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Pirracchio R, Venkatesh B, Legrand M. Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections: A Review. JAMA 2024; 332:318-328. [PMID: 38865154 DOI: 10.1001/jama.2024.6096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Importance Severe pulmonary infections, including COVID-19, community-acquired pneumonia, influenza, and Pneumocystis pneumonia, are a leading cause of death among adults worldwide. Pulmonary infections in critically ill patients may cause septic shock, acute respiratory distress syndrome, or both, which are associated with mortality rates ranging between 30% and 50%. Observations Corticosteroids mitigate the immune response to infection and improve outcomes for patients with several types of severe pulmonary infections. Low-dose corticosteroids, defined as less than or equal to 400 mg hydrocortisone equivalent daily, can reduce mortality of patients with severe COVID-19, community-acquired pneumonia, and Pneumocystis pneumonia. A randomized clinical trial of 6425 patients hospitalized with COVID-19 who required supplemental oxygen or noninvasive or invasive mechanical ventilation reported that dexamethasone 6 mg daily for 10 days decreased 28-day mortality (23% vs 26%). A meta-analysis that included 7 randomized clinical trials of 1689 patients treated in the intensive care unit for severe bacterial community-acquired pneumonia reported that hydrocortisone equivalent less than or equal to 400 mg daily for 8 days or fewer was associated with lower 30-day mortality compared with placebo (10% vs 16%). In a meta-analysis of 6 randomized clinical trials, low-dose corticosteroids were associated with lower mortality rates compared with placebo for patients with HIV and moderate to severe Pneumocystis pneumonia (13% vs 25%). In a predefined subgroup analysis of a trial of low-dose steroid treatment for septic shock, patients with community-acquired pneumonia randomized to 7 days of intravenous hydrocortisone 50 mg every 6 hours and fludrocortisone 50 μg daily had decreased mortality compared with the placebo group (39% vs 51%). For patients with acute respiratory distress syndrome caused by various conditions, low-dose corticosteroids were associated with decreased in-hospital mortality (34% vs 45%) according to a meta-analysis of 8 studies that included 1091 patients. Adverse effects of low-dose corticosteroids may include hyperglycemia, gastrointestinal bleeding, neuropsychiatric disorders, muscle weakness, hypernatremia, and secondary infections. Conclusions and Relevance Treatment with low-dose corticosteroids is associated with decreased mortality for patients with severe COVID-19 infection, severe community-acquired bacterial pneumonia, and moderate to severe Pneumocystis pneumonia (for patients with HIV). Low-dose corticosteroids may also benefit critically ill patients with respiratory infections who have septic shock, acute respiratory distress syndrome, or both.
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Affiliation(s)
- Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, University of California San Francisco
- Associate Editor, JAMA
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, University of New South Wales Sydney, Australia
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - Matthieu Legrand
- Department of Anesthesia and Perioperative Medicine, University of California San Francisco
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2
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Cilloniz C, Dy-Agra G, Pagcatipunan RS, Torres A. Viral Pneumonia: From Influenza to COVID-19. Semin Respir Crit Care Med 2024; 45:207-224. [PMID: 38228165 DOI: 10.1055/s-0043-1777796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Respiratory viruses are increasingly recognized as a cause of community-acquired pneumonia (CAP). The implementation of new diagnostic technologies has facilitated their identification, especially in vulnerable population such as immunocompromised and elderly patients and those with severe cases of pneumonia. In terms of severity and outcomes, viral pneumonia caused by influenza viruses appears similar to that caused by non-influenza viruses. Although several respiratory viruses may cause CAP, antiviral therapy is available only in cases of CAP caused by influenza virus or respiratory syncytial virus. Currently, evidence-based supportive care is key to managing severe viral pneumonia. We discuss the evidence surrounding epidemiology, diagnosis, management, treatment, and prevention of viral pneumonia.
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Affiliation(s)
- Catia Cilloniz
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Guinevere Dy-Agra
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Rodolfo S Pagcatipunan
- Institute of Pulmonary Medicine, St Luke's Medical Center-Global City, Taguig, Metro Manila, Philippines
| | - Antoni Torres
- Hospital Clinic of Barcelona, IDIBAPS, CIBERESA, Barcelona, Spain
- School of Medicine, University of Barcelona, Barcelona, Spain
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3
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Chung E, Leem AY, Chung KS, Kang YA, Park MS, Kim YS, Jang HJ, Lee SH. Differences of respiratory mechanics in mechanical ventilation of acute respiratory distress syndrome between patients with COVID-19 and Influenza A. Respir Res 2024; 25:112. [PMID: 38448933 PMCID: PMC10919012 DOI: 10.1186/s12931-024-02730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Whether COVID-19-induced acute respiratory distress syndrome (ARDS) should be approached differently in terms of mechanical ventilation therapy compared to other virus-induced ARDS is debatable. Therefore, we aimed to ascertain whether the respiratory mechanical characteristics of COVID-19-induced ARDS differ from those of influenza A induced ARDS, in order to establish a rationale for mechanical ventilation therapy in COVID-19-induced ARDS. METHODS This was a retrospective cohort study comparing patients with COVID-19-induced ARDS and influenza A induced ARDS. We included intensive care unit (ICU) patients with COVID-19 or Influenza A aged ≥ 19, who were diagnosed with ARDS according to the Berlin definition between January 2015 and July 2021. Ventilation parameters for respiratory mechanics were collected at specific times on days one, three, and seven after intubation. RESULTS The median age of the 87 participants was 71.0 (62.0-78.0) years old, and 63.2% were male. The ratio of partial pressure of oxygen in arterial blood to the fractional of inspiratory oxygen concentration in COVID-19-induced ARDS was lower than that in influenza A induced ARDS during the initial stages of mechanical ventilation (influenza A induced ARDS 216.1 vs. COVID-19-induced ARDS 167.9, p = 0.009, day 1). The positive end expiratory pressure remained consistently higher in the COVID-19 group throughout the follow-up period (7.0 vs. 10.0, p < 0.001, day 1). COVID-19 and influenza A initially showed different directions for peak inspiratory pressure and dynamic compliance; however, after day 3, both groups exhibited similar directions. Dynamic driving pressure exhibited opposite trends between the two groups during mechanical ventilation. CONCLUSIONS Respiratory mechanics show clear differences between COVID-19-induced ARDS and influenza A induced ARDS. Based on these findings, we can consider future treatment strategies for COVID-19-induced ARDS.
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Affiliation(s)
- Eunki Chung
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Ah Young Leem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyung Soo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hye Jin Jang
- Division of Pulmonary, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea.
| | - Su Hwan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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4
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Hamad Y, Bell TD, Kadri SS. Shifting Tides: Is It Time to Embrace Adjunctive Corticosteroids for Community-Acquired Pneumonia? Clin Infect Dis 2023; 77:1714-1716. [PMID: 37879118 PMCID: PMC11032190 DOI: 10.1093/cid/ciad498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Yasir Hamad
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Taison D Bell
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia, USA
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Sameer S Kadri
- Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
- Critical Care Medicine Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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5
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Jiang H, Zhang Z. Immune response in influenza virus infection and modulation of immune injury by viral neuraminidase. Virol J 2023; 20:193. [PMID: 37641134 PMCID: PMC10463456 DOI: 10.1186/s12985-023-02164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Influenza A viruses cause severe respiratory illnesses in humans and animals. Overreaction of the innate immune response to influenza virus infection results in hypercytokinemia, which is responsible for mortality and morbidity. The influenza A virus surface glycoprotein neuraminidase (NA) plays a vital role in viral attachment, entry, and virion release from infected cells. NA acts as a sialidase, which cleaves sialic acids from cell surface proteins and carbohydrate side chains on nascent virions. Here, we review progress in understanding the role of NA in modulating host immune response to influenza virus infection. We also discuss recent exciting findings targeting NA protein to interrupt influenza-induced immune injury.
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Affiliation(s)
- Hongyu Jiang
- The People's Hospital of Dayi Country, Chengdu, Sichuan, China
- Inflammation and Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan, China
| | - Zongde Zhang
- The People's Hospital of Dayi Country, Chengdu, Sichuan, China.
- Inflammation and Allergic Diseases Research Unit, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
- School of Basic Medical Sciences, Southwest Medical University, Luzhou, Sichuan, China.
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6
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Latreille E, Lee WL. Modulation of the Host Response as a Therapeutic Strategy in Severe Lung Infections. Viruses 2023; 15:1462. [PMID: 37515150 PMCID: PMC10386155 DOI: 10.3390/v15071462] [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: 06/02/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Respiratory pathogens such as influenza and SARS-CoV-2 can cause severe lung infections leading to acute respiratory distress syndrome (ARDS). The pathophysiology of ARDS includes an excessive host immune response, lung epithelial and endothelial cell death and loss of the epithelial and endothelial barrier integrity, culminating in pulmonary oedema and respiratory failure. Traditional approaches for the treatment of respiratory infections include drugs that exert direct anti-pathogen effects (e.g., antivirals). However, such agents are typically ineffective or insufficient after the development of ARDS. Modulation of the host response has emerged as a promising alternative therapeutic approach to mitigate damage to the host for the treatment of respiratory infections; in principle, this strategy should also be less susceptible to the development of pathogen resistance. In this review, we discuss different host-targeting strategies against pathogen-induced ARDS. Developing therapeutics that enhance the host response is a pathogen-agnostic approach that will help prepare for the next pandemic.
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Affiliation(s)
- Elyse Latreille
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Warren L Lee
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
- Department of Medicine, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON M5B 1T8, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8, Canada
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7
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Wurster S, Pantaleón García J, Albert ND, Jiang Y, Bhoda K, Kulkarni VV, Wang Y, Walsh TJ, Evans S, Kontoyiannis DP. Development of a Corticosteroid-Immunosuppressed Mouse Model to Study the Pathogenesis and Therapy of Influenza-Associated Pulmonary Aspergillosis. J Infect Dis 2023; 227:901-906. [PMID: 36611269 PMCID: PMC10319956 DOI: 10.1093/infdis/jiad001] [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: 09/09/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Influenza-associated pulmonary aspergillosis (IAPA) is a feared complication in patients with influenza tracheobronchitis, especially those receiving corticosteroids. Herein, we established a novel IAPA mouse model with low-inoculum Aspergillus infection and compared outcomes in mice with and without cortisone acetate (CA) immunosuppression. CA was an independent predictor of increased morbidity/mortality in mice with IAPA. Early antifungal treatment with liposomal amphotericin B was pivotal to improve IAPA outcomes in CA-immunosuppressed mice, even after prior antiviral therapy with oseltamivir. In summary, our model recapitulates key clinical features of IAPA and provides a robust preclinical platform to study the pathogenesis and treatment of IAPA.
