation cohorts during the first and second waves of the pandemic (n = 996; n = 1011). Uniform manifold approximation and projection (UMAP) dimension reduction and Gaussian mixture model (GMM) analysis was used to define patient clusters. 29 clusters were defined in the training cohort and associated with markedly different mortality rates, which were predictive within confirmation datasets. Deconvolution of clinical features within clusters identified unexpected relationships between variables. Integration of large datasets using UMAP-assisted clustering can therefore identify patient subgroups with prognostic information and uncovers unexpected interactions between clinical variables. This application of machine learning represents a powerful approach for delineating disease pathogenesis and potential therapeutic interventions.
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Affiliation(s)
- David Greenwood
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- The Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Thomas Taverner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J. Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Malcolm James Price
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Suzy Gallier
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Carly Welch
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Health Data Research, London, UK
| | - Duncan Murray
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hilary Fanning
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Ball
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research, London, UK
| | | | - Wayne Croft
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- The Centre for Computational Biology, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Corresponding author
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Trujillo-Rodriguez M, Muñoz-Muela E, Serna-Gallego A, Praena-Fernández JM, Pérez-Gómez A, Gasca-Capote C, Vitallé J, Peraire J, Palacios-Baena ZR, Cabrera JJ, Ruiz-Mateos E, Poveda E, López-Cortés LE, Rull A, Gutierrez-Valencia A, López-Cortés LF. Clinical, laboratory data and inflammatory biomarkers at baseline as early discharge predictors in hospitalized SARS-CoV-2 infected patients. PLoS One 2022; 17:e0269875. [PMID: 35834501 PMCID: PMC9282584 DOI: 10.1371/journal.pone.0269875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background The SARS-CoV-2 pandemic has overwhelmed hospital services due to the rapid transmission of the virus and its severity in a high percentage of cases. Having tools to predict which patients can be safely early discharged would help to improve this situation. Methods Patients confirmed as SARS-CoV-2 infection from four Spanish hospitals. Clinical, demographic, laboratory data and plasma samples were collected at admission. The patients were classified into mild and severe/critical groups according to 4-point ordinal categories based on oxygen therapy requirements. Logistic regression models were performed in mild patients with only clinical and routine laboratory parameters and adding plasma pro-inflammatory cytokine levels to predict both early discharge and worsening. Results 333 patients were included. At admission, 307 patients were classified as mild patients. Age, oxygen saturation, Lactate Dehydrogenase, D-dimers, neutrophil-lymphocyte ratio (NLR), and oral corticosteroids treatment were predictors of early discharge (area under curve (AUC), 0.786; sensitivity (SE) 68.5%; specificity (S), 74.5%; positive predictive value (PPV), 74.4%; and negative predictive value (NPV), 68.9%). When cytokines were included, lower interferon-γ-inducible protein 10 and higher Interleukin 1 beta levels were associated with early discharge (AUC, 0.819; SE, 91.7%; S, 56.6%; PPV, 69.3%; and NPV, 86.5%). The model to predict worsening included male sex, oxygen saturation, no corticosteroids treatment, C-reactive protein and Nod-like receptor as independent factors (AUC, 0.903; SE, 97.1%; S, 68.8%; PPV, 30.4%; and NPV, 99.4%). The model was slightly improved by including the determinations of interleukine-8, Macrophage inflammatory protein-1 beta and soluble IL-2Rα (CD25) (AUC, 0.952; SE, 97.1%; S, 98.1%; PPV, 82.7%; and NPV, 99.6%). Conclusions Clinical and routine laboratory data at admission strongly predict non-worsening during the first two weeks; therefore, these variables could help identify those patients who do not need a long hospitalization and improve hospital overcrowding. Determination of pro-inflammatory cytokines moderately improves these predictive capacities.
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Affiliation(s)
- María Trujillo-Rodriguez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Esperanza Muñoz-Muela
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Ana Serna-Gallego
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | | | - Alberto Pérez-Gómez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Carmen Gasca-Capote
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Joana Vitallé
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Joaquim Peraire
- Hospital Universitari de Tarragona Joan XXIII (HJ23), Tarragona, Spain
- Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Zaira R. Palacios-Baena
- Clinical Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
| | - Jorge Julio Cabrera
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur) Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Ezequiel Ruiz-Mateos
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
| | - Eva Poveda
- Microbiology Service, Galicia Sur Health Research Institute (IIS Galicia Sur), Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Vigo, Spain
| | - Luis Eduardo López-Cortés
- Clinical Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
| | - Anna Rull
- Hospital Universitari de Tarragona Joan XXIII (HJ23), Tarragona, Spain
- Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
- CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Alicia Gutierrez-Valencia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
- * E-mail:
| | - Luis Fernando López-Cortés
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital, CSIC, University of Seville, Seville, Spain
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Graziano E, Peghin M, De Martino M, De Carlo C, Da Porto A, Bulfone L, Casarsa V, Sozio E, Fabris M, Cifù A, Grassi B, Curcio F, Isola M, Sechi LA, Tascini C, Croatto L, Ditaranto P, Ditaranto LM. The impact of body composition on mortality of COVID-19 hospitalized patients: A prospective study on abdominal fat, obesity paradox and sarcopenia. Clin Nutr ESPEN 2022; 51:437-444. [PMID: 36184240 PMCID: PMC9295328 DOI: 10.1016/j.clnesp.2022.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
Background & aims Obesity has been described as a predisposing risk factor to severe forms of COVID-19, but conflicting results are emerging on its real impact on the mortality of COVID-19. We aimed to compare clinical outcomes and mortality among COVID-19 patients according to obesity, metabolic syndrome and adiposity distribution. Methods We conducted a prospective observational study of all consecutive adult patients with a confirmed diagnosis of SARS-CoV-2 infection admitted to the Infectious Diseases Clinic at Udine Hospital, Italy, from January 2021 to February 2021. At admission, the study population was submitted to specific anthropometric, laboratory and bioimpedance analysis (BIA) measurements and divided into five groups according to: 1) BMI < or >30 kg/m2; 2) waist circumference (WC) < or >98 cm for women, < or >102 cm for men; 3) presence or absence of metabolic syndrome (MS); 4) visceral adipose tissue (VAT) distribution; and 5) presence or absence of sarcopenia (SP) both based on BIA. We then compared clinical outcomes (ventilatory support, intensive care unit (ICU) admission, ICU length of stay, total hospital length of stay and mortality), immune and inflammatory makers and infectious and non-infectious acute complications within the five groups. Results A total of 195 patients were enrolled in the study. The mean age of patients was 71 years (IQR 61–80) and 64.6% (126) were male. The most common comorbidities were hypertension (55.9%) and MS (55.4%). Overall mortality was 19.5%. Abdominal adiposity, measured both with WC and with BIA, and SP were significantly associated with need for increased ventilator support (p = 0.013 for WC; p = 0.037, 0.027 and 0.009 for VAT; p = 0.004 and 0.036 for FMI; and p = 0.051 for SP), but not with ICU admission (WC p = 0.627, VAT p = 0.153, FMI p = 0.519 and SP p = 0.938), length of stay (WC p = 0.345, VAT p = 0.650, FMI p = 0.159 and SP p = 0.992) and mortality (WC p = 0.277, VAT p = 0.533, FMI p = 0.957 and SP p = 0.211). Obesity and MS did not discriminate for the intensity of ventilatory outcome (p = 0.142 and p = 0.198, respectively), ICU admission (p = 0.802 and p = 0.947, respectively), length of stay (p = 0.471 and p = 0.768, respectively) and mortality (p = 0.495 and p = 0.268, respectively). We did not find significant differences in inflammatory markers and secondary complications within the five groups. Conclusions In patients admitted with COVID-19, increased WC, visceral abdominal fat and SP are associated with higher need for ventilatory support. However, obesity, MS, SP and abdominal adiposity are not sensitive predictive factors for mortality.
