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Brito C, de Araujo Mariz C, Freitas de Oliveira França R, Lopes EP, Silva LE, Neto RL, Viana IF, Montarroyos U, Duarte C, Lacerda HR, de Brito Ximenes P, de Oliveira Viana RC, Lima RGD, Carneiro APS, Braga C. Clinical-laboratory characteristics predictive of COVID-19 severity: a prospective hospital cohort, in Pernambuco, Northeast Brazil. Braz J Microbiol 2024; 55:2643-2654. [PMID: 38955981 PMCID: PMC11405567 DOI: 10.1007/s42770-024-01382-2] [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: 01/30/2024] [Accepted: 05/13/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To describe the clinical-laboratory profile and analyze the factors associated with the severity of COVID-19. METHODS A prospective cohort study involving patients with COVID-19 admitted to a tertiary hospital in Recife, Brazil. All cases were confirmed by RT-PCR and classified according to severity criteria. A descriptive statistical analysis of the population's characteristics was conducted. Risk factors associated with the outcome of the case according to severity were analyzed by calculating the odds ratio (OR) using the general equation estimation (GEE) model. RESULTS Among the 75 cases included, 64% were female, and 62.7% were aged 65 years or older. The median length of stay was 9 days (6 - 14). Hypertension (65.3%) and Diabetes Mellitus (36%) were the most frequent comorbidities. Severe forms of COVID-19 constituted 41.3% of the sample. The factors associated with severity were a history of asthma (OR=4.58, 95%CI:1.13 - 18.7), report of anorexia (OR=1, 12, 95%CI:1.01-1.24), and laboratory changes that included elevated platelets (OR=1.00, 95% CI:1.00-1.01), elevated D'Dimer (OR=1, 26, 95% CI:1.04-1.52), elevated aspartate aminotransferase (OR=1.00, 95% CI:1.00-1.01), and gamma-glutamyl transferase (OR=1.22, IC95 %:0.98-1.51), hypernatremia (OR=1.31, 95%CI:1.12-1.52), and hyperkalemia (OR=1.21, 95% CI:1.04-1.41). CONCLUSION Multisystemic involvement with a tendency for thrombophilia, electrolyte disturbances, and hepatic aggression, reflected by laboratory changes, were factors associated with the severity of COVID-19.
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Affiliation(s)
- Carlos Brito
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
- Department of Internal Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.
- Department of Immunology, Autoimune Research Institute, Recife, Pernambuco, Brazil.
| | | | | | - Edmundo Pessoa Lopes
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
- Department of Internal Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Laura Emanuelle Silva
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | - Roberto Lins Neto
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation - FIOCRUZ, Recife, Pernambuco, Brazil
| | - Isabelle Freire Viana
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation - FIOCRUZ, Recife, Pernambuco, Brazil
| | - Ulisses Montarroyos
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation - FIOCRUZ, Recife, Pernambuco, Brazil
| | - Claudio Duarte
- Servidores do Estado Hospital, Recife, Pernambuco, Brazil
| | - Heloisa Ramos Lacerda
- Postgraduate Program in Tropical Medicine, Center of Medical Sciences, Universidade Federal de Pernambuco (UFPE), Recife, Brazil
| | | | | | | | | | - Cynthia Braga
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation - FIOCRUZ, Recife, Pernambuco, Brazil
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Chang MC, Wu PF, Ho YC, Lin WY, Wu CY, Liu SY, Liu CJ, Lin YT. Clinical outcomes and safety of remdesivir in hospitalized individuals with COVID-19, with or without severe renal impairment. J Infect Public Health 2024; 17:102460. [PMID: 38820894 DOI: 10.1016/j.jiph.2024.05.048] [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: 03/13/2024] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The use of remdesivir in patients with coronavirus disease 2019 (COVID-19) and severe renal impairment has been approved; however, limited clinical data exist. Accordingly, we aimed to compare outcomes and adverse events associated with remdesivir in hospitalized patients with COVID-19, with and without severe renal impairment. METHODS Hospitalized patients with COVID-19 undergoing a 5-day remdesivir course at Taipei Veterans General Hospital from April 1 to July 31, 2022, were enrolled. Comparative analysis of outcomes and safety between patients with or without severe renal impairment (estimated glomerular filtration rate of < 30 mL/min per 1.73 m2) were conducted. Prognostic factors associated with 28-day mortality in patients with severe renal impairment were investigated using logistic regression analysis. RESULTS A total of 671 hospitalized patients, including 132 patients with severe renal impairment, who received a 5-day course of remdesivir were analyzed. The 28-day mortality was higher in patients with severe renal impairment than in patients without severe renal impairment (15.2% vs. 7.8%). The proportion of patients with acute kidney injury (AKI) and deteriorated liver function after completing remdesivir therapy was similar between the patients with and without severe renal impairment, and the recovery rate of AKI was similar in both groups. The sequential organ failure assessment score was an independent factor associated with 28-day mortality in patients with severe renal impairment. CONCLUSIONS Remdesivir was well-tolerated in hospitalized patients with COVID-19, regardless of renal function. Our findings support the recent recommendation to administer remdesivir in patients with severe renal impairment.
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Affiliation(s)
- Min-Chi Chang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ping-Feng Wu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Chien Ho
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Ying Lin
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Ying Wu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Szu-Yu Liu
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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3
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Greville G, Cremen S, O'Neill S, Azarian S, Brady G, McCormack W, Dyer AH, Bourke NM, Touzelet O, Courtney D, Power UF, Dowling P, Gallagher TK, Bamford CGG, Robinson MW. Type 1 interferon auto-antibodies are elevated in patients with decompensated liver cirrhosis. Clin Exp Immunol 2024; 215:177-189. [PMID: 37917972 PMCID: PMC10847822 DOI: 10.1093/cei/uxad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023] Open
Abstract
Patients with decompensated liver cirrhosis, in particular those classified as Childs-Pugh class C, are at increased risk of severe coronavirus disease-2019 (COVID-19) upon infection with severe acute respiratory coronavirus 2 (SARS-CoV-2). The biological mechanisms underlying this are unknown. We aimed to examine the levels of serum intrinsic antiviral proteins as well as alterations in the innate antiviral immune response in patients with decompensated liver cirrhosis. Serum from 53 SARS-