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Affiliation(s)
- Sebastian Wurster
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jezreel Pantaleón García
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Nathaniel D Albert
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Keerthi Bhoda
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Vikram V Kulkarni
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Yongxing Wang
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Thomas J Walsh
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
| | - Scott Evans
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Virk S, Quazi MA, Nasrullah A, Shah A, Kudron E, Chourasia P, Javed A, Jain P, Gangu K, Cheema T, DiSilvio B, Sheikh AB. Comparing Clinical Outcomes of COVID-19 and Influenza-Induced Acute Respiratory Distress Syndrome: A Propensity-Matched Analysis. Viruses 2023; 15:v15040922. [PMID: 37112902 PMCID: PMC10144713 DOI: 10.3390/v15040922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is one the leading causes of mortality and morbidity in patients with COVID-19 and Influenza, with only small number of studies comparing these two viral illnesses in the setting of ARDS. Given the pathogenic differences in the two viruses, this study shows trends in national hospitalization and outcomes associated with COVID-19- and Influenza-related ARDS. To evaluate and compare the risk factors and rates of the adverse clinical outcomes in patients with COVID-19 associated ARDS (C-ARDS) relative to Influenza-related ARDS (I-ARDS), we utilized the National Inpatient Sample (NIS) database 2020. Our sample includes 106,720 patients hospitalized with either C-ARDS or I-ARDS between January and December 2020, of which 103,845 (97.3%) had C-ARDS and 2875 (2.7%) had I-ARDS. Propensity-matched analysis demonstrated a significantly higher in-hospital mortality (aOR 3.2, 95% CI 2.5-4.2, p < 0.001), longer mean length of stay (18.7 days vs. 14.5 days, p < 0.001), higher likelihood of requiring vasopressors (aOR 1.7, 95% CI 2.5-4.2) and invasive mechanical ventilation (IMV) (aOR 1.6, 95% CI 1.3-2.1) in C-ARDS patients. Our study shows that COVID-19-related ARDS patients had a higher rate of complications, including higher in-hospital mortality and a higher need for vasopressors and invasive mechanical ventilation relative to Influenza-related ARDS; however, it also showed an increased utilization of mechanical circulatory support and non-invasive ventilation in Influenza-related ARDS. It emphasizes the need for early detection and management of COVID-19.
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Affiliation(s)
- Shiza Virk
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Mohammed A Quazi
- Department of Mathematics and Statistics, University of New Mexico, Albuquerque, NM 87106, USA
| | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Aaisha Shah
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Evan Kudron
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Anam Javed
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Priyanka Jain
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Tariq Cheema
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Briana DiSilvio
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburg, PA 15212, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87106, USA
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9
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Krishnan R, Stapledon CJM, Mostafavi H, Freitas JR, Liu X, Mahalingam S, Zaid A. Anti-inflammatory actions of Pentosan polysulfate sodium in a mouse model of influenza virus A/PR8/34-induced pulmonary inflammation. Front Immunol 2023; 14:1030879. [PMID: 36845136 PMCID: PMC9947849 DOI: 10.3389/fimmu.2023.1030879] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction There is an unmet medical need for effective anti-inflammatory agents for the treatment of acute and post-acute lung inflammation caused by respiratory viruses. The semi-synthetic polysaccharide, Pentosan polysulfate sodium (PPS), an inhibitor of NF-kB activation, was investigated for its systemic and local anti-inflammatory effects in a mouse model of influenza virus A/PR8/1934 (PR8 strain) mediated infection. Methods Immunocompetent C57BL/6J mice were infected intranasally with a sublethal dose of PR8 and treated subcutaneously with 3 or 6 mg/kg PPS or vehicle. Disease was monitored and tissues were collected at the acute (8 days post-infection; dpi) or post-acute (21 dpi) phase of disease to assess the effect of PPS on PR8-induced pathology. Results In the acute phase of PR8 infection, PPS treatment was associated with a reduction in weight loss and improvement in oxygen saturation when compared to vehicle-treated mice. Associated with these clinical improvements, PPS treatment showed a significant retention in the numbers of protective SiglecF+ resident alveolar macrophages, despite uneventful changes in pulmonary leukocyte infiltrates assessed by flow cytometry. PPS treatment in PR8- infected mice showed significant reductions systemically but not locally of the inflammatory molecules, IL-6, IFN-g, TNF-a, IL-12p70 and CCL2. In the post-acute phase of infection, PPS demonstrated a reduction in the pulmonary fibrotic biomarkers, sICAM-1 and complement factor C5b9. Discussion The systemic and local anti-inflammatory actions of PPS may regulate acute and post-acute pulmonary inflammation and tissue remodeling mediated by PR8 infection, which warrants further investigation.
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Affiliation(s)
- Ravi Krishnan
- Research and Development, Paradigm Biopharmaceuticals Ltd., Melbourne, VIC, Australia
| | | | - Helen Mostafavi
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Center for Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
| | - Joseph R. Freitas
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Center for Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
| | - Xiang Liu
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Center for Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
| | - Suresh Mahalingam
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Center for Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
| | - Ali Zaid
- Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
- Global Virus Network (GVN) Center for Excellence in Arboviruses, Griffith University, Gold Coast, QLD, Australia
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10
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Wallis RS, O'Garra A, Sher A, Wack A. Host-directed immunotherapy of viral and bacterial infections: past, present and future. Nat Rev Immunol 2023; 23:121-133. [PMID: 35672482 PMCID: PMC9171745 DOI: 10.1038/s41577-022-00734-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 02/06/2023]
Abstract
The advent of COVID-19 and the persistent threat of infectious diseases such as tuberculosis, malaria, influenza and HIV/AIDS remind us of the marked impact that infections continue to have on public health. Some of the most effective protective measures are vaccines but these have been difficult to develop for some of these infectious diseases even after decades of research. The development of drugs and immunotherapies acting directly against the pathogen can be equally challenging, and such pathogen-directed therapeutics have the potential disadvantage of selecting for resistance. An alternative approach is provided by host-directed therapies, which interfere with host cellular processes required for pathogen survival or replication, or target the host immune response to infection (immunotherapies) to either augment immunity or ameliorate immunopathology. Here, we provide a historical perspective of host-directed immunotherapeutic interventions for viral and bacterial infections and then focus on SARS-CoV-2 and Mycobacterium tuberculosis, two major human pathogens of the current era, to indicate the key lessons learned and discuss candidate immunotherapeutic approaches, with a focus on drugs currently in clinical trials.
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Affiliation(s)
- Robert S Wallis
- The Aurum Institute, Johannesburg, South Africa.
- Vanderbilt University, Nashville, TN, USA.
- Rutgers University, Newark, NJ, USA.
- Case Western Reserve University, Cleveland, OH, USA.
| | - Anne O'Garra
- Immunoregulation and Infection Laboratory, The Francis Crick Institute, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alan Sher
- Immunobiology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andreas Wack
- Immunoregulation Laboratory, The Francis Crick Institute, London, UK.
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11
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Alhudiri IM, Saad SR, Abusrewil Z, Amer AO, El Meshri SE, Bin Abdallah MN, Elghazal MM, Said MH, Ebrahim FO, Abusanina MS, Ben Elfghi M, Abdusalam MM, Elzagheid A. A Preliminary Study on the Frequency of Influenza Infections during the Early 2022 Amid COVID-19 Epidemic in Libya. IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2023. [DOI: 10.1055/s-0042-1760225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Background At the time of conducting this study, we were at the peak of the influenza season, and influenza vaccinations were not readily accessible throughout the country. Thus, predisposing many high-risk individuals to influenza infections in a time when coronavirus disease 2019 (COVID-19) was also highly circulating, and the emerging Omicron variant of concern was peaking in many countries worldwide.
Methods We conducted a brief survey to prospectively estimate the frequency of influenza A and B and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in samples received at our laboratories at Libyan Biotechnology Research Center, Tripoli, Libya, between December 1, 2021, and January 31, 2022, for patients complaining of respiratory symptoms using a multiplex reverse transcription-polymerase chain reaction test for SARS-COV-2, influenza A and B, and RSV.
Results We analyzed nasopharyngeal swabs in viral transport media from 2,186 samples. About 27% (589/2186) of study patients tested positive for SARS-COV-2, 2.8% (61/2186) were positive for influenza A virus, 0.18% (4/2186) for influenza B virus, and 1.4% (31/2186) tested positive for RSV.
Conclusions These results revealed that along with COVID-19, influenza infections were also rising. As the COVID-19 pandemic continues, the most significant concern is the development of an influenza outbreak in the upcoming months. Therefore, continuing annual influenza vaccination is critical to increasing population immunity. National influenza surveillance and testing should also be conducted. Furthermore, sequencing and antigenic characterization should be performed regularly. There is a need for continuous monitoring in national laboratories to detect any zoonotic cases and substantial viral evolution.