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Benítez ID, de Batlle J, Torres G, González J, de Gonzalo-Calvo D, Targa AD, Gort-Paniello C, Moncusí-Moix A, Ceccato A, Fernández-Barat L, Ferrer R, Garcia-Gasulla D, Menéndez R, Motos A, Peñuelas O, Riera J, Bermejo-Martin JF, Peñasco Y, Ricart P, Martin Delgado MC, Aguilera L, Rodríguez A, Boado Varela MV, Suarez-Sipmann F, Pozo-Laderas JC, Solé-Violan J, Nieto M, Novo MA, Barberán J, Amaya Villar R, Garnacho-Montero J, García-Garmendia JL, Gómez JM, Lorente JÁ, Blandino Ortiz A, Tamayo Lomas L, López-Ramos E, Úbeda A, Catalán-González M, Sánchez-Miralles A, Martínez Varela I, Jorge García RN, Franco N, Gumucio-Sanguino VD, Huerta Garcia A, Bustamante-Munguira E, Valdivia LJ, Caballero J, Gallego E, Martínez de la Gándara A, Castellanos-Ortega Á, Trenado J, Marin-Corral J, Albaiceta GM, de la Torre MDC, Loza-Vázquez A, Vidal P, Lopez Messa J, Añón JM, Carbajales Pérez C, Sagredo V, Bofill N, Carbonell N, Socias L, Barberà C, Estella A, Valledor Mendez M, Diaz E, López Lago A, Torres A, Barbé F. Prognostic implications of comorbidity patterns in critically ill COVID-19 patients: A multicenter, observational study. Lancet Reg Health Eur 2022; 18:100422. [PMID: 35655660 PMCID: PMC9148543 DOI: 10.1016/j.lanepe.2022.100422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The clinical heterogeneity of COVID-19 suggests the existence of different phenotypes with prognostic implications. We aimed to analyze comorbidity patterns in critically ill COVID-19 patients and assess their impact on in-hospital outcomes, response to treatment and sequelae. Methods Multicenter prospective/retrospective observational study in intensive care units of 55 Spanish hospitals. 5866 PCR-confirmed COVID-19 patients had comorbidities recorded at hospital admission; clinical and biological parameters, in-hospital procedures and complications throughout the stay; and, clinical complications, persistent symptoms and sequelae at 3 and 6 months. Findings Latent class analysis identified 3 phenotypes using training and test subcohorts: low-morbidity (n=3385; 58%), younger and with few comorbidities; high-morbidity (n=2074; 35%), with high comorbid burden; and renal-morbidity (n=407; 7%), with chronic kidney disease (CKD), high comorbidity burden and the worst oxygenation profile. Renal-morbidity and high-morbidity had more in-hospital complications and higher mortality risk than low-morbidity (adjusted HR (95% CI): 1.57 (1.34-1.84) and 1.16 (1.05-1.28), respectively). Corticosteroids, but not tocilizumab, were associated with lower mortality risk (HR (95% CI) 0.76 (0.63-0.93)), especially in renal-morbidity and high-morbidity. Renal-morbidity and high-morbidity showed the worst lung function throughout the follow-up, with renal-morbidity having the highest risk of infectious complications (6%), emergency visits (29%) or hospital readmissions (14%) at 6 months (p<0.01). Interpretation Comorbidity-based phenotypes were identified and associated with different expression of in-hospital complications, mortality, treatment response, and sequelae, with CKD playing a major role. This could help clinicians in day-to-day decision making including the management of post-discharge COVID-19 sequelae. Funding ISCIII, UNESPA, CIBERES, FEDER, ESF.
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Motloch LJ, Jirak P, Gareeva D, Davtyan P, Gumerov R, Lakman I, Tataurov A, Zulkarneev R, Kabirov I, Cai B, Valeev B, Pavlov V, Kopp K, Hoppe UC, Lichtenauer M, Fiedler L, Pistulli R, Zagidullin N. Cardiovascular Biomarkers for Prediction of in-hospital and 1-Year Post-discharge Mortality in Patients With COVID-19 Pneumonia. Front Med (Lausanne) 2022; 9:906665. [PMID: 35836945 PMCID: PMC9273888 DOI: 10.3389/fmed.2022.906665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Aims While COVID-19 affects the cardiovascular system, the potential clinical impact of cardiovascular biomarkers on predicting outcomes in COVID-19 patients is still unknown. Therefore, to investigate this issue we analyzed the prognostic potential of cardiac biomarkers on in-hospital and long-term post-discharge mortality of patients with COVID-19 pneumonia. Methods Serum soluble ST2, VCAM-1, and hs-TnI were evaluated upon admission in 280 consecutive patients hospitalized with COVID-19-associated pneumonia in a single, tertiary care center. Patient clinical and laboratory characteristics and the concentration of biomarkers were correlated with in-hospital [Hospital stay: 11 days (10; 14)] and post-discharge all-cause mortality at 1 year follow-up [FU: 354 days (342; 361)]. Results 11 patients died while hospitalized for COVID-19 (3.9%), and 11 patients died during the 1-year post-discharge follow-up period (n = 11, 4.1%). Using multivariate analysis, VCAM-1 was shown to predict mortality during the hospital period (HR 1.081, CI 95% 1.035;1.129, p = 0.017), but not ST2 or hs-TnI. In contrast, during one-year FU post hospital discharge, ST2 (HR 1.006, 95% CI 1.002;1.009, p < 0.001) and hs-TnI (HR 1.362, 95% CI 1.050;1.766, p = 0.024) predicted mortality, although not VCAM-1. Conclusion In patients hospitalized with Covid-19 pneumonia, elevated levels of VCAM-1 at admission were associated with in-hospital mortality, while ST2 and hs-TnI might predict post-discharge mortality in long term follow-up.
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Affiliation(s)
- Lukas J. Motloch
- University Clinic for Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
- *Correspondence: Lukas J. Motloch
| | - Peter Jirak
- University Clinic for Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Diana Gareeva
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Paruir Davtyan
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Ruslan Gumerov
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Irina Lakman
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
- Department of Biomedical Engineering, Ufa State Aviation Technical University, Ufa, Russia
- Scientific Laboratory for the Socio-Economic Region Problems Investigation, Bashkir State University, Ufa, Russia
| | - Aleksandr Tataurov
- Scientific Laboratory for the Socio-Economic Region Problems Investigation, Bashkir State University, Ufa, Russia
| | - Rustem Zulkarneev
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Ildar Kabirov
- Department of Urology, Bashkir State Medical University, Ufa, Russia
| | - Benzhi Cai
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- The Key Laboratory of Cardiovascular Medicine Research, Ministry of Education, Department of Pharmacy at the Second Affiliated Hospital, and Department of Pharmacology at College of Pharmacy, Harbin Medical University, Harbin, China
| | - Bairas Valeev
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
| | - Valentin Pavlov
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- Department of Urology, Bashkir State Medical University, Ufa, Russia
| | - Kristen Kopp
- University Clinic for Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Uta C. Hoppe
- University Clinic for Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Michael Lichtenauer
- University Clinic for Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Fiedler
- University Clinic for Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
- Department of Internal Medicine, Cardiology, Nephrology and Intensive Care Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - Rudin Pistulli
- Department of Cardiology I, Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Munster, Munster, Germany
| | - Naufal Zagidullin
- Cardiovascular Disease in COVID-19, International Research Network, Ufa, Russia
- Department of Internal Diseases, Bashkir State Medical University, Ufa, Russia
- Department of Biomedical Engineering, Ufa State Aviation Technical University, Ufa, Russia
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Anti-SARS-CoV-2 Titers Predict the Severity of COVID-19. Viruses 2022; 14:v14051089. [PMID: 35632830 PMCID: PMC9143418 DOI: 10.3390/v14051089] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 is associated with a wide spectrum of disease, ranging from asymptomatic infection to acute respiratory distress syndrome. Some biomarkers may predict disease severity. Among them, the anti-SARS-CoV-2 antibody response has been related to severe disease. The aim of this study was to assess the correlation between the anti-SARS-CoV-2 serological response and COVID-19 outcome. Demographic, clinical, and biological data from nasopharyngeal-PCR confirmed COVID-19 hospitalized patients were prospectively collected between April and August 2020 at our institution. All patients had serial weekly serology testing for a maximum of three blood samples or until discharge. Two different serological assays were used: a chemiluminescent assay and an in-house developed Luminex immunoassay. Kinetics of the serological response and correlation between the antibody titers and outcome were assessed. Among the 70 patients enrolled in the study, 22 required invasive ventilation, 29 required non-invasive ventilation or oxygen supplementation, and 19 did not require any oxygen supplementation. Median duration of symptoms upon admission for the three groups were 13, 8, and 9 days, respectively. Antibody titers gradually increased for up to 3 weeks since the onset of symptoms for patients requiring oxygen supplementation with significantly higher antibody titers for patients requiring invasive ventilation. Antibody titers on admission were also significantly higher in severely ill patients and serology performed well in predicting the necessity of invasive ventilation (AUC: 0.79, 95% CI: 0.67–0.9). Serology testing at admission may be a good indicator to identify severe COVID-19 patients who will require invasive mechanical ventilation.
