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Matheus S, Houcke S, Lontsi Ngoulla GR, Higel N, Ba A, Cook F, Gourjault C, Nkontcho F, Demar M, Nacher M, Djossou F, Hommel D, Résiere D, Pujo JM, Kallel H. Mortality Trend of Severe COVID-19 in Under-Vaccinated Population Admitted to ICU in French Amazonia. Trop Med Infect Dis 2024; 9:15. [PMID: 38251212 PMCID: PMC10820344 DOI: 10.3390/tropicalmed9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Until December 2021, French Guiana (FG), located in South America, faced four consecutive COVID-19 epidemic waves. This study sought to analyze the mortality trend of severe COVID-19 patients admitted to the referral ICU of FG. (2) Methods: We conducted a prospective, observational, and non-interventional study in ICU at Cayenne Hospital. We included 383 patients older than 18 admitted with SARS-CoV-2-related pneumonia hospitalized from May 2020 to December 2021. The study covers three periods. Period 1 (Waves 1 and 2, original variant), period 2 (Wave 3, Gamma variant), and period 3 (Wave 4, Delta variant). (3) Results: The median age was 63 years (52-70). Frailty was diagnosed in 36 patients over 70 (32.4%). Only 4.8% of patients were vaccinated. The median ICU LOS was 10 days (6-19). Hospital mortality was 37.3%. It was 30.9% in period 1, 36.6% in period 2 (p = 0.329 vs. period 1), and 47.1% in period 3 (0.015 vs. period 1). In multivariate analysis, independent factors associated with hospital mortality included age greater than 40 years (]40-60 years] OR = 5.2, 95%CI: 1.4-19.5; (]60-70 years] OR = 8.5, 95%CI: 2.2-32; (]70+ years] OR = 17.9, 95%CI: 4.5-70.9), frailty (OR = 5.6, 95%CI: 2.2-17.2), immunosuppression (OR = 2.6, 95%CI: 1.05-6.7), and MV use (OR = 11, 95%CI: 6.1-19.9). This model had an overall sensitivity of 72%, a specificity of 80.4%, a positive predictive value of 68.7%, and a negative predictive value of 82.8%. (4) Conclusions: The mortality of severe COVID-19 patients in French Amazonia was higher during the Delta variant wave. This over-death could be explained by the virulence of the responsible SARS-CoV-2 variant and the under-vaccination coverage of the studied population.
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Affiliation(s)
- Séverine Matheus
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Stéphanie Houcke
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Guy Roger Lontsi Ngoulla
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Nicolas Higel
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Abesetou Ba
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Fabrice Cook
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Cyrille Gourjault
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Flaubert Nkontcho
- Pharmacy Department, Cayenne General Hospital, Cayenne 97300, French Guiana;
| | - Magalie Demar
- Polyvalent Biology Department, Cayenne General Hospital, Cayenne 97300, French Guiana;
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, Cayenne 97300, French Guiana; (F.D.); (J.M.P.)
| | - Mathieu Nacher
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne General Hospital, Cayenne 97300, French Guiana;
| | - Félix Djossou
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, Cayenne 97300, French Guiana; (F.D.); (J.M.P.)
- Tropical and Infectious Diseases Department, Cayenne General Hospital, Cayenne 97300, French Guiana
| | - Didier Hommel
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
| | - Dabor Résiere
- Intensive Care Unit, Martinique University Hospital, Fort de France 97261, Martinique;
| | - Jean Marc Pujo
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, Cayenne 97300, French Guiana; (F.D.); (J.M.P.)
- Emergency Department, Cayenne General Hospital, Cayenne 97300, French Guiana
| | - Hatem Kallel
- Intensive Care Unit, Cayenne General Hospital, Cayenne 97300, French Guiana; (S.M.); (S.H.); (G.R.L.N.); (A.B.); (F.C.); (D.H.)
- Tropical Biome and Immunopathology CNRS UMR-9017, Inserm U 1019, Université de Guyane, Cayenne 97300, French Guiana; (F.D.); (J.M.P.)
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Johnstone KF, Herzberg MC. Antimicrobial peptides: Defending the mucosal epithelial barrier. FRONTIERS IN ORAL HEALTH 2022; 3:958480. [PMID: 35979535 PMCID: PMC9376388 DOI: 10.3389/froh.2022.958480] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
The recent epidemic caused by aerosolized SARS-CoV-2 virus illustrates the importance and vulnerability of the mucosal epithelial barrier against infection. Antimicrobial proteins and peptides (AMPs) are key to the epithelial barrier, providing immunity against microbes. In primitive life forms, AMPs protect the integument and the gut against pathogenic microbes. AMPs have also evolved in humans and other mammals to enhance newer, complex innate and adaptive immunity to favor the persistence of commensals over pathogenic microbes. The canonical AMPs are helictical peptides that form lethal pores in microbial membranes. In higher life forms, this type of AMP is exemplified by the defensin family of AMPs. In epithelial tissues, defensins, and calprotectin (complex of S100A8 and S100A9) have evolved to work cooperatively. The mechanisms of action differ. Unlike defensins, calprotectin sequesters essential trace metals from microbes, which inhibits growth. This review focuses on defensins and calprotectin as AMPs that appear to work cooperatively to fortify the epithelial barrier against infection. The antimicrobial spectrum is broad with overlap between the two AMPs. In mice, experimental models highlight the contribution of both AMPs to candidiasis as a fungal infection and periodontitis resulting from bacterial dysbiosis. These AMPs appear to contribute to innate immunity in humans, protecting the commensal microflora and restricting the emergence of pathobionts and pathogens. A striking example in human innate immunity is that elevated serum calprotectin protects against neonatal sepsis. Calprotectin is also remarkable because of functional differences when localized in epithelial and neutrophil cytoplasm or released into the extracellular environment. In the cytoplasm, calprotectin appears to protect against invasive pathogens. Extracellularly, calprotectin can engage pathogen-recognition receptors to activate innate immune and proinflammatory mechanisms. In inflamed epithelial and other tissue spaces, calprotectin, DNA, and histones are released from degranulated neutrophils to form insoluble antimicrobial barriers termed neutrophil extracellular traps. Hence, calprotectin and other AMPs use several strategies to provide microbial control and stimulate innate immunity.
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Affiliation(s)
| | - Mark C. Herzberg
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, United States
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