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Affiliation(s)
- Inas M. Alhudiri
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Saad R. Saad
- Isolation Center, Tripoli University Hospital, Tripoli, Libya
| | - Zakarya Abusrewil
- Forensic Medicine and Toxicology Department, University of Tripoli, Tripoli, Libya
| | - Asel O. Amer
- Isolation Center, Tripoli University Hospital, Tripoli, Libya
| | - Salah Edin El Meshri
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
| | | | | | - Mohamed H. Said
- Vaccination Unit, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Fawzi O. Ebrahim
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mohamed S. Abusanina
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mohammed Ben Elfghi
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Mohamed M. Abdusalam
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
| | - Adam Elzagheid
- Genetic Engineering, Cell Biology and Microbiology Departments, Libyan Biotechnology Research Center, Tripoli, Libya
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12
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Cilloniz C, Luna CM, Hurtado JC, Marcos MÁ, Torres A. Respiratory viruses: their importance and lessons learned from COVID-19. Eur Respir Rev 2022; 31:31/166/220051. [PMID: 36261158 DOI: 10.1183/16000617.0051-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/30/2022] [Indexed: 01/08/2023] Open
Abstract
Respiratory virus infection can cause severe illnesses capable of inducing acute respiratory failure that can progress rapidly to acute respiratory distress syndrome (ARDS). ARDS is related to poor outcomes, especially in individuals with a higher risk of infection, such as the elderly and those with comorbidities, i.e. obesity, asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. Despite this, effective antiviral treatments available for severe viral lung infections are scarce. The coronavirus disease 2019 (COVID-19) pandemic demonstrated that there is also a need to understand the role of airborne transmission of respiratory viruses. Robust evidence supporting this exists, but better comprehension could help implement adequate measures to mitigate respiratory viral infections. In severe viral lung infections, early diagnosis, risk stratification and prognosis are essential in managing patients. Biomarkers can provide reliable, timely and accessible information possibly helpful for clinicians in managing severe lung viral infections. Although respiratory viruses highly impact global health, more research is needed to improve care and prognosis of severe lung viral infections. In this review, we discuss the epidemiology, diagnosis, clinical characteristics, management and prognosis of patients with severe infections due to respiratory viruses.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain .,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.,Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - Carlos M Luna
- Pneumology Division, Hospital of Clínicas, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Juan Carlos Hurtado
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - María Ángeles Marcos
- Dept of Microbiology, Hospital Clinic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
| | - Antoni Torres
- Pneumology Dept, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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13
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Slim MA, Appelman B, Peters-Sengers H, Dongelmans DA, de Keizer NF, Schade RP, de Boer MGJ, Müller MCA, Vlaar APJ, Wiersinga WJ, van Vught LA. Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands. Open Forum Infect Dis 2022; 9:ofac632. [PMID: 36519114 PMCID: PMC9745783 DOI: 10.1093/ofid/ofac632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/20/2022] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive. METHODS We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted. RESULTS Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67-64 years; P < .001), in in-hospital mortality on the ward (21%-15%; P < .001), and a trend in the ICU (24%-16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22-1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03-1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69-0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality. CONCLUSIONS Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
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Affiliation(s)
- Marleen A Slim
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Brent Appelman
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Hessel Peters-Sengers
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands
- Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam—Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Rogier P Schade
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcella C A Müller
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Division of Infectious Diseases, Department of Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke A van Vught
- Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
- Department of Intensive Care, Amsterdam University Medical Centers—Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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14
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Targeted delivery of an anti-inflammatory corticosteroid to Ly6C/G-positive cells abates severity of influenza A symptoms. Proc Natl Acad Sci U S A 2022; 119:e2211065119. [PMID: 36252038 PMCID: PMC9618054 DOI: 10.1073/pnas.2211065119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The distribution of Ly6C/G-positive cells in response to an infection of the mouse respiratory tract with influenza A virus was followed noninvasively over time by immuno-positron emission tomography. We converted nanobodies that recognize Ly6C and Ly6G, markers of neutrophils and other myeloid cells, as well as an influenza hemagglutinin-specific nanobody, into 89Zr-labeled PEGylated positron emission tomography (PET) imaging agents. The PET images showed strong accumulation of these imaging agents in the lungs of infected mice. Immunohistochemistry of influenza virus-infected mice and control mice, injected with a biotinylated and PEGylated version of the Ly6C/G-specific nanobody, showed the presence of abundant Ly6C/G-positive myeloid cells and positivity for Ly6C/G on bronchial epithelium in influenza virus-infected mice. This is consistent with focal inflammation in the lungs, a finding that correlated well with the immuno-PET results. No such signals were detected in control mice. Having shown by PET the accumulation of the Ly6C/G-specific nanobody in infected lungs, we synthesized conjugates of Ly6C/G-specific nanobodies with dexamethasone to enable targeted delivery of this immunosuppressive corticosteroid to sites of inflammation. Such conjugates reduced the weight loss that accompanies infection, while the equivalent amount of free dexamethasone was without effect. Nanobody-drug conjugates thus enable delivery of drugs to particular cell types at the appropriate anatomic site(s). By avoiding systemic exposure to free dexamethasone, this strategy minimizes its undesirable side effects because of the much lower effective dose of the nanobody-dexamethasone conjugate. The ability to selectively target inflammatory cells may find application in the treatment of other infections or other immune-mediated diseases.
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15
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Bowen A, Zucker J, Shen Y, Huang S, Yan Q, Annavajhala MK, Uhlemann AC, Kuhn L, Sobieszczyk M, Castor D. Reduction in risk of death among patients admitted with COVID-19 between first and second epidemic waves in New York City. Open Forum Infect Dis 2022; 9:ofac436. [PMID: 36131846 PMCID: PMC9452151 DOI: 10.1093/ofid/ofac436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Many regions have experienced successive epidemic waves of COVID-19 since the emergence of SARS-CoV-2 with heterogeneous differences in mortality. Elucidating factors differentially associated with mortality between epidemic waves may inform clinical and public health strategies.
Methods
We examined clinical and demographic data among patients admitted with COVID-19 during the first (March-August 2020) and second (August 2020-March 2021) epidemic waves at an academic medical center in New York City.
Results
Hospitalized patients (N = 4631) had lower overall and 30-day in-hospital mortality, defined as death or discharge to hospice, during the second wave (14% and 11%) than the first (22% and 21%). The wave 2 in-hospital mortality decrease persisted after adjusting for several potential confounders. Adjusting for the volume of COVID-19 admissions, a measure of health system strain, accounted for the mortality difference between waves. Several demographic and clinical patient factors were associated with an increased risk of mortality independent of wave; SARS-CoV-2 cycle threshold, Do-Not-Intubate status, oxygen requirement, and intensive care unit admission.
Conclusions
This work suggests that increased in-hospital mortality rates observed during the first epidemic wave were partly due to strain on hospital resources. Preparations for future epidemics should prioritize evidence-based patient risks, treatment paradigms, and approaches to augment hospital capacity.
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Affiliation(s)
- Anthony Bowen
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
| | - Yanhan Shen
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York , USA
| | - Simian Huang
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
| | - Qiheng Yan
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York , USA
| | - Medini K Annavajhala
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
| | - Anne Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center , New York , USA
| | - Magdalena Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
| | - Delivette Castor
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center , New York , USA
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16
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Hong TH, Lee HS, Kim NE, Lee KJ, Kim YK, An JN, Kim JH, Kim HW, Park S. Recent Increases in Influenza-Related Hospitalizations, Critical Care Resource Use, and In-Hospital Mortality: A 10-Year Population-Based Study in South Korea. J Clin Med 2022; 11:jcm11164911. [PMID: 36013150 PMCID: PMC9410240 DOI: 10.3390/jcm11164911] [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: 08/03/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Long-term trends in influenza-related hospitalizations, critical care resource use, and hospital outcomes since the 2009 H1N1 influenza pandemic season have been rarely studied for adult populations. Materials and Methods: Adult patients from the Korean Health Insurance Review and Assessment Service who were hospitalized with influenza over a 10-year period (2009−2019) were analyzed. The incidence rates of hospitalization, critical care resource use, and in-hospital death were calculated using mid-year population census data. Results: In total, 300,152 hospitalized patients with influenza were identified (men, 35.7%; admission to tertiary hospitals, 9.4%). Although the age-adjusted hospitalization rate initially decreased since the 2009 H1N1 pandemic (52.61/100,000 population in 2009/2010), it began to increase again in 2013/2014 and reached a peak of 169.86/100,000 population in 2017/2018 (p < 0.001). The in-hospital mortality rate showed a similar increasing trend as the hospitalization, with a peak of 1.44/100,000 population in 2017/2018 (vs. 0.35/100,000 population in 2009/2010; p < 0.001). The high incidence rates of both hospitalization and in-hospital mortality were mainly attributable to patients aged ≥60 years. The rate of intensive care unit admission and the use of mechanical ventilation, continuous renal replacement therapy and vasopressors have also increased from the 2013/2014 season. The incidence of heart failure was the most frequent complication investigated, with a three-fold increase in the last two seasons since 2009/2010. In multivariate analysis adjusted for covariates, among hospitalized patients, type of hospitals and 2009 H1N1 pandemic season were associated with in-hospital mortality. Conclusions: We confirmed that the rates of hospitalization, critical care resource use, and in-hospital mortality by influenza have increased again in recent years. Therefore, strategies are needed to reduce infections and optimize resource use with a greater focus on older people.
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Affiliation(s)
- Tae Hwa Hong
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Hyung Seok Lee
- Department of Nephrology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Nam-Eun Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
| | - Kyu Jin Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Yong Kyun Kim
- Department of Infectious Disease, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Jung Nam An
- Department of Nephrology, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Joo-Hee Kim
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Hyung Won Kim
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Correspondence:
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17
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Pacheco-Hernández LM, Ramírez-Noyola JA, Gómez-García IA, Ignacio-Cortés S, Zúñiga J, Choreño-Parra JA. Comparing the Cytokine Storms of COVID-19 and Pandemic Influenza. J Interferon Cytokine Res 2022; 42:369-392. [PMID: 35674675 PMCID: PMC9422807 DOI: 10.1089/jir.2022.0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/19/2022] [Indexed: 12/15/2022] Open
Abstract
Emerging respiratory viruses are major health threats due to their potential to cause massive outbreaks. Over the past 2 years, the coronavirus disease 2019 (COVID-19) pandemic has caused millions of cases of severe infection and deaths worldwide. Although natural and vaccine-induced protective immune mechanisms against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been increasingly identified, the factors that determine morbimortality are less clear. Comparing the immune signatures of COVID-19 and other severe respiratory infections such as the pandemic influenza might help dissipate current controversies about the origin of their severe manifestations. As such, identifying homologies in the immunopathology of both diseases could provide targets for immunotherapy directed to block shared pathogenic mechanisms. Meanwhile, finding unique characteristics that differentiate each infection could shed light on specific immune alterations exploitable for diagnostic and individualized therapeutics for each case. In this study, we summarize immunopathological aspects of COVID-19 and pandemic influenza from the perspective of cytokine storms as the driving force underlying morbidity. Thereby, we analyze similarities and differences in the cytokine profiles of both infections, aiming to bring forward those molecules more attractive for translational medicine and drug development.
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Affiliation(s)
- Lynette Miroslava Pacheco-Hernández
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Jazmín Ariadna Ramírez-Noyola
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” Mexico City, Mexico
- Programa de Maestría en Ciencias de la Salud, Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Salvador Díaz Mirón and Plan de San Luis, Mexico City, Mexico
| | - Itzel Alejandra Gómez-García
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Sergio Ignacio-Cortés
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Joaquín Zúñiga
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - José Alberto Choreño-Parra
- Laboratory of Immunobiology and Genetics, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
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18
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Wu Q, Pennini ME, Bergmann JN, Kozak ML, Herring K, Sciarretta KL, Armstrong KL. Applying lessons learned from COVID-19 therapeutic trials to improve future ALI/ARDS trials. Open Forum Infect Dis 2022; 9:ofac381. [PMID: 35983268 PMCID: PMC9379817 DOI: 10.1093/ofid/ofac381] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022] Open
Abstract
Host-directed therapeutics targeting immune dysregulation are considered the most promising approach to address the unmet clinical need for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). To better understand the current clinical study landscape and gaps in treating hospitalized patients with severe or critical COVID-19, we identified COVID-19 trials developing host-directed therapies registered at ClinicalTrials.gov and discussed the factors contributing to the success vs failure of these studies. We have learned, instead of the one-size-fits-all approach, future clinical trials evaluating a targeted immunomodulatory agent in heterogeneous patients with ALI/ARDS due to COVID-19 or other infectious diseases can use immune-based biomarkers in addition to clinical and demographic characteristics to improve patient stratification and inform clinical decision-making. Identifying distinct patient subgroups based on immune profiles across the disease trajectory, regardless of the causative pathogen, may accelerate evaluating host-directed therapeutics in trials of ALI/ARDS and related conditions (eg, sepsis).