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Methi F, Hernæs KH, Skyrud KD, Magnusson K. Pandemic trends in health care use: From the hospital bed to self-care with COVID-19. PLoS One 2022; 17:e0265812. [PMID: 35320323 PMCID: PMC8942224 DOI: 10.1371/journal.pone.0265812] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/08/2022] [Indexed: 01/08/2023] Open
Abstract
AIM To explore whether the acute 30-day burden of COVID-19 on health care use has changed from February 2020 to February 2022. METHODS In all Norwegians (N = 493 520) who tested positive for SARS-CoV-2 in four pandemic waves (February 26th, 2020 -February 16th, 2021 (1st wave dominated by the Wuhan strain), February 17th-July 10th, 2021 (2nd wave dominated by the Alpha variant), July 11th-December 27th, 2021 (3rd wave dominated by the Delta variant), and December 28th, 2021 -January 14th, 2022 (4th wave dominated by the Omicron variant)), we studied the age- and sex-specific share of patients (by age groups 1-19, 20-67, and 68 or more) who had: 1) Relied on self-care, 2) used outpatient care (visiting general practitioners or emergency ward for COVID-19), and 3) used inpatient care (hospitalized ≥24 hours with COVID-19). RESULTS We find a remarkable decline in the use of health care services among COVID-19 patients for all age/sex groups throughout the pandemic. From 83% [95%CI = 83%-84%] visiting outpatient care in the first wave, to 80% [81%-81%], 69% [69%-69%], and 59% [59%-59%] in the second, third, and fourth wave. Similarly, from 4.9% [95%CI = 4.7%-5.0%] visiting inpatient care in the first wave, to 3.6% [3.4%-3.7%], 1.4% [1.3%-1.4%], and 0.5% [0.4%-0.5%]. Of persons testing positive for SARS-CoV-2, 41% [41%-41%] relied on self-care in the 30 days after testing positive in the fourth wave, compared to 16% [15%-16%] in the first wave. CONCLUSION From 2020 to 2022, the use of COVID-19 related outpatient care services decreased with 29%, whereas the use of COVID-19 related inpatient care services decreased with 80%.
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Affiliation(s)
- Fredrik Methi
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Kjersti Helene Hernæs
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Karin Magnusson
- Cluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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Masotti L, Landini G, Panigada G, Grifoni E, Tarquini R, Cei F, Cimolato BMA, Vannucchi V, Di Pietro M, Piani F, Fortini A, Faraone A, Nenci G, Cipollini F, Blanc P, Lotti P, Di Natale M, Risaliti F, Aquilini D, Seravalle C, Bribani A, Farsi A, Micheletti I, Cioni E, Pelagalli G, Mattaliano C, Pinto G, Madonia EM, Sivieri I, Mannini M, Valoriani A, Brancati S, Rosselli M, Pavone E, Burla MC, Sergi A. PREDICTORS OF POOR OUTCOME IN TOCILIZUMAB TREATED PATIENTS WITH SARS-CoV-2 RELATED SEVERE RESPIRATORY FAILURE: A MULTICENTRE REAL WORLD STUDY. Int Immunopharmacol 2022; 107:108709. [PMID: 35334359 PMCID: PMC8938681 DOI: 10.1016/j.intimp.2022.108709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/05/2022] [Accepted: 03/13/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Luca Masotti
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy.
| | | | - Grazia Panigada
- Internal Medicine, SS Damiano and Cosma Hospital, Pescia, Italy
| | - Elisa Grifoni
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | | | - Francesco Cei
- Internal Medicine I, San Giuseppe Hospital, Empoli, Italy
| | | | - Vieri Vannucchi
- Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy
| | - Massimo Di Pietro
- Infectious Diseases, Santa Maria Annunziata Hospital, Florence, Italy
| | - Fiorella Piani
- Internal Medicine, Santa Maria Annunziata Hospital, Florence, Italy
| | - Alberto Fortini
- Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Antonio Faraone
- Internal Medicine, San Giovanni di Dio Hospital, Florence, Italy
| | - Gabriele Nenci
- Internal Medicine II, San Jacopo Hospital, Pistoia, Italy
| | | | | | - Pamela Lotti
- Internal Medicine, Santo Stefano Hospital, Prato, Italy
| | | | | | | | | | - Andrea Bribani
- Internal Medicine, Serristori Hospital, Figline Valdarno, Italy
| | - Alessandro Farsi
- Allergology and Clinical Immunology, Ex Misericordia and Dolce Hospital, Prato, Italy
| | | | - Elisa Cioni
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | | | | | - Gabriele Pinto
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | | | - Irene Sivieri
- Internal Medicine II, San Giuseppe Hospital, Empoli, Italy
| | | | | | | | | | - Eleonora Pavone
- SOC Governance Farmaceutica and Appropriatezza Prescrittiva, Azienda USL Toscana Centro, Italy
| | - Maria Chiara Burla
- SOC Governance Farmaceutica and Appropriatezza Prescrittiva, Azienda USL Toscana Centro, Italy
| | - Alessandro Sergi
- SOC Monitoraggio and Programmazione performance clinico-assistenziale, Azienda USL Toscana Centro, Italy
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Kamenshchikov NO, Berra L, Carroll RW. Therapeutic Effects of Inhaled Nitric Oxide Therapy in COVID-19 Patients. Biomedicines 2022; 10:biomedicines10020369. [PMID: 35203578 PMCID: PMC8962307 DOI: 10.3390/biomedicines10020369] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 01/08/2023] Open
Abstract
The global COVID-19 pandemic has become the largest public health challenge of recent years. The incidence of COVID-19-related acute hypoxemic respiratory failure (AHRF) occurs in up to 15% of hospitalized patients. Antiviral drugs currently available to clinicians have little to no effect on mortality, length of in-hospital stay, the need for mechanical ventilation, or long-term effects. Inhaled nitric oxide (iNO) administration is a promising new non-standard approach to directly treat viral burden while enhancing oxygenation. Along with its putative antiviral affect in COVID-19 patients, iNO can reduce inflammatory cell-mediated lung injury by inhibiting neutrophil activation, lowering pulmonary vascular resistance and decreasing edema in the alveolar spaces, collectively enhancing ventilation/perfusion matching. This narrative review article presents recent literature on the iNO therapy use for COVID-19 patients. The authors suggest that early administration of the iNO therapy may be a safe and promising approach for the treatment of COVID-19 patients. The authors also discuss unconventional approaches to treatment, continuous versus intermittent high-dose iNO therapy, timing of initiation of therapy (early versus late), and novel delivery systems. Future laboratory and clinical research is required to define the role of iNO as an adjunct therapy against bacterial, viral, and fungal infections.