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Affiliation(s)
- Qun Wu
- Influenza and Emerging Infectious Diseases Division (IEIDD), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
| | - Meghan E Pennini
- Division of Research Innovation and Ventures (DRIVe), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
| | - Julie N Bergmann
- Division of Chemical Biological Radiological Nuclear (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
| | - Marina L Kozak
- Division of Chemical Biological Radiological Nuclear (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
| | - Kristen Herring
- Division of Chemical Biological Radiological Nuclear (CBRN), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
| | - Kimberly L Sciarretta
- Division of Research Innovation and Ventures (DRIVe), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
| | - Kimberly L Armstrong
- Influenza and Emerging Infectious Diseases Division (IEIDD), Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), Department of Health and Human Services (HHS) , Washington, DC , United States of America
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19
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Cillóniz C, Pericàs JM, Rojas JR, Torres A. Severe Infections Due to Respiratory Viruses. Semin Respir Crit Care Med 2022; 43:60-74. [PMID: 35172359 DOI: 10.1055/s-0041-1740982] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Severe viral infections may result in severe illnesses capable of causing acute respiratory failure that could progress rapidly to acute respiratory distress syndrome (ARDS), related to worse outcomes, especially in individuals with a higher risk of infection, including the elderly and those with comorbidities such as asthma, diabetes mellitus and chronic respiratory or cardiovascular disease. In addition, in cases of severe viral pneumonia, co-infection with bacteria such as Streptococcus pneumoniae and Staphylococcus aureus is related to worse outcomes. Respiratory viruses like influenza, rhinovirus, parainfluenza, adenovirus, metapneumovirus, respiratory syncytial virus, and coronavirus have increasingly been detected. This trend has become more prevalent, especially in critically ill patients, due to the availability and implementation of molecular assays in clinical practice. Respiratory viruses have been diagnosed as a frequent cause of severe pneumonia, including cases of community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-associated pneumonia. In this review, we will discuss the epidemiology, diagnosis, clinical characteristics, management, and prognosis of patients with severe infections due to respiratory viruses, with a focus on influenza viruses, non-influenza viruses, and coronaviruses.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.,Internal Medicine Department, Vall d'Hebron Institute for Research, Barcelona, Spain
| | - Jorge R Rojas
- Department of Pneumology, Hospital Regional Docente Clínico Quirúrgico Daniel Alcides Carrión, Huancayo, Perú
| | - Antoni Torres
- Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
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20
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Agustí A, De Stefano G, Levi A, Muñoz X, Romero-Mesones C, Sibila O, Lopez-Giraldo A, Moral VP, Curto E, Echazarreta AL, Márquez SE, Pascual-Guàrdia S, Santos S, Marin A, Valdés L, Saldarini F, Salgado C, Casanovas G, Varea S, Ríos J, Faner R. Add-on inhaled budesonide in the treatment of hospitalised patients with COVID-19: a randomised clinical trial. Eur Respir J 2022; 59:13993003.03036-2021. [PMID: 35144989 PMCID: PMC8832375 DOI: 10.1183/13993003.03036-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 12/13/2022]
Abstract
SARS-CoV-2 vaccines have been extremely effective in reducing the incidence of severe coronavirus disease 2019 (COVID-19) [1, 2], but effective and safe treatments for acute infection are still limited [3, 4]. An uncontrolled pulmonary inflammatory response to SARS-CoV-2 is considered a key pathogenic mechanism of COVID-19 progression [5], so systemic dexamethasone is recommended in severe cases [4, 6]. On the other hand, in very mild patients at home, inhaled corticosteroids (ICS) may prevent disease progression [7–10]. Whether ICS can also prevent disease progression in patients hospitalised because of COVID-19 has not been explored previously. Accordingly, we designed an investigator-initiated, open-label, randomised clinical trial (RCT) to explore the efficacy of adding inhaled budesonide to usual care to prevent disease progression in patients hospitalised because of COVID-19 pneumonia. We also carefully monitored the safety of this intervention since there are concerns about the use of systemic corticosteroids in other viral (influenza) lung infections [11]. The addition of inhaled budesonide to usual care is safe and may reduce the risk of disease progression in patients hospitalised because of COVID-19 pneumoniahttps://bit.ly/3tEQo3p
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Affiliation(s)
- Alvar Agustí
- Hospital Clinic, Barcelona, Spain .,Universitat Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain
| | - Gaston De Stefano
- Servicio de Neumotisiologia, Hospital Francisco Muñiz, Buenos Aires, Argentina
| | - Alberto Levi
- Servicio de Neumotisiologia, Hospital Francisco Muñiz, Buenos Aires, Argentina
| | - Xavier Muñoz
- CIBER Enfermedades Respiratorias, Spain.,Servei Pneumologia H. Vall d'Hebron, Barcelona Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona
| | | | - Oriol Sibila
- Hospital Clinic, Barcelona, Spain.,Universitat Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain
| | - Alejandra Lopez-Giraldo
- Universitat Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain
| | - Vicente Plaza Moral
- CIBER Enfermedades Respiratorias, Spain.,Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Curto
- CIBER Enfermedades Respiratorias, Spain.,Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrés L Echazarreta
- Servicio de Neumonología, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | - Silvana E Márquez
- Servicio de Neumonología, Hospital San Juan de Dios de La Plata, Buenos Aires, Argentina
| | - Sergi Pascual-Guàrdia
- CIBER Enfermedades Respiratorias, Spain.,Servei de Pneumologia, Hospital del Mar - IMIM, Barcelona, Spain.,Universitat Pompeu Fabra Barcelona, Spain
| | - Salud Santos
- Universitat Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain.,Department of Pulmonary Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.,Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Spain
| | - Alicia Marin
- CIBER Enfermedades Respiratorias, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Luis Valdés
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.,Instituto de Investigaciones Sanitarias (IDIS), Santiago de Compostela, Spain.,Universidad de Santiago de Compostela, Spain
| | - Fernando Saldarini
- Sección de Neumotisiologia, Hospital Donación Francisco Santojanni, Buenos Aires, Argentina
| | - Clara Salgado
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno
| | - Georgina Casanovas
- Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sara Varea
- Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Ríos
- Hospital Clinic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona
| | - Rosa Faner
- Universitat Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,CIBER Enfermedades Respiratorias, Spain
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21
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Caiazzo E, Rezig AOM, Bruzzese D, Ialenti A, Cicala C, Cleland JGF, Guzik TJ, Maffia P, Pellicori P. Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials. Pharmacol Res 2022; 176:106053. [PMID: 34979235 PMCID: PMC8719379 DOI: 10.1016/j.phrs.2021.106053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. OBJECTIVES to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. METHODS We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. RESULTS No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 - 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. CONCLUSIONS Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.
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Affiliation(s)
- Elisabetta Caiazzo
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Asma O M Rezig
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Dario Bruzzese
- Department of Public health, University of Naples Federico II, Naples, Italy
| | - Armando Ialenti
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carla Cicala
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - John G F Cleland
- Robertson Centre for Biostatistics, and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, UK; National Heart & Lung Institute, Imperial College London, UK
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy; Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, UK.
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22
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Chen JT, Ostermann M. Review of Anti-inflammatory and Anti-viral therapeutics for hospitalized patients infected with SARS-CoV-2. Crit Care Clin 2022; 38:587-600. [PMID: 35667745 PMCID: PMC8841241 DOI: 10.1016/j.ccc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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No evidence of harmful effects of steroids in severe exacerbations of COPD associated with influenza. Infection 2022; 50:699-707. [PMID: 35091985 PMCID: PMC8799421 DOI: 10.1007/s15010-021-01743-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022]
Abstract
Purpose Methods Results Conclusion Supplementary Information
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24
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Chen L, Han X, Li Y, Zhang C, Xing X. Flu-IV score: a predictive tool for assessing the risk of invasive mechanical ventilation in patients with influenza-related pneumonia. BMC Pulm Med 2022; 22:47. [PMID: 35093039 PMCID: PMC8799963 DOI: 10.1186/s12890-022-01833-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/03/2021] [Indexed: 02/08/2023] Open
Abstract
Background The need for invasive mechanical ventilation (IMV) is linked to significant morbidity and mortality in patients with influenza-related pneumonia (Flu-p). We aimed to develop an assessment tool to predict IMV among Flu-p patients within 14 days of admission. Methods In total, 1107 Flu-p patients from five teaching hospitals were retrospectively enrolled from January 2012 to December 2019, including 895 patients in the derivation cohort and 212 patients in the validation cohort. The predictive model was established based on independent risk factors for IMV in the Flu-p patients from the derivation cohort. Results Overall, 10.6% (117/1107) of patients underwent IMV within 14 days of admission. Multivariate regression analyses revealed that the following factors were associated with IMV: early neuraminidase inhibitor use (− 3 points), lymphocytes < 0.8 × 109/L (1 point), multi-lobar infiltrates (1 point), systemic corticosteroid use (1 point), age ≥ 65 years old (1 points), PaO2/FiO2 < 300 mmHg (2 points), respiratory rate ≥ 30 breaths/min (3 points), and arterial PH < 7.35 (4 points). A total score of five points was used to identify patients at risk of IMV. This model had a sensitivity of 85.5%, a specificity of 88.8%, and exhibited better predictive performance than the ROX index (AUROC = 0.909 vs. 0.594, p = 0.004), modified ROX index (AUROC = 0.909 vs. 0.633, p = 0.012), and HACOR scale (AUROC = 0.909 vs. 0.622, p < 0.001) using the validation cohort. Conclusions Flu-IV score is a valuable prediction rule for 14-day IMV rates in Flu-p patients. However, it should be validated in a prospective study before implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01833-2.
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25
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FakhriRavari A, Jin S, Kachouei FH, Le D, Lopez M. Systemic corticosteroids for management of COVID-19: Saving lives or causing harm? Int J Immunopathol Pharmacol 2021; 35:20587384211063976. [PMID: 34923856 PMCID: PMC8725047 DOI: 10.1177/20587384211063976] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The underlying cause of many complications associated with severe COVID-19 is attributed to the inflammatory cytokine storm that leads to acute respiratory distress syndrome (ARDS), which appears to be the leading cause of death in COVID-19. Systemic corticosteroids have anti-inflammatory activity through repression of pro-inflammatory genes and inhibition of inflammatory cytokines, which makes them a potential medical intervention to diminish the upregulated inflammatory response. Early in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the role of corticosteroids was unclear. Corticosteroid use in other indications such as ARDS and septic shock has proven benefit while its use in other respiratory viral pneumonias is associated with reduced viral clearance and increased secondary infections. This review article evaluates the benefits and harms of systemic corticosteroids in patients with COVID-19 to assist clinicians in improving patient outcomes, including patient safety. Dexamethasone up to 10 days is the preferred regimen to reduce mortality risk in COVID-19 patients requiring oxygen support, mechanical ventilation, or extracorporeal membrane oxygenation. If dexamethasone is unavailable, other corticosteroids can be substituted at equivalent doses. Higher doses of corticosteroids may be beneficial in patients who develop ARDS. Corticosteroids should be avoided early in the disease course when patients do not require oxygen support because of potential harms.
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Affiliation(s)
| | | | | | - Diana Le
- 15471Loma Linda University, Loma Linda, CA, USA
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26
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Abstract
Influenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.
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Affiliation(s)
- Liam S O'Driscoll
- Department of Intensive Care Medicine, St. James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, St. James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland.,Respiratory Medicine, Hospital Clinic, IDIBAPS, Universidad de Barcelona, CIBERes, Barcelona, Spain
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27
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Szakmany T, Duric N. Cytokine inhibitors in COVID-19: looking back to move forward. Minerva Anestesiol 2021; 87:848-850. [PMID: 34514771 DOI: 10.23736/s0375-9393.21.15837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tamas Szakmany
- Critical Care Directorate, Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran, UK - .,Division of Population Medicine, Department of Anaesthesia, Intensive Care and Pain Medicine, Cardiff University, Cardiff, UK -
| | - Natalie Duric
- Critical Care Directorate, Grange University Hospital, Aneurin Bevan University Health Board, Cwmbran, UK
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28
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Chong WH, Saha BK, Chopra A. Does COVID-19 pneumonia signify secondary organizing pneumonia?: A narrative review comparing the similarities between these two distinct entities. Heart Lung 2021; 50:667-674. [PMID: 34098237 PMCID: PMC8164344 DOI: 10.1016/j.hrtlng.2021.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022]
Abstract
Multiple observational studies have described the similarities between COVID-19 pneumonia and organizing pneumonia (OP). These two entities clinically manifest with mild and subacute respiratory symptoms, often with a delayed diagnosis due to the atypical ARDS and silent hypoxemia presentation. Radiological features are often indistinguishable between the two. With the increase in antemortem lung biopsies and autopsies being performed, more histopathological findings of OP and its variant, acute fibrinous and organizing pneumonia (AFOP), are being diagnosed. These entities are known complications of viral infections as a delayed immunological process, explaining the favorable response to corticosteroids. Clinicians should be vigilant to diagnose this under-recognized entity of secondary OP in people with COVID-19 when clinical deterioration occurs, especially with compatible radiologic findings and recent cessation of corticosteroids. Despite the proven benefits of corticosteroids in treating COVID-19, treatment approaches can be more effective as OP often requires higher doses and a more prolonged therapy duration for remission and preventing relapses. The purpose of our narrative review is to compare the similarities between COVID-19 pneumonia and OP, emphasizing the clinical, radiological, and histopathological features based on the evidence available in the literature.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany 12208, New York, USA.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri, USA
| | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany 12208, New York, USA
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29
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Merk VM, Brunner T. Immunosuppressive glucocorticoids at epithelial barriers in the regulation of anti-viral immune response. VITAMINS AND HORMONES 2021; 117:77-100. [PMID: 34420586 DOI: 10.1016/bs.vh.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The anti-inflammatory action of adrenal-derived glucocorticoids has been recognized since several decades. This knowledge has found broad application in the clinics and today synthetic glucocorticoids are widely used in the treatment of various inflammatory diseases. However, the use of synthetic glucocorticoids in the treatment of diseases associated with viral infections of epithelial surfaces, like the lung or the intestine, is still under debate and seems not as efficient as desired. Basic research on the anti-viral immune responses and on regulatory mechanisms in the prevention of immunopathological disorders, however, has led us back again to focus on endogenous glucocorticoid synthesis. It has become established that this synthesis is not restricted to the adrenal glands alone, but that numerous tissues also produce glucocorticoids in situ. Extra-adrenal derived glucocorticoids have the capacity to locally control and maintain immune homeostasis under steady-state and inflammatory conditions. Here, we discuss the current knowledge of extra-adrenal glucocorticoid synthesis in the lung and the intestine, and its role in the regulation of anti-viral immune responses.
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Affiliation(s)
- V M Merk
- Chair of Biochemical Pharmacology, Department of Biology, University of Konstanz, Konstanz, Germany
| | - T Brunner
- Chair of Biochemical Pharmacology, Department of Biology, University of Konstanz, Konstanz, Germany.
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30
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Pedrina J, Stambas J. Targeting the Host Response: Can We Manipulate Extracellular Matrix Metalloproteinase Activity to Improve Influenza Virus Infection Outcomes? Front Mol Biosci 2021; 8:703456. [PMID: 34291090 PMCID: PMC8287203 DOI: 10.3389/fmolb.2021.703456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Each year, hundreds of thousands of individuals succumb to influenza virus infection and its associated complications. Several preventative and therapeutic options may be applied in order to preserve life. These traditional approaches include administration of seasonal influenza vaccines, pharmacological interventions in the form of antiviral drug therapy and supportive clinical approaches including mechanical ventilation and extracorporeal membrane oxygenation. While these measures have shown varying degrees of success, antiviral therapies and vaccination are constrained due to ongoing antigenic drift. Moreover, clinical approaches can also be associated with complications and drawbacks. These factors have led to the exploration and development of more sophisticated and nuanced therapeutic approaches involving host proteins. Advances in immunotherapy in the cancer field or administration of steroids following virus infection have highlighted the therapeutic potential of targeting host immune responses. We have now reached a point where we can consider the contribution of other “non-traditional” host components such as the extracellular matrix in immunity. Herein, we will review current, established therapeutic interventions and consider novel therapeutic approaches involving the extracellular matrix.
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Affiliation(s)
- Jess Pedrina
- Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - John Stambas
- Faculty of Health, School of Medicine, Deakin University, Geelong, VIC, Australia
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31
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Richardson E, García-Bernal D, Calabretta E, Jara R, Palomo M, Baron RM, Yanik G, Fareed J, Vlodavsky I, Iacobelli M, Díaz-Ricart M, Richardson PG, Carlo-Stella C, Moraleda JM. Defibrotide: potential for treating endothelial dysfunction related to viral and post-infectious syndromes. Expert Opin Ther Targets 2021; 25:423-433. [PMID: 34167431 DOI: 10.1080/14728222.2021.1944101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Defibrotide (DF) is a polyribonucleotide with antithrombotic, pro-fibrinolytic, and anti-inflammatory effects on endothelium. These effects and the established safety of DF present DF as a strong candidate to treat viral and post-infectious syndromes involving endothelial dysfunction. AREAS COVERED We discuss DF and other therapeutic agents that have the potential to target endothelial components of pathogenesis in viral and post-infectious syndromes. We introduce defibrotide (DF), describe its mechanisms of action, and explore its established pleiotropic effects on the endothelium. We describe the established pathophysiology of Coronavirus Disease 2019 (COVID-19) and highlight the processes specific to COVID-19 potentially modulated by DF. We also present influenza A and viral hemorrhagic fevers, especially those caused by hantavirus, Ebola virus, and dengue virus, as viral syndromes in which DF might serve therapeutic benefit. Finally, we offer our opinion on novel treatment strategies targeting endothelial dysfunction in viral infections and their severe manifestations. EXPERT OPINION Given the critical role of endothelial dysfunction in numerous infectious syndromes, in particular COVID-19, therapeutic pharmacology for these conditions should increasingly prioritize endothelial stabilization. Several agents with endothelial protective properties should be further studied as treatments for severe viral infections and vasculitides, especially where other therapeutic modalities have failed.
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Affiliation(s)
- Edward Richardson
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, Connecticut, USA.,Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - David García-Bernal
- Department of Medicine, Stem Cell Transplant and Cell Therapy Unit, IMIB-Arrixaca, Virgen De La Arrixaca University Hospital, University of Murcia, Murcia, Spain
| | - Eleonora Calabretta
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milano, Italy.,Department of Oncology and Hematology, IRCCS - Humanitas Research Hospital, Rozzano-Milano, Italy
| | - Rubén Jara
- Intensive Care Unit, Virgen De La Arrixaca University Hospital, University of Murcia, Murcia, Spain
| | - Marta Palomo
- Josep Carreras Leukaemia Research Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Barcelona Endothelium Team, Barcelona, Spain
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Yanik
- Department of Pediatrics, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Blood and Marrow Transplantation Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Jawed Fareed
- Department of Molecular Pharmacology and Therapeutics, Hemostasis and Thrombosis Research Laboratories, Loyola University Medical Center, Chicago, Illinois, USA
| | - Israel Vlodavsky
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | - Maribel Díaz-Ricart
- Barcelona Endothelium Team, Barcelona, Spain.,Hematopathology, Pathology Department, CDB, Hospital Clinic, Barcelona, Spain.,IDIBAPS, Barcelona, Spain
| | - Paul G Richardson
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, Connecticut, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Division of Hematologic Malignancy, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Carmelo Carlo-Stella
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, Connecticut, USA.,Department of Biomedical Sciences, Humanitas University, Rozzano-Milano, Italy.,Department of Oncology and Hematology, IRCCS - Humanitas Research Hospital, Rozzano-Milano, Italy.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose M Moraleda
- Department of Medicine, Stem Cell Transplant and Cell Therapy Unit, IMIB-Arrixaca, Virgen De La Arrixaca University Hospital, University of Murcia, Murcia, Spain
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32
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Chua KH, Mohamed IN, Mohd Yunus MH, Shafinaz Md Nor N, Kamil K, Ugusman A, Kumar J. The Anti-Viral and Anti-Inflammatory Properties of Edible Bird's Nest in Influenza and Coronavirus Infections: From Pre-Clinical to Potential Clinical Application. Front Pharmacol 2021; 12:633292. [PMID: 34025406 PMCID: PMC8138174 DOI: 10.3389/fphar.2021.633292] [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: 11/25/2020] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
Edible bird's nest (BN) is a Chinese traditional medicine with innumerable health benefits, including anti-viral, anti-inflammatory, neuroprotective, and immunomodulatory effects. A small number of studies have reported the anti-viral effects of EBN against influenza infections using in vitro and in vivo models, highlighting the importance of sialic acid and thymol derivatives in their therapeutic effects. At present, studies have reported that EBN suppresses the replicated virus from exiting the host cells, reduces the viral replication, endosomal trafficking of the virus, intracellular viral autophagy process, secretion of pro-inflammatory cytokines, reorient the actin cytoskeleton of the infected cells, and increase the lysosomal degradation of viral materials. In other models of disease, EBN attenuates oxidative stress-induced cellular apoptosis, enhances proliferation and activation of B-cells and their antibody secretion. Given the sum of its therapeutic actions, EBN appears to be a candidate that is worth further exploring for its protective effects against diseases transmitted through air droplets. At present, anti-viral drugs are employed as the first-line defense against respiratory viral infections, unless vaccines are available for the specific pathogens. In patients with severe symptoms due to exacerbated cytokine secretion, anti-inflammatory agents are applied. Treatment efficacy varies across the patients, and in times of a pandemic like COVID-19, many of the drugs are still at the experimental stage. In this review, we present a comprehensive overview of anti-viral and anti-inflammatory effects of EBN, chemical constituents from various EBN preparation techniques, and drugs currently used to treat influenza and novel coronavirus infections. We also aim to review the pathogenesis of influenza A and coronavirus, and the potential of EBN in their clinical application. We also describe the current literature in human consumption of EBN, known allergenic or contaminant presence, and the focus of future direction on how these can be addressed to further improve EBN for potential clinical application.