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Affiliation(s)
- Nikolay O. Kamenshchikov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia
- Correspondence:
| | - Lorenzo Berra
- Department of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA;
| | - Ryan W. Carroll
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA;
- Division of Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
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Coronavirus Disease 2019 Temperature Trajectories Correlate With Hyperinflammatory and Hypercoagulable Subphenotypes. Crit Care Med 2022; 50:212-223. [PMID: 35100194 PMCID: PMC8796835 DOI: 10.1097/ccm.0000000000005397] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Body temperature trajectories of infected patients are associated with specific immune profiles and survival. We determined the association between temperature trajectories and distinct manifestations of coronavirus disease 2019. DESIGN Retrospective observational study. SETTING Four hospitals within an academic healthcare system from March 2020 to February 2021. PATIENTS All adult patients hospitalized with coronavirus disease 2019. INTERVENTIONS Using a validated group-based trajectory model, we classified patients into four previously defined temperature trajectory subphenotypes using oral temperature measurements from the first 72 hours of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. MEASUREMENTS AND MAIN RESULTS The 5,903 hospitalized coronavirus disease 2019 patients were classified into four subphenotypes: hyperthermic slow resolvers (n = 1,452, 25%), hyperthermic fast resolvers (1,469, 25%), normothermics (2,126, 36%), and hypothermics (856, 15%). Hypothermics had abnormal coagulation markers, with the highest d-dimer and fibrin monomers (p < 0.001) and the highest prevalence of cerebrovascular accidents (10%, p = 0.001). The prevalence of venous thromboembolism was significantly different between subphenotypes (p = 0.005), with the highest rate in hypothermics (8.5%) and lowest in hyperthermic slow resolvers (5.1%). Hyperthermic slow resolvers had abnormal inflammatory markers, with the highest C-reactive protein, ferritin, and interleukin-6 (p < 0.001). Hyperthermic slow resolvers had increased odds of mechanical ventilation, vasopressors, and 30-day inpatient mortality (odds ratio, 1.58; 95% CI, 1.13-2.19) compared with hyperthermic fast resolvers. Over the course of the pandemic, we observed a drastic decrease in the prevalence of hyperthermic slow resolvers, from representing 53% of admissions in March 2020 to less than 15% by 2021. We found that dexamethasone use was associated with significant reduction in probability of hyperthermic slow resolvers membership (27% reduction; 95% CI, 23-31%; p < 0.001). CONCLUSIONS Hypothermics had abnormal coagulation markers, suggesting a hypercoagulable subphenotype. Hyperthermic slow resolvers had elevated inflammatory markers and the highest odds of mortality, suggesting a hyperinflammatory subphenotype. Future work should investigate whether temperature subphenotypes benefit from targeted antithrombotic and anti-inflammatory strategies.
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Peer Review of “COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis”. JMIRX MED 2021; 2:e35516. [PMCID: PMC10414339 DOI: 10.2196/35516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2023]
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Schmidt M, Guidet B, Demoule A, Ponnaiah M, Fartoukh M, Puybasset L, Combes A, Hajage D. Predicting 90-day survival of patients with COVID-19: Survival of Severely Ill COVID (SOSIC) scores. Ann Intensive Care 2021; 11:170. [PMID: 34897559 PMCID: PMC8665857 DOI: 10.1186/s13613-021-00956-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Predicting outcomes of critically ill intensive care unit (ICU) patients with coronavirus-19 disease (COVID-19) is a major challenge to avoid futile, and prolonged ICU stays. METHODS The objective was to develop predictive survival models for patients with COVID-19 after 1-to-2 weeks in ICU. Based on the COVID-ICU cohort, which prospectively collected characteristics, management, and outcomes of critically ill patients with COVID-19. Machine learning was used to develop dynamic, clinically useful models able to predict 90-day mortality using ICU data collected on day (D) 1, D7 or D14. RESULTS Survival of Severely Ill COVID (SOSIC)-1, SOSIC-7, and SOSIC-14 scores were constructed with 4244, 2877, and 1349 patients, respectively, randomly assigned to development or test datasets. The three models selected 15 ICU-entry variables recorded on D1, D7, or D14. Cardiovascular, renal, and pulmonary functions on prediction D7 or D14 were among the most heavily weighted inputs for both models. For the test dataset, SOSIC-7's area under the ROC curve was slightly higher (0.80 [0.74-0.86]) than those for SOSIC-1 (0.76 [0.71-0.81]) and SOSIC-14 (0.76 [0.68-0.83]). Similarly, SOSIC-1 and SOSIC-7 had excellent calibration curves, with similar Brier scores for the three models. CONCLUSION The SOSIC scores showed that entering 15 to 27 baseline and dynamic clinical parameters into an automatable XGBoost algorithm can potentially accurately predict the likely 90-day mortality post-ICU admission (sosic.shinyapps.io/shiny). Although external SOSIC-score validation is still needed, it is an additional tool to strengthen decisions about life-sustaining treatments and informing family members of likely prognosis.
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Affiliation(s)
- Matthieu Schmidt
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France. .,Service de Médecine Intensive-Réanimation, Institut de Cardiologie, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), 47, bd de l'Hôpital, 75651, Paris Cedex 13, France. .,Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Bertrand Guidet
- Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,Institut Pierre-Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Saint-Antoine, INSERM, Service de Réanimation, Sorbonne Université, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,Service de Pneumologie, Médecine Intensive-Réanimation (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM UMRS_1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Maharajah Ponnaiah
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, APHP, Paris, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, Créteil, France
| | - Louis Puybasset
- CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France.,Department of Anesthesiology & Critical Care, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Alain Combes
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France.,Service de Médecine Intensive-Réanimation, Institut de Cardiologie, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.,Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - David Hajage
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), INSER, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Loucera C, Peña-Chilet M, Esteban-Medina M, Muñoyerro-Muñiz D, Villegas R, Lopez-Miranda J, Rodriguez-Baño J, Túnez I, Bouillon R, Dopazo J, Quesada Gomez JM. Real world evidence of calcifediol or vitamin D prescription and mortality rate of COVID-19 in a retrospective cohort of hospitalized Andalusian patients. Sci Rep 2021; 11:23380. [PMID: 34862422 PMCID: PMC8642445 DOI: 10.1038/s41598-021-02701-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 is a major worldwide health problem because of acute respiratory distress syndrome, and mortality. Several lines of evidence have suggested a relationship between the vitamin D endocrine system and severity of COVID-19. We present a survival study on a retrospective cohort of 15,968 patients, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. Based on a central registry of electronic health records (the Andalusian Population Health Database, BPS), prescription of vitamin D or its metabolites within 15-30 days before hospitalization were recorded. The effect of prescription of vitamin D (metabolites) for other indication previous to the hospitalization was studied with respect to patient survival. Kaplan-Meier survival curves and hazard ratios support an association between prescription of these metabolites and patient survival. Such association was stronger for calcifediol (Hazard Ratio, HR = 0.67, with 95% confidence interval, CI, of [0.50-0.91]) than for cholecalciferol (HR = 0.75, with 95% CI of [0.61-0.91]), when prescribed 15 days prior hospitalization. Although the relation is maintained, there is a general decrease of this effect when a longer period of 30 days prior hospitalization is considered (calcifediol HR = 0.73, with 95% CI [0.57-0.95] and cholecalciferol HR = 0.88, with 95% CI [0.75, 1.03]), suggesting that association was stronger when the prescription was closer to the hospitalization.