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Affiliation(s)
- Kien Hui Chua
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Mohd Heikal Mohd Yunus
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Norefrina Shafinaz Md Nor
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Khidhir Kamil
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
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33
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Chen L, Han X, Li Y, Zhang C, Xing X. Complications of Cardiovascular Events in Patients Hospitalized with Influenza-Related Pneumonia. Infect Drug Resist 2021; 14:1363-1373. [PMID: 33859482 PMCID: PMC8043795 DOI: 10.2147/idr.s305509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/25/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Influenza virus infections are a key cause of community-acquired pneumonia (CAP). Cardiovascular events (CVEs) are common among CAP and influenza patients, but there have been few population-based studies of influenza-related pneumonia (Flu-p) patients published to date. Methods A retrospective analysis of 1191 immunocompetent hospitalized adult Flu-p patients from January 2012 to December 2018 in five teaching hospitals in China was conducted. Results A total of 24.6% (293/1191) of patients developed at least one form of CVE-related complication while hospitalized. In a multivariate logistic regression analysis, hypertension, cerebrovascular disease, coronary artery disease, preexisting heart failure, systolic blood pressure <90 mmHg, respiratory rates ≥30 breaths/min, a lymphocyte count <0.8×109/L, PaO2/FiO2 <300 mmHg, and systemic corticosteroid administration were independently associated with the incidence of CVEs; while early neuraminidase inhibitor treatment and angiotensin converting enzyme inhibitors/angiotensin II receptor blocker treatment were associated with a lower risk of CVEs. After controlling for potential confounding variables, we determined that CVEs were linked to a higher risk of 30-day mortality (OR 3.307, 95% CI 2.198–4.975, p < 0.001) in Flu-p patients. Conclusion CVE-related complications are common among hospitalized Flu-p patients and are associated with negative patient outcomes. Clarifying these CVE-related risk factors can aid in their clinical prevention and management.
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Affiliation(s)
- Liang Chen
- Department of Infectious Diseases, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, People's Republic of China
| | - Xiudi Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao City, People's Republic of China
| | - YanLi Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunxiao Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Huimin Hospital, Beijing, People's Republic of China
| | - Xiqian Xing
- Department of Pulmonary and Critical Care Medicine, The 2nd People's Hospital of Yunnan Province, Kunming City, People's Republic of China
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34
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Fragkou PC, Moschopoulos CD, Karofylakis E, Kelesidis T, Tsiodras S. Update in Viral Infections in the Intensive Care Unit. Front Med (Lausanne) 2021; 8:575580. [PMID: 33708775 PMCID: PMC7940368 DOI: 10.3389/fmed.2021.575580] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/02/2021] [Indexed: 12/15/2022] Open
Abstract
The advent of highly sensitive molecular diagnostic techniques has improved our ability to detect viral pathogens leading to severe and often fatal infections that require admission to the Intensive Care Unit (ICU). Viral infections in the ICU have pleomorphic clinical presentations including pneumonia, acute respiratory distress syndrome, respiratory failure, central or peripheral nervous system manifestations, and viral-induced shock. Besides de novo infections, certain viruses fall into latency and can be reactivated in both immunosuppressed and immunocompetent critically ill patients. Depending on the viral strain, transmission occurs either directly through contact with infectious materials and large droplets, or indirectly through suspended air particles (airborne transmission of droplet nuclei). Many viruses can efficiently spread within hospital environment leading to in-hospital outbreaks, sometimes with high rates of mortality and morbidity, thus infection control measures are of paramount importance. Despite the advances in detecting viral pathogens, limited progress has been made in antiviral treatments, contributing to unexpectedly high rates of unfavorable outcomes. Herein, we review the most updated data on epidemiology, common clinical features, diagnosis, pathogenesis, treatment and prevention of severe community- and hospital-acquired viral infections in the ICU settings.
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Affiliation(s)
- Paraskevi C. Fragkou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Charalampos D. Moschopoulos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Emmanouil Karofylakis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
| | - Theodoros Kelesidis
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, “Attikon” University Hospital, Athens, Greece
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Martin-Loeches I, Torres A. Corticosteroids for CAP, influenza and COVID-19: when, how and benefits or harm? Eur Respir Rev 2021; 30:30/159/200346. [PMID: 33568526 PMCID: PMC7877325 DOI: 10.1183/16000617.0346-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Corticosteroids have been considered in medicine for a long time, and they are broadly prescribed. In infectious diseases, corticosteroids have been regarded as a thread due to their immunosuppressive effects and therefore their anti-inflammatory properties. MAIN: In recent years, there have been several studies published that aimed to determine the role of corticosteroids in patients with community-acquired pneumonia (CAP), because, despite significant advances in new antibiotics and supportive care, deaths of patients with CAP remain unacceptably high. While the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) CAP guidelines did not mention the use of corticosteroids in the management of CAP, the recently published 2019 IDSA/ATS guidelines recommended their use in patients with septic shock refractory to vasopressors and fluid resuscitation. Regarding viral infection, the use of corticosteroids in patients with influenza has shown to be associated with significantly higher mortality and higher incidence of nosocomial infection, while in patients with coronavirus disease 2019 (COVID-19) there is a good body of evidence of the benefit of corticosteroids in terms of mortality. CONCLUSIONS The use of corticosteroids has been considered as a potential alternative co-adjuvant treatment in patients with pneumonia. In patients with COVID-19, the evidence is quite strong and there is a clear benefit of the use of corticosteroids in those patients presenting severe forms of disease.
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Affiliation(s)
- Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Dept of Intensive Care Medicine, St James's University Hospital, Dublin, Ireland .,Trinity Centre for Health Sciences, Dublin, Ireland.,Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,CIBERes, Barcelona, Spain
| | - Antoni Torres
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.,Universitat de Barcelona, Barcelona, Spain.,CIBERes, Barcelona, Spain
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36
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Lee SI, Lim CM, Koh Y, Huh JW, Lee JS, Hong SB. The effectiveness of vitamin C for patients with severe viral pneumonia in respiratory failure. J Thorac Dis 2021; 13:632-641. [PMID: 33717536 PMCID: PMC7947518 DOI: 10.21037/jtd-20-1306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Vitamin C is a well-known antioxidant and essential cofactor for numerous biological reactions. Several studies reported that vitamin C can improve the symptoms and prognosis of patients with sepsis and respiratory infection. We aimed to examine the effect of vitamin C when used in viral pneumonia patients with severe respiratory failure. Methods Total 201 patients with viral pneumonia were included, of them 35 patients used vitamin C. We performed a statistical analysis through a propensity score matching of the age and baseline characteristics of these patients. Results There were differences between the vitamin C group and non-vitamin C group in terms of age (60±15 vs. 66±14, P=0.03), extracorporeal membrane oxygenation (28.6% vs. 5.4%, P<0.001), and procalcitonin (3±8 vs. 9±23, P=0.02). The 28-day mortality was not different between the two groups (20.0% vs. 24.7%, P=0.33). In the propensity-matched group, the 28-day mortality was not significantly different between the two groups (20.0% vs. 37.1%, P=0.07). Moreover, no difference was observed in shock reversal within 14 days (45.7% vs. 25.7%, P=0.08) and recovery after acute kidney injury (52.9% vs. 66.7%, P=0.41) between the two groups. Vitamin C was not a prognostic factor for 28-day mortality (P=0.33). Conclusions In this study adjunctive intravenous vitamin C therapy alone was not associated with improvement of the 28-day mortality and prognosis in patients with severe viral pneumonia with respiratory failure.
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Affiliation(s)
- Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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37
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Papamanoli A, Yoo J, Grewal P, Predun W, Hotelling J, Jacob R, Mojahedi A, Skopicki HA, Mansour M, Marcos LA, Kalogeropoulos AP. High-dose methylprednisolone in nonintubated patients with severe COVID-19 pneumonia. Eur J Clin Invest 2021; 51:e13458. [PMID: 33219551 PMCID: PMC7744876 DOI: 10.1111/eci.13458] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/02/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID-19). Data on methylprednisolone are limited. METHODS Retrospective cohort of consecutive adults with severe COVID-19 pneumonia on high-flow oxygen (FiO2 ≥ 50%) admitted to an academic centre in New York, from 1 March to 15 April 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resource utilization. RESULTS Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95% CI 0.47-0.86; P = .003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95% CI 0.40-0.79; P = .001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator-free days (95% CI 0.5-5.1; P = .017) and 2.6 more intensive care-free days (95% CI 0.2-4.9; P = .033) during the first 28 days. Complication rates were not higher with methylprednisolone. CONCLUSIONS In nonintubated patients with severe COVID-19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less-intensive care resource utilization without excess complications.
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Affiliation(s)
- Aikaterini Papamanoli
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jeanwoo Yoo
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Prabhjot Grewal
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - William Predun
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Jessica Hotelling
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Robin Jacob
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Azad Mojahedi
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Hal A Skopicki
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Mohamed Mansour
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Luis A Marcos
- Division of Infectious Diseases, Department of Medicine, Stony Brook University, Stony Brook, NY, USA
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38
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Spinner CD, Barton J, Biever P, Klein M, Rieg S, Schneider J, Thoden J, Wagner D, Kern WV. [Steroids in infection medicine]. Dtsch Med Wochenschr 2021; 146:162-166. [PMID: 33513649 DOI: 10.1055/a-1302-3530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Corticosteroids have been found as useful adjunctive therapy in patients with various infections and hyperinflammation-associated disease. They are recommended in practice guidelines for patients with tuberculous and pneumococcal meningitis and patients with immune reconstitution syndrome associated with antiretroviral therapy. A new indication is severe COVID-19. Evidence from clinical trials is insufficient to allow the routine use of steroids among patients with septic shock, community-acquired pneumonia or tuberculous pericarditis.
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Affiliation(s)
- Christoph D Spinner
- Technische Universität München, Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin II, München
| | - Jürgen Barton
- Klinikum der Ludwig-Maximilians-Universität Klinikum, Medizinische Klinik und Poliklinik V, München
| | - Paul Biever
- Universitätsklinikum Freiburg, Abteilung Infektiologie, Klinik für Innere Medizin II, Freiburg.,Universitätsklinikum Freiburg, Klinik für Innere Medizin III, und Universitäts-Herzzentrum Freiburg - Bad Krozingen, Klinik für Kardiologie und Angiologie I, Freiburg
| | - Matthias Klein
- Klinikum der Ludwig-Maximilians-Universität Klinikum, Neurologische Klinik und Poliklinik, 81377 München
| | - Siegbert Rieg
- Universitätsklinikum Freiburg, Abteilung Infektiologie, Klinik für Innere Medizin II, Freiburg
| | - Jochen Schneider
- Technische Universität München, Fakultät für Medizin, Klinikum rechts der Isar, Klinik und Poliklinik für Innere Medizin II, München
| | - Jan Thoden
- Gemeinschaftspraxis Drs. Scholz/Thoden/Sandrock, Fachärzte für Innere Medizin, Rheumatologie, Infektiologie, Freiburg
| | - Dirk Wagner
- Universitätsklinikum Freiburg, Abteilung Infektiologie, Klinik für Innere Medizin II, Freiburg
| | - Winfried V Kern
- Universitätsklinikum Freiburg, Abteilung Infektiologie, Klinik für Innere Medizin II, Freiburg.,Albert-Ludwigs-Universität, Medizinische Fakultät, Freiburg
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39
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Pfortmueller CA, Spinetti T, Urman RD, Luedi MM, Schefold JC. COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment - A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:351-368. [PMID: 34511224 PMCID: PMC7831801 DOI: 10.1016/j.bpa.2020.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic “waves,” intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS “atypical.” Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.
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Affiliation(s)
- Carmen A Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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40
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Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, Yao L, Motaghi S, Couban RJ, Ghadimi M, Bala MM, Gomaa H, Fang F, Xiao Y, Guyatt GH. Efficacité et innocuité des corticostéroïdes dans le traitement de la COVID-19 selon des données pour la COVID-19, d’autres infections aux coronavirus, l’influenza, la pneumonie extrahospitalière et le syndrome de détresse respiratoire aiguë : revue systématique et méta-analyse. CMAJ 2020; 192:E1571-E1584. [PMID: 33229355 DOI: 10.1503/cmaj.200645-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zhikang Ye
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Ying Wang
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Luis Enrique Colunga-Lozano
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Manya Prasad
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Wimonchat Tangamornsuksan
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Bram Rochwerg
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Liang Yao
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Shahrzad Motaghi
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Rachel J Couban
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Maryam Ghadimi
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Malgorzata M Bala
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Huda Gomaa
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Fang Fang
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Yingqi Xiao
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Gordon H Guyatt
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
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Rafiullah M, Siddiqui K. Corticosteroid use in viral pneumonia: experience so far and the dexamethasone breakthrough in coronavirus disease-2019. J Comp Eff Res 2020; 9:1247-1254. [PMID: 33245242 PMCID: PMC7694443 DOI: 10.2217/cer-2020-0146] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dexamethasone was shown to decrease the mortality in coronavirus disease-2019 (COVID-19) recently. Use of corticosteroids was harmful in other coronavirus infections previously. WHO recommended against routine use of corticosteroids in COVID-19. In view of these, we reviewed the evidence about the use of corticosteroids in virus-induced acute respiratory distress syndrome (ARDS). Corticosteroids are beneficial in ARDS regardless of etiology. However, they increased the mortality rate in influenza-associated ARDS. In SARS and the Middle East respiratory syndrome, corticosteroids increased the mortality, delayed the viral clearance and increased the length of hospital stay. In the case of COVID-19, the available evidence from retrospective and observational studies is inconclusive about the corticosteroid use. Low-dose therapies appear to be effective. Evidence from a randomized control study found dexamethasone is effective in decreasing mortality in severe COVID-19 cases. More studies are needed to validate the benefit of corticosteroids in COVID-19.
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Affiliation(s)
- Mohamed Rafiullah
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Siddiqui
- Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Effects of Corticosteroid Treatment for Non-Severe COVID-19 Pneumonia: A Propensity Score-Based Analysis. Shock 2020; 54:638-643. [PMID: 32496422 DOI: 10.1097/shk.0000000000001574] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The effects of corticosteroid treatment on non-severe COVID-19 pneumonia patients are unknown. To determine the impacts of adjuvant corticosteroid administrated to patients with non-severe COVID-19 pneumonia. METHOD A retrospective cohort study based on propensity score analysis was designed to explore the effects of corticosteroid on several clinical outcomes. RESULTS One hundred thirty-two patients satisfied the inclusion criteria and 35 pairs were generated according to propensity score matching. Compared to non-corticosteroid group, the CT score on day 7 was significantly higher in corticosteroid group (8.6 (interquartile range [IQR], 2.8-11.5) versus 12.0 (IQR, 5.0-19.3), P = 0.046). In corticosteroid group, more patients progressed to severe cases (11.4% versus 2.9%, P = 0.353), hospital stay (23.5 days (IQR, 19-29 d) versus 20.2 days (IQR, 14-25.3 d), P = 0.079) and duration of viral shedding (20.3 days (IQR, 15.2-24.8 d) versus 19.4 days (IQR, 11.5-28.3 d), P = 0.669) were prolonged, while fever time (9.5 days (IQR, 6.5-12.2 d) versus 10.2 days (IQR, 6.8-14 d), P = 0.28) was shortened; however, all these data revealed no statistically significant differences. CONCLUSION Corticosteroid might have a negative effect on lung injury recovery in non-severe COVID-19 pneumonia patients; however, the results of this study must be interpreted with caution because of confounding factors.
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Fernández-Ruiz M, Aguado JM. Immunomodulatory Therapies for COVID-19 in Solid Organ Transplant Recipients. CURRENT TRANSPLANTATION REPORTS 2020; 7:379-389. [PMID: 33110739 PMCID: PMC7581948 DOI: 10.1007/s40472-020-00306-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
Purpose of Review Severe coronavirus disease 2019 (COVID-19) is characterized by the development of a deleterious hyperinflammatory response, in which the pleiotropic cytokine interleukin (IL)-6 plays a pivotal role. The administration of immunomodulatory therapies has been proposed to revert the tissue damage induced by COVID-19-related cytokine release syndrome (CRS). The present review summarizes the biological rationale and available clinical experience with this therapeutic strategy in the specific scenario solid organ transplantation (SOT). Recent Findings A number of case reports, case series, and non-controlled cohort studies have assessed the efficacy and safety of the anti-IL-6-receptor monoclonal tocilizumab in SOT (namely kidney transplantation) recipients with COVID-19 pneumonia and CRS. Although the heterogeneity in patient management and the lack of a control group limit the interpretation of these results, tocilizumab therapy appears to provide some clinical benefit in post-transplant COVID-19 and to be reasonably safe in terms of bacterial superinfection. A large randomized clinical trial (RCT) has shown survival benefit with adjuvant corticosteroids in non-transplant patients, but supporting evidence is scarce for SOT recipients and confounded by the variable adjustment of baseline immunosuppression. Anecdotal experiences have been reported with the use of the anti-IL-1 agent anakinra and the NLRP3 inflammasome inhibitor colchicine in this population. Summary Immunomodulation has emerged as a promising option for SOT recipients with COVID-19-related CRS, with available experience mainly restricted to the anti-IL-6 agent tocilizumab. However, the supporting evidence is scarce and of low quality. In the absence of RCT, observational studies including well-matched control groups should be designed in future.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª planta, bloque D. Avda. de Córdoba, s/n, 28041 Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Actividades Ambulatorias, 2ª planta, bloque D. Avda. de Córdoba, s/n, 28041 Madrid, Spain.,Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Petersen MW, Meyhoff TS, Helleberg M, Kjær MN, Granholm A, Hjortsø CJS, Jensen TS, Møller MH, Hjortrup PB, Wetterslev M, Vesterlund GK, Russell L, Jørgensen VL, Tjelle K, Benfield T, Ulrik CS, Andreasen AS, Mohr T, Bestle MH, Poulsen LM, Hitz MF, Hildebrandt T, Knudsen LS, Møller A, Sølling CG, Brøchner AC, Rasmussen BS, Nielsen H, Christensen S, Strøm T, Cronhjort M, Wahlin RR, Jakob S, Cioccari L, Venkatesh B, Hammond N, Jha V, Myatra SN, Gluud C, Lange T, Perner A. Low-dose hydrocortisone in patients with COVID-19 and severe hypoxia (COVID STEROID) trial-Protocol and statistical analysis plan. Acta Anaesthesiol Scand 2020; 64:1365-1375. [PMID: 32779728 PMCID: PMC7404666 DOI: 10.1111/aas.13673] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/12/2020] [Indexed: 01/08/2023]
Abstract
Introduction Severe acute respiratory syndrome coronavirus‐2 has caused a pandemic of coronavirus disease (COVID‐19) with many patients developing hypoxic respiratory failure. Corticosteroids reduce the time on mechanical ventilation, length of stay in the intensive care unit and potentially also mortality in similar patient populations. However, corticosteroids have undesirable effects, including longer time to viral clearance. Clinical equipoise on the use of corticosteroids for COVID‐19 exists. Methods The COVID STEROID trial is an international, randomised, stratified, blinded clinical trial. We will allocate 1000 adult patients with COVID‐19 receiving ≥10 L/min of oxygen or on mechanical ventilation to intravenous hydrocortisone 200 mg daily vs placebo (0.9% saline) for 7 days. The primary outcome is days alive without life support (ie mechanical ventilation, circulatory support, and renal replacement therapy) at day 28. Secondary outcomes are serious adverse reactions at day 14; days alive without life support at day 90; days alive and out of hospital at day 90; all‐cause mortality at day 28, day 90, and 1 year; and health‐related quality of life at 1 year. We will conduct the statistical analyses according to this protocol, including interim analyses for every 250 patients followed for 28 days. The primary outcome will be compared using the Kryger Jensen and Lange test in the intention to treat population and reported as differences in means and medians with 95% confidence intervals. Discussion The COVID STEROID trial will provide important evidence to guide the use of corticosteroids in COVID‐19 and severe hypoxia.