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Affiliation(s)
- Carlos Loucera
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
| | - María Peña-Chilet
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
- Bioinformatics in Rare Diseases (BiER), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, 41013, Seville, Spain
| | - Marina Esteban-Medina
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
| | - Dolores Muñoyerro-Muñiz
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, Seville, Spain
| | - Román Villegas
- Subdirección Técnica Asesora de Gestión de la Información, Servicio Andaluz de Salud, Seville, Spain
| | - Jose Lopez-Miranda
- Internal Medicine Department, IMIBIC/Reina Sofia University Hospital/University of Cordoba, 14004, Córdoba, Spain
- CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Jesus Rodriguez-Baño
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
- Departamento de Medicina, Universidad de Sevilla, Seville, Spain
| | - Isaac Túnez
- Departamento de Bioquimica y Biología Molecular, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain
- Instituto Maimónides de Investigacion Biomédica de Córdoba (IMIBIC), 14004, Córdoba, Spain
- G. Técnico de Expertos de Andalucía para Estudios de Suplementos e Intervención Nutricional Frente a Covid-19, SGIDIS, Consejería de Salud y Familias, Junta de Andalucia, Seville, Spain
- Secretaria General de Investigación, Desarrollo e Innovación en Salud, Consejería de Salud y Familias de la Junta de Andalucía, Seville, Spain
| | - Roger Bouillon
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KULeuven, Herestraat, 3000, Leuven, Belgium
| | - Joaquin Dopazo
- Clinical Bioinformatics Area, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain.
- Institute of Biomedicine of Seville (IBIS), Hospital Virgen del Rocio, 41013, Seville, Spain.
- Bioinformatics in Rare Diseases (BiER), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), FPS, Hospital Virgen del Rocio, 41013, Seville, Spain.
- FPS/ELIXIR-ES, Fundación Progreso y Salud (FPS), CDCA, Hospital Virgen del Rocio, 41013, Seville, Spain.
| | - Jose Manuel Quesada Gomez
- Instituto Maimónides de Investigacion Biomédica de Córdoba (IMIBIC), 14004, Córdoba, Spain.
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Hospital Universitario Reina Sofía, Universidad de Córdoba, Menéndez Pidal s/n, 14004, Córdoba, Spain.
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Bos LDJ, Sjoding M, Sinha P, Bhavani SV, Lyons PG, Bewley AF, Botta M, Tsonas AM, Serpa Neto A, Schultz MJ, Dickson RP, Paulus F. Longitudinal respiratory subphenotypes in patients with COVID-19-related acute respiratory distress syndrome: results from three observational cohorts. THE LANCET. RESPIRATORY MEDICINE 2021; 9:1377-1386. [PMID: 34653374 PMCID: PMC8510633 DOI: 10.1016/s2213-2600(21)00365-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with COVID-19-related acute respiratory distress syndrome (ARDS) have been postulated to present with distinct respiratory subphenotypes. However, most phenotyping schema have been limited by sample size, disregard for temporal dynamics, and insufficient validation. We aimed to identify respiratory subphenotypes of COVID-19-related ARDS using unbiased data-driven approaches. METHODS PRoVENT-COVID was an investigator-initiated, national, multicentre, prospective, observational cohort study at 22 intensive care units (ICUs) in the Netherlands. Consecutive patients who had received invasive mechanical ventilation for COVID-19 (aged 18 years or older) served as the derivation cohort, and similar patients from two ICUs in the USA served as the replication cohorts. COVID-19 was confirmed by positive RT-PCR. We used latent class analysis to identify subphenotypes using clinically available respiratory data cross-sectionally at baseline, and longitudinally using 8-hourly data from the first 4 days of invasive ventilation. We used group-based trajectory modelling to evaluate trajectories of individual variables and to facilitate potential clinical translation. The PRoVENT-COVID study is registered with ClinicalTrials.gov, NCT04346342. FINDINGS Between March 1, 2020, and May 15, 2020, 1007 patients were admitted to participating ICUs in the Netherlands, and included in the derivation cohort. Data for 288 patients were included in replication cohort 1 and 326 in replication cohort 2. Cross-sectional latent class analysis did not identify any underlying subphenotypes. Longitudinal latent class analysis identified two distinct subphenotypes. Subphenotype 2 was characterised by higher mechanical power, minute ventilation, and ventilatory ratio over the first 4 days of invasive mechanical ventilation than subphenotype 1, but PaO2/FiO2, pH, and compliance of the respiratory system did not differ between the two subphenotypes. 185 (28%) of 671 patients with subphenotype 1 and 109 (32%) of 336 patients with subphenotype 2 had died at day 28 (p=0·10). However, patients with subphenotype 2 had fewer ventilator-free days at day 28 (median 0, IQR 0-15 vs 5, 0-17; p=0·016) and more frequent venous thrombotic events (109 [32%] of 336 patients vs 176 [26%] of 671 patients; p=0·048) compared with subphenotype 1. Group-based trajectory modelling revealed trajectories of ventilatory ratio and mechanical power with similar dynamics to those observed in latent class analysis-derived trajectory subphenotypes. The two trajectories were: a stable value for ventilatory ratio or mechanical power over the first 4 days of invasive mechanical ventilation (trajectory A) or an upward trajectory (trajectory B). However, upward trajectories were better independent prognosticators for 28-day mortality (OR 1·64, 95% CI 1·17-2·29 for ventilatory ratio; 1·82, 1·24-2·66 for mechanical power). The association between upward ventilatory ratio trajectories (trajectory B) and 28-day mortality was confirmed in the replication cohorts (OR 4·65, 95% CI 1·87-11·6 for ventilatory ratio in replication cohort 1; 1·89, 1·05-3·37 for ventilatory ratio in replication cohort 2). INTERPRETATION At baseline, COVID-19-related ARDS has no consistent respiratory subphenotype. Patients diverged from a fairly homogenous to a more heterogeneous population, with trajectories of ventilatory ratio and mechanical power being the most discriminatory. Modelling these parameters alone provided prognostic value for duration of mechanical ventilation and mortality. FUNDING Amsterdam UMC.
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Affiliation(s)
- Lieuwe D J Bos
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands,Correspondence to: Dr Lieuwe D J Bos, Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam 1105AZ, Netherlands
| | - Michael Sjoding
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Pratik Sinha
- Washington University School of Medicine, St Louis, MO, USA
| | - Sivasubramanium V Bhavani
- Department of Medicine, University of Chicago, Chicago, IL, USA,Department of Medicine, Emory University, Atlanta, GA, USA
| | | | - Alice F Bewley
- Washington University School of Medicine, St Louis, MO, USA
| | - Michela Botta
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands
| | - Anissa M Tsonas
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands
| | - Ary Serpa Neto
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, VIC, Australia,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil,Data Analytics Research and Evaluation (DARE) Centre, Austin Hospital and University of Melbourne, Melbourne, VIC, Australia
| | - Marcus J Schultz
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands,Nuffield Department of Medicine, University of Oxford, Oxford, UK,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Robert P Dickson
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Frederique Paulus
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anaesthesiology (L·E·I·C·A), Amsterdam UMC, Amsterdam, Netherlands
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Moreno G, Carbonell R, Martin-Loeches I, Solé-Violán J, Correig I Fraga E, Gómez J, Ruiz-Botella M, Trefler S, Bodí M, Murcia Paya J, Díaz E, Vidal-Cortes P, Papiol E, Albaya Moreno A, Sancho Chinesta S, Socias Crespi L, Lorente MDC, Loza Vázquez A, Vara Arlanzon R, Recio MT, Ballesteros JC, Ferrer R, Fernandez Rey E, Restrepo MI, Estella Á, Margarit Ribas A, Guasch N, Reyes LF, Marín-Corral J, Rodríguez A. Corticosteroid treatment and mortality in mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients: a multicentre cohort study. Ann Intensive Care 2021; 11:159. [PMID: 34825976 PMCID: PMC8617372 DOI: 10.1186/s13613-021-00951-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Some unanswered questions persist regarding the effectiveness of corticosteroids for severe coronavirus disease 2019 (COVID-19) patients. We aimed to assess the clinical effect of corticosteroids on intensive care unit (ICU) mortality among mechanically ventilated COVID-19-associated acute respiratory distress syndrome (ARDS) patients. METHODS This was a retrospective study of prospectively collected data conducted in 70 ICUs (68 Spanish, one Andorran, one Irish), including mechanically ventilated COVID-19-associated ARDS patients admitted between February 6 and September 20, 2020. Individuals who received corticosteroids for refractory shock were excluded. Patients exposed to corticosteroids at admission were matched with patients without corticosteroids through propensity score matching. Primary outcome was all-cause ICU mortality. Secondary outcomes were to compare in-hospital mortality, ventilator-free days at 28 days, respiratory superinfection and length of stay between patients with corticosteroids and those without corticosteroids. We performed survival analysis accounting for competing risks and subgroup sensitivity analysis. RESULTS We included 1835 mechanically ventilated COVID-19-associated ARDS, of whom 1117 (60.9%) received corticosteroids. After propensity score matching, ICU mortality did not differ between patients treated with corticosteroids and untreated patients (33.8% vs. 30.9%; p = 0.28). In survival analysis, corticosteroid treatment at ICU admission was associated with short-term survival benefit (HR 0.53; 95% CI 0.39-0.72), although beyond the 17th day of admission, this effect switched and there was an increased ICU mortality (long-term HR 1.68; 95% CI 1.16-2.45). The sensitivity analysis reinforced the results. Subgroups of age < 60 years, severe ARDS and corticosteroids plus tocilizumab could have greatest benefit from corticosteroids as short-term decreased ICU mortality without long-term negative effects were observed. Larger length of stay was observed with corticosteroids among non-survivors both in the ICU and in hospital. There were no significant differences for the remaining secondary outcomes. CONCLUSIONS Our results suggest that corticosteroid treatment for mechanically ventilated COVID-19-associated ARDS had a biphasic time-dependent effect on ICU mortality. Specific subgroups showed clear effect on improving survival with corticosteroid use. Therefore, further research is required to identify treatment-responsive subgroups among the mechanically ventilated COVID-19-associated ARDS patients.
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Affiliation(s)
- Gerard Moreno
- Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain.
| | - Raquel Carbonell
- Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
| | - Jordi Solé-Violán
- Critical Care Department, Doctor Negrín University Hospital, Gran Canaria, Spain
| | | | - Josep Gómez
- Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain
- Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain
| | - Manuel Ruiz-Botella
- Critical Care Department, Autonomous University of Barcelona (UAB), Joan XXIII University Hospital, C/ Dr Mallafrè Guasch, 4, 43005, Tarragona, Spain
- Tarragona Health Data Research Working Group (THeDaR), Joan XXIII University Hospital, Tarragona, Spain
| | - Sandra Trefler
- Critical Care Department, URV/IISPV/CIBERES, Joan XXIII University Hospital, Tarragona, Spain
| | - María Bodí
- Critical Care Department, URV/IISPV/CIBERES, Joan XXIII University Hospital, Tarragona, Spain
| | - Josefa Murcia Paya
- Critical Care Department, Santa Lucía General University Hospital, Cartagena, Spain
| | - Emili Díaz
- Critical Care Department, Autonomous University of Barcelona (UAB), Parc Taulí Hospital, Sabadell, Spain
| | | | - Elisabeth Papiol
- Critical Care Department, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | | | | | | | - Ana Loza Vázquez
- Critical Care Department, Virgen de Valme University Hospital, Sevilla, Spain
| | | | - María Teresa Recio
- Critical Care Department, University Hospital of Salamanca, Salamanca, Spain
| | | | - Ricard Ferrer
- Critical Care Department, Investigation Group SODIR-VIHR, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - Marcos I Restrepo
- Department of Medicine, South Texas Veterans Health Care System and University of Texas Health, San Antonio, TX, USA
| | - Ángel Estella
- Critical Care Department, Jerez University Hospital, Jerez, Spain
| | - Antonio Margarit Ribas
- Critical Care Department, Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, Andorra
| | - Neus Guasch
- Critical Care Department, Nostra Senyora de Meritxell Hospital, Escaldes-Engordany, Andorra
| | - Luis F Reyes
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
| | - Judith Marín-Corral
- Autonomous University of Barcelona (UAB) - Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Alejandro Rodríguez
- Critical Care Department, URV/IISPV/CIBERES, Joan XXIII University Hospital, Tarragona, Spain
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Les facteurs pronostiques dans la Covid-19. NPG NEUROLOGIE - PSYCHIATRIE - GÉRIATRIE 2021. [PMCID: PMC8206591 DOI: 10.1016/j.npg.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Depuis la fin de l’année 2019, la France, de même que l’ensemble des pays du monde, est confrontée à une situation épidémiologique inédite : la Covid-19. Les personnes les plus vulnérables, et notamment les personnes âgées sont particulièrement touchées par cette épidémie. Bien que de nombreux patients se rétablissent complètement, plusieurs facteurs conduisent à un mauvais pronostic. Diverses études ont proposé comme objectif d’identifier les facteurs pronostiques de mortalité et d’évolution vers une maladie grave pour les patients diagnostiqués avec la Covid-19. Certains de ces facteurs pronostiques peuvent être utilisés dans la prise de décision relative à la prise en charge des patients infectés par la Covid-19.
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Fernández-Ruiz M. COVID-19 en receptores de trasplante renal: ¿qué hemos aprendido tras 18 meses de pandemia? ENFERMERÍA NEFROLÓGICA 2021; 24:219-231. [DOI: 10.37551/s2254-28842021020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
La infección por el SARS-CoV-2 (COVID-19) ha supuesto un importante impacto en la actividad trasplantadora en nuestro país. En su condición de paciente inmunodeprimido y con frecuentes comorbilidades, era esperable que la mortalidad y el riesgo de complicaciones asociadas a la COVID-19 en el receptor de trasplante renal (TR) fueran mayores en comparación con la población general, si bien la información al respecto en los primeros meses de la pandemia era muy limitada. Desde marzo de 2020 hemos mejorado rápidamente nuestro conocimiento acerca de la epidemiología, características clínicas y manejo de la COVID-19 post-trasplante. La presente revisión pretende recopilar la información disponible a julio de 2021 en respuesta a una serie de cuestiones relevantes: ¿cómo se manifiesta clínicamente la infección por SARS-CoV-2 en receptores de TR?, ¿cuáles son sus factores pronósticos?, ¿es más grave la COVID-19 en el contexto del TR respecto a los pacientes inmunocompetentes?, ¿de qué opciones de tratamiento antiviral disponemos actualmente para el receptor de TR?, ¿cuál es la experiencia disponible con los tratamientos inmunomoduladores? y, por último, ¿son eficaces las vacunas frente a la COVID-19 basadas en ARN mensajero en esta población?. A pesar de los avances realizados aún son varios los aspectos que debemos mejorar en nuestro abordaje de la infección por SARS-CoV-2 en el ámbito específico del TR.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12). Madrid, Departamento de Medicina. Facultad de Medicina. Universidad Complutense. Madrid
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Teng C, Thampy U, Bae JY, Cai P, Dixon RAF, Liu Q, Li P. Identification of Phenotypes Among COVID-19 Patients in the United States Using Latent Class Analysis. Infect Drug Resist 2021; 14:3865-3871. [PMID: 34584430 PMCID: PMC8464321 DOI: 10.2147/idr.s331907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/31/2021] [Indexed: 01/31/2023] Open
Abstract
Background Coronavirus disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) is a heterogeneous disorder with a complex pathogenesis. Recent studies from Spain and France have indicated that underlying phenotypes may exist among patients admitted to the hospital with COVID-19. Whether those same phenotypes exist in the United States (US) remains unclear. Using latent class analysis (LCA), we sought to determine whether clinical phenotypes exist among patients admitted for COVID-19. Methods We reviewed the charts of adult patients who were hospitalized primarily for COVID-19 at Greenwich Hospital and performed LCA using variables based on patient demographics and comorbidities. To further examine the reliability and replicability of the clustering results, we repeated LCA on the cohort of patients who died during hospitalization for COVID-19. Results Two phenotypes were identified in patients admitted for COVID-19 (N = 483). According to phenotype, patients were designated as cluster 1 (C1) or cluster 2 (C2). C1 (n = 193) consisted of older individuals with more comorbidities and a higher mortality rate (25.4% vs 8.97%, p < 0.001) than patients in C2. C2 (n = 290) consisted of younger individuals who were more likely to be obese, male, and nonwhite, with higher levels of the inflammatory markers C-reactive protein and alanine aminotransferase. When we performed LCA on the cohort of patients who died during hospitalization for COVID-19 (n = 75), we found that the distribution of patient baseline characteristics and comorbidities was similar to that of the entire cohort of patients admitted for COVID-19. Conclusion Using LCA, we identified two clinical phenotypes of patients who were admitted to our hospital for COVID-19. These findings may reflect different pathophysiologic processes that lead to moderate to severe COVID-19 and may be useful for identifying treatment targets and selecting patients with severe COVID-19 disease for future clinical trials.
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Affiliation(s)
- Catherine Teng
- Department of Medicine, Yale New Haven Health - Greenwich Hospital, Greenwich, CT, USA
| | - Unnikrishna Thampy
- Department of Medicine, Yale New Haven Health - Greenwich Hospital, Greenwich, CT, USA
| | - Ju Young Bae
- Department of Medicine, Yale New Haven Health - Greenwich Hospital, Greenwich, CT, USA
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Richard A F Dixon
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Qi Liu
- Molecular Cardiology Research, Texas Heart Institute, Houston, TX, USA
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA
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Pharmacokinetics and Safety of XAV-19, a Swine Glyco-humanized Polyclonal Anti-SARS-CoV-2 Antibody, for COVID-19-Related Moderate Pneumonia: a Randomized, Double-Blind, Placebo-Controlled, Phase IIa Study. Antimicrob Agents Chemother 2021; 65:e0123721. [PMID: 34181475 PMCID: PMC8370226 DOI: 10.1128/aac.01237-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We assessed the pharmacokinetics and safety of XAV-19, a swine glyco-humanized polyclonal antibody against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in coronavirus disease 2019 (COVID-19)-related moderate pneumonia. The objective was to evaluate the optimal dose and safety of XAV-19 during this first administration to patients with COVID-19-related moderate pneumonia. In this phase IIa trial, adults with COVID-19-related moderate pneumonia with a duration of ≤10 days were randomized to receive an infusion of XAV-19 at 0.5 mg/kg of body weight at day 1 and day 5 (group 1), 2 mg/kg at day 1 and day 5 (group 2), or 2 mg/kg at day 1 (group 3) or placebo. Eighteen patients (n = 7 for group 1, n = 1 for group 2, n = 5 for group 3, and n = 5 for placebo) were enrolled. Baseline characteristics were similar across groups; median XAV-19 serum concentrations (ranges) at the time of the maximum serum concentration of the drug (Cmax) and at day 8 were 9.1 (5.2 to 18.1) and 6.4 (2.8 to 11.9) μg/ml, 71.5 and 47.2 μg/ml, and 50.4 (29.1 to 55.0) and 20.3 (12.0 to 22.7) μg/ml for groups 1, 2, and 3, respectively (P = 0.012). The median terminal half-life (range) was estimated at 11.4 (5.5 to 13.9) days for 2 mg/kg of XAV-19 at day 1. Serum XAV-19 concentrations were above the target concentration of 10 μg/ml (2-fold the in vitro 100% inhibitory concentration [IC100]) from the end of perfusion to more than 8 days for XAV-19 at 2 mg/kg at day 1. No hypersensitivity or infusion-related reactions were reported during treatment, and there were no discontinuations for adverse events and no serious adverse events related to the study drug. A single intravenous dose of 2 mg/kg of XAV-19 demonstrated high serum concentrations, predictive of potent durable neutralizing activity with good tolerability. (This study has been registered at ClinicalTrials.gov under identifier NCT04453384.)
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Sánchez-Marteles M, Rubio-Gracia J, Peña-Fresneda N, Garcés-Horna V, Gracia-Tello B, Martínez-Lostao L, Crespo-Aznárez S, Pérez-Calvo JI, Giménez-López I. Early Measurement of Blood sST2 Is a Good Predictor of Death and Poor Outcomes in Patients Admitted for COVID-19 Infection. J Clin Med 2021; 10:3534. [PMID: 34441830 PMCID: PMC8396994 DOI: 10.3390/jcm10163534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/08/2021] [Accepted: 08/08/2021] [Indexed: 01/08/2023] Open
Abstract
Although several biomarkers have shown correlation to prognosis in COVID-19 patients, their clinical value is limited because of lack of specificity, suboptimal sensibility or poor dynamic behavior. We hypothesized that circulating soluble ST2 (sST2) could be associated to a worse outcome in COVID-19. In total, 152 patients admitted for confirmed COVID-19 were included in a prospective non-interventional, observational study. Blood samples were drawn at admission, 48-72 h later and at discharge. sST2 concentrations and routine blood laboratory were analyzed. Primary endpoints were admission at intensive care unit (ICU) and mortality. Median age was 57.5 years [Standard Deviation (SD: 12.8)], 60.4% males. 10% of patients (n = 15) were derived to ICU and/or died during admission. Median (IQR) sST2 serum concentration (ng/mL) rose to 53.1 (30.9) at admission, peaked at 48-72 h (79.5(64)) and returned to admission levels at discharge (44.9[36.7]). A concentration of sST2 above 58.9 ng/mL was identified patients progressing to ICU admission or death. Results remained significant after multivariable analysis. The area under the receiver operating characteristics curve (AUC) of sST2 for endpoints was 0.776 (p = 0.001). In patients admitted for COVID-19 infection, early measurement of sST2 was able to identify patients at risk of severe complications or death.
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Affiliation(s)
- Marta Sánchez-Marteles
- Department of Internal Medicine, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain; (J.R.-G.); (V.G.-H.); (B.G.-T.); (S.C.-A.); (J.I.P.-C.)
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
| | - Jorge Rubio-Gracia
- Department of Internal Medicine, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain; (J.R.-G.); (V.G.-H.); (B.G.-T.); (S.C.-A.); (J.I.P.-C.)
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
| | - Natacha Peña-Fresneda
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
- Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
| | - Vanesa Garcés-Horna
- Department of Internal Medicine, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain; (J.R.-G.); (V.G.-H.); (B.G.-T.); (S.C.-A.); (J.I.P.-C.)
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
| | - Borja Gracia-Tello
- Department of Internal Medicine, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain; (J.R.-G.); (V.G.-H.); (B.G.-T.); (S.C.-A.); (J.I.P.-C.)
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
| | - Luis Martínez-Lostao
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
- Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
- Department of Immunology, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain
| | - Silvia Crespo-Aznárez
- Department of Internal Medicine, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain; (J.R.-G.); (V.G.-H.); (B.G.-T.); (S.C.-A.); (J.I.P.-C.)
| | - Juan Ignacio Pérez-Calvo
- Department of Internal Medicine, Hospital Clínico Universitario, Lozano Blesa, 50009 Zaragoza, Spain; (J.R.-G.); (V.G.-H.); (B.G.-T.); (S.C.-A.); (J.I.P.-C.)
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
- Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
| | - Ignacio Giménez-López
- Aragon Health Research Institute (IIS Aragón), 50009 Zaragoza, Spain; (N.P.-F.); (L.M.-L.); (I.G.-L.)
- Facultad de Medicina, University of Zaragoza, 50009 Zaragoza, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), 50009 Zaragoza, Spain
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Zucker J, Gomez-Simmonds A, Purpura LJ, Shoucri S, LaSota E, Morley NE, Sovic BW, Castellon MA, Theodore DA, Bartram LL, Miko BA, Scherer ML, Meyers KA, Turner WC, Kelly M, Pavlicova M, Basaraba CN, Baldwin MR, Brodie D, Burkart KM, Bathon J, Uhlemann AC, Yin MT, Castor D, Sobieszczyk ME. Supervised Machine Learning Approach to Identify Early Predictors of Poor Outcome in Patients with COVID-19 Presenting to a Large Quaternary Care Hospital in New York City. J Clin Med 2021; 10:jcm10163523. [PMID: 34441819 PMCID: PMC8397083 DOI: 10.3390/jcm10163523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/04/2021] [Accepted: 08/08/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The progression of clinical manifestations in patients with coronavirus disease 2019 (COVID-19) highlights the need to account for symptom duration at the time of hospital presentation in decision-making algorithms. Methods: We performed a nested case–control analysis of 4103 adult patients with COVID-19 and at least 28 days of follow-up who presented to a New York City medical center. Multivariable logistic regression and classification and regression tree (CART) analysis were used to identify predictors of poor outcome. Results: Patients presenting to the hospital earlier in their disease course were older, had more comorbidities, and a greater proportion decompensated (<4 days, 41%; 4–8 days, 31%; >8 days, 26%). The first recorded oxygen delivery method was the most important predictor of decompensation overall in CART analysis. In patients with symptoms for <4, 4–8, and >8 days, requiring at least non-rebreather, age ≥ 63 years, and neutrophil/lymphocyte ratio ≥ 5.1; requiring at least non-rebreather, IL-6 ≥ 24.7 pg/mL, and D-dimer ≥ 2.4 µg/mL; and IL-6 ≥ 64.3 pg/mL, requiring non-rebreather, and CRP ≥ 152.5 mg/mL in predictive models were independently associated with poor outcome, respectively. Conclusion: Symptom duration in tandem with initial clinical and laboratory markers can be used to identify patients with COVID-19 at increased risk for poor outcomes.
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Affiliation(s)
- Jason Zucker
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
- Correspondence: ; Tel.: +1-201-723-6637
| | - Angela Gomez-Simmonds
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Lawrence J. Purpura
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Sherif Shoucri
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Elijah LaSota
- Tulane University School of Medicine, Tulane Medical Center, New Orleans, LA 70112, USA;
| | - Nicholas E. Morley
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Brit W. Sovic
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Marvin A. Castellon
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Deborah A. Theodore
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Logan L. Bartram
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Benjamin A. Miko
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Matthew L. Scherer
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Kathrine A. Meyers
- Aaron Diamond AIDS Research Center, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA;
| | - William C. Turner
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Maureen Kelly
- General Internal Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; (W.C.T.); (M.K.)
| | - Martina Pavlicova
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Cale N. Basaraba
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.P.); (C.N.B.)
| | - Matthew R. Baldwin
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Daniel Brodie
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Kristin M. Burkart
- Division of Pulmonology, Columbia University Irving Medical Center, New York, NY 10032, USA; (M.R.B.); (D.B.); (K.M.B.)
| | - Joan Bathon
- Division of Rheumatology, Columbia University Irving Medical Center, New York, NY 10032, USA;
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Michael T. Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Delivette Castor
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, NY 10032, USA; (A.G.-S.); (L.J.P.); (S.S.); (B.W.S.); (M.A.C.); (D.A.T.); (B.A.M.); (M.L.S.); (A.-C.U.); (M.T.Y.); (D.C.); (M.E.S.)
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Márquez-Salinas A, Fermín-Martínez CA, Antonio-Villa NE, Vargas-Vázquez A, Guerra EC, Campos-Muñoz A, Zavala-Romero L, Mehta R, Bahena-López JP, Ortiz-Brizuela E, González-Lara MF, Roman-Montes CM, Martinez-Guerra BA, Ponce de Leon A, Sifuentes-Osornio J, Gutiérrez-Robledo LM, Aguilar-Salinas CA, Bello-Chavolla OY. Adaptive Metabolic and Inflammatory Responses Identified Using Accelerated Aging Metrics Are Linked to Adverse Outcomes in Severe SARS-CoV-2 Infection. J Gerontol A Biol Sci Med Sci 2021; 76:e117-e126. [PMID: 33721886 PMCID: PMC7989655 DOI: 10.1093/gerona/glab078] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Chronological age (CA) is a predictor of adverse COVID-19 outcomes; however, CA alone does not capture individual responses to SARS-CoV-2 infection. Here, we evaluated the influence of aging metrics PhenoAge and PhenoAgeAccel to predict adverse COVID-19 outcomes. Furthermore, we sought to model adaptive metabolic and inflammatory responses to severe SARS-CoV-2 infection using individual PhenoAge components. Methods In this retrospective cohort study, we assessed cases admitted to a COVID-19 reference center in Mexico City. PhenoAge and PhenoAgeAccel were estimated using laboratory values at admission. Cox proportional hazards models were fitted to estimate risk for COVID-19 lethality and adverse outcomes (ICU admission, intubation, or death). To explore reproducible patterns which model adaptive responses to SARS-CoV-2 infection, we used k-means clustering using PhenoAge components. Results We included 1068 subjects of whom 222 presented critical illness and 218 died. PhenoAge was a better predictor of adverse outcomes and lethality compared to CA and SpO2 and its predictive capacity was sustained for all age groups. Patients with responses associated to PhenoAgeAccel>0 had higher risk of death and critical illness compared to those with lower values (log-rank p<0.001). Using unsupervised clustering we identified four adaptive responses to SARS-CoV-2 infection: 1) Inflammaging associated with CA, 2) metabolic dysfunction associated with cardio-metabolic comorbidities, 3) unfavorable hematological response, and 4) response associated with favorable outcomes. Conclusions Adaptive responses related to accelerated aging metrics are linked to adverse COVID-19 outcomes and have unique and distinguishable features. PhenoAge is a better predictor of adverse outcomes compared to CA.
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Affiliation(s)
- Alejandro Márquez-Salinas
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carlos A Fermín-Martínez
- MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neftalí Eduardo Antonio-Villa
- MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Enrique C Guerra
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM), Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Campos-Muñoz
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Lilian Zavala-Romero
- AFINES, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Roopa Mehta
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Edgar Ortiz-Brizuela
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carla M Roman-Montes
- Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bernardo A Martinez-Guerra
- Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce de Leon
- Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Infectology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Direction of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Mexico
| | - Omar Yaxmehen Bello-Chavolla
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico.,Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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50
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Darmon M, Dumas G. Anticipating outcomes for patients with COVID-19 and identifying prognosis patterns. THE LANCET INFECTIOUS DISEASES 2021; 21:744-745. [PMID: 33636149 PMCID: PMC7906629 DOI: 10.1016/s1473-3099(21)00073-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Michael Darmon
- APHP, Service de médecine intensive et de réanimation, Hôpital Saint-Louis, 75010 Paris, France; Université de Paris, ECSTRA team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France.
| | - Guillaume Dumas
- APHP, Service de médecine intensive et de réanimation, Hôpital Saint-Louis, 75010 Paris, France; Université de Paris, ECSTRA team, UMR 1153, Center of Epidemiology and Biostatistics, INSERM, Paris, France
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