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Majmundar M, Kansara T, Lenik JM, Park H, Ghosh K, Doshi R, Shah P, Kumar A, Amin H, Chaudhari S, Habtes I. Efficacy of corticosteroids in non-intensive care unit patients with COVID-19 pneumonia from the New York Metropolitan region. PLoS One 2020; 15:e0238827. [PMID: 32903258 PMCID: PMC7480842 DOI: 10.1371/journal.pone.0238827] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The role of systemic corticosteroid as a therapeutic agent for patients with COVID-19 pneumonia is controversial. OBJECTIVE The purpose of this study was to evaluate the effect of corticosteroids in non-intensive care unit (ICU) patients with COVID-19 pneumonia complicated by acute hypoxemic respiratory failure (AHRF). METHODS This was a single-center retrospective cohort study, from 16th March, 2020 to 30th April, 2020; final follow-up on 10th May, 2020. 265 patients consecutively admitted to the non-ICU wards with laboratory-confirmed COVID-19 pneumonia were screened for inclusion. 205 patients who developed AHRF (SpO2/FiO2 ≤ 440 or PaO2/FiO2 ≤ 300) were only included in the final study. Direct admission to the Intensive care unit (ICU), patients developing composite primary outcome within 24 hours of admission, and patients who never became hypoxic during their stay in the hospital were excluded. Patients were divided into two cohorts based on corticosteroid. The primary outcome was a composite of ICU transfer, intubation, or in-hospital mortality. Secondary outcomes were ICU transfer, intubation, in-hospital mortality, discharge, length of stay, and daily trend of SpO2/FiO2 (SF) ratio from the index date. Cox-proportional hazard regression was implemented to analyze the time to event outcomes. RESULT Among 205 patients, 60 (29.27%) were treated with corticosteroid. The mean age was ~57 years, and ~75% were men. Thirteen patients (22.41%) developed a primary composite outcome in the corticosteroid cohort vs. 54 (37.5%) patients in the non-corticosteroid cohort (P = 0.039). The adjusted hazard ratio (HR) for the development of the composite primary outcome was 0.15 (95% CI, 0.07-0.33; P <0.001). The adjusted hazard ratio for ICU transfer was 0.16 (95% CI, 0.07 to 0.34; P < 0.001), intubation was 0.31 (95% CI, 0.14 to 0.70; P- 0.005), death was 0.53 (95% CI, 0.22 to 1.31; P- 0.172), composite of death or intubation was 0.31 (95% CI, 0.15 to 0.66; P- 0.002) and discharge was 3.65 (95% CI, 2.20 to 6.06; P<0.001). The corticosteroid cohort had increasing SpO2/FiO2 over time compared to the non-corticosteroid cohort who experience decreasing SpO2/FiO2 over time. CONCLUSION Among non-ICU patients hospitalized with COVID-19 pneumonia complicated by AHRF, treatment with corticosteroid was associated with a significantly lower risk of the primary composite outcome of ICU transfer, intubation, or in-hospital death, composite of intubation or death and individual components of the primary outcome.
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Affiliation(s)
- Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Tikal Kansara
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Joanna Marta Lenik
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Hansang Park
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Kuldeep Ghosh
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Rajkumar Doshi
- Department of Internal Medicine, Reno School of Medicine, University of Nevada, Reno, NV, United States of America
| | - Palak Shah
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Ashish Kumar
- Department of Critical Care Medicine, St John’s Medical College Hospital, Bengaluru, Karnataka, India
| | - Hossam Amin
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Shobhana Chaudhari
- Department of Internal Medicine, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
| | - Imnett Habtes
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Metropolitan Hospital, New York Medical College, New York, NY, United States of America
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Matera MG, Rogliani P, Bianco A, Cazzola M. Pharmacological management of adult patients with acute respiratory distress syndrome. Expert Opin Pharmacother 2020; 21:2169-2183. [PMID: 32783481 DOI: 10.1080/14656566.2020.1801636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION There is still no definite drug for acute respiratory distress syndrome (ARDS) that is capable of reducing either short-term or long-term mortality. Therefore, great efforts are being made to identify a pharmacological approach that can be really effective. AREAS COVERED This review focuses on current challenges and future directions in the pharmacological management of ARDS, regardless of anti-infective treatments. The authors have excluded small randomized controlled trials (RCTs) with less than 60 patients because those studies do not have statistical power for outcome data, and also anecdotal trials but have considered the last meta-analysis on any drug. EXPERT OPINION There has been substantial progress in our knowledge of ARDS over the past two decades and many drugs have been used in its treatment. Nevertheless, effective targeted pharmacological treatments for ARDS are still lacking. The likely reason why a pharmacological approach is beneficial for some patients, but harmful for others is that ARDS is an extremely heterogeneous syndrome. To overcome this issue, a precision approach for ARDS, whereby therapies are specifically targeted to patients most likely to benefit, has been proposed. At present, however, the application of this approach seems to be a difficult task.
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Affiliation(s)
- Maria Gabriella Matera
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli" , Naples, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata" , Rome, Italy
| | - Andrea Bianco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli"/Monaldi Hospital , Naples, Italy
| | - Mario Cazzola
- Department of Experimental Medicine, University of Rome "Tor Vergata" , Rome, Italy
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47
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Yousefifard M, Mohamed Ali K, Aghaei A, Zali A, Madani Neishaboori A, Zarghi A, Safari S, Hashemi B, Forouzanfar MM, Hosseini M. Corticosteroids on the Management of Coronavirus Disease 2019 (COVID-19): A Systemic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1411-1421. [PMID: 33083317 PMCID: PMC7554375 DOI: 10.18502/ijph.v49i8.3863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). Method: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI). Results: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections. Conclusion: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.
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Affiliation(s)
- Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Abbas Aghaei
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Comprehensive Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Afshin Zarghi
- Department of Medicinal Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Emergency Department, Shohadye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrooz Hashemi
- Emergency Department, Shohadye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Forouzanfar
- Emergency Department, Shohadye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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48
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Matera MG, Rogliani P, Calzetta L, Cazzola M. Pharmacological management of COVID-19 patients with ARDS (CARDS): A narrative review. Respir Med 2020; 171:106114. [PMID: 32795902 PMCID: PMC7402220 DOI: 10.1016/j.rmed.2020.106114] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/30/2020] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is highly infectious. It has been highlighted that if not expertly and individually managed with consideration of the vasocentric features, a COVID-19 patient with an acute respiratory distress syndrome (CARDS) may eventually develop multiorgan failure. Unfortunately, there is still no definite drug for CARDS that is capable of reducing either short-term or long-term mortality and no specific treatments for COVID-19 exist right now. In this narrative review, based on a selective literature search in EMBASE, MEDLINE, Scopus, The Cochrane Library, Web of Science, and Google Scholar and ClinicalTrials.gov, we have examined the emerging evidence on the possible treatment of CARDS. Although numerous pharmacologic therapies to improve clinical outcomes in CARDS have been studied also in clinical trials, none have shown efficacy and there is great uncertainty about their effectiveness. There is still no recommendation for the therapeutic use of any specific agent to treat CARDS because no drugs are validated to have significant efficacy in clinical treatment of COVID-19 patients in large-scale trials. However, there exist a number of drugs that may be useful at least in some patients. The real challenge now is to link the right patient to the right treatment.
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Affiliation(s)
- Maria Gabriella Matera
- Unit of Pharmacology, Dept. Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Luigino Calzetta
- Unit of Respiratory Disease and Lung Function Dept. Medicine and Surgery, University of Parma, Parma, Italy
| | - Mario Cazzola
- Unit of Respiratory Medicine, Dept. Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
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49
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Flick H, Arns BM, Bolitschek J, Bucher B, Cima K, Gingrich E, Handzhiev S, Hochmair M, Horak F, Idzko M, Jaksch P, Kovacs G, Kropfmüller R, Lamprecht B, Löffler-Ragg J, Meilinger M, Olschewski H, Pfleger A, Puchner B, Puelacher C, Prior C, Rodriguez P, Salzer H, Schenk P, Schindler O, Stelzmüller I, Strenger V, Täubl H, Urban M, Wagner M, Wimberger F, Zacharasiewicz A, Zwick RH, Eber E. Management of patients with SARS-CoV-2 infections and of patients with chronic lung diseases during the COVID-19 pandemic (as of 9 May 2020) : Statement of the Austrian Society of Pneumology (ASP). Wien Klin Wochenschr 2020; 132:365-386. [PMID: 32533443 PMCID: PMC7291190 DOI: 10.1007/s00508-020-01691-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is currently a challenge worldwide. In Austria, a crisis within the healthcare system has so far been prevented. The treatment of patients with community-acquired pneumonia (CAP), including SARS-CoV‑2 infections, should continue to be based on evidence-based CAP guidelines during the pandemic; however, COVID-19 specific adjustments are useful. The treatment of patients with chronic lung diseases has to be adapted during the pandemic but must still be guaranteed.
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Affiliation(s)
- Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Brigitte Bucher
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Katharina Cima
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | | | - Sabin Handzhiev
- Department of Pulmonology, University Hospital Krems, Krems, Austria
| | - Maximilian Hochmair
- Respiratory Oncology Unit, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | | | - Marco Idzko
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Roland Kropfmüller
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II (Infectious Diseases, Pneumology, Rheumatology), Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Meilinger
- Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | | | | | | | - Patricia Rodriguez
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Helmut Salzer
- Department of Pulmonology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
| | - Peter Schenk
- Department of Pulmonology, Landesklinikum Hochegg, Grimmenstein, Austria
| | - Otmar Schindler
- Department of Internal, Respiratory and Critical Care Medicine, State Hospital II, Location Enzenbach, Gratwein-Straßengel, Austria
| | | | - Volker Strenger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Helmut Täubl
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Matthias Urban
- Department of Internal and Respiratory Medicine, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Marlies Wagner
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | | | - Angela Zacharasiewicz
- Department of Paediatrics, Teaching Hospital of the Medical University of Vienna, Wilhelminen Hospital, Vienna, Austria
| | | | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, 8036, Graz, Austria.
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50
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Yang JW, Yang L, Luo RG, Xu JF. Corticosteroid administration for viral pneumonia: COVID-19 and beyond. Clin Microbiol Infect 2020; 26:1171-1177. [PMID: 32603802 PMCID: PMC7320691 DOI: 10.1016/j.cmi.2020.06.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
Background Corticosteroids are commonly used as adjuvant therapy for acute respiratory distress syndrome by many clinicians because of their perceived anti-inflammatory effects. However, for patients with severe viral pneumonia, the corticosteroid treatment is highly controversial. Objectives The purpose of this review is to systematically evaluate the effect and potential mechanism of corticosteroid administration in pandemic viral pneumonia. Sources We comprehensively searched all manuscripts on corticosteroid therapy for influenza, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and SARS coronavirus 2 (SARS-CoV-2) viral pneumonia from the PubMed, EMBASE, Web of Science and Cochrane Library databases. Content We systematically summarized the effects of corticosteroid therapy for pandemic viral pneumonia and the potential mechanism of action for corticosteroids in coronavirus disease 2019 (COVID-19). Implications Observational studies showed that corticosteroid treatment was associated with increased mortality and nosocomial infections for influenza and delayed virus clearance for SARS-CoV and MERS-CoV. Limited data on corticosteroid therapy for COVID-19 were reported. Corticosteroids were used in about a fifth of patients (670/2995, 22.4%). Although clinical observational studies reported the improvement in symptoms and oxygenation for individuals with severe COVID-19 who received corticosteroid therapy, case fatality rate in the corticosteroid group was significantly higher than that in the non-corticosteroid group (69/443, 15.6% versus 56/1310, 4.3%). Compared individuals with non-severe disease, those with severe disease were more likely to receive corticosteroid therapy (201/382, 52.6% versus 201/1310, 15.3%). Although there is no evidence that corticosteroid therapy reduces mortality in people with COVID-19, some improvements in clinical symptoms and oxygenation were reported in some clinical observational studies. Excessive inflammatory response and lymphopenia might be critical factors associated with severity of and mortality from COVID-19. Sufficiently powered randomized controlled trials with rigorous inclusion/exclusion criteria and standardized dose and duration of corticosteroids are needed to verify the effectiveness and safety of corticosteroid therapy.
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Affiliation(s)
- J-W Yang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - L Yang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - R-G Luo
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - J-F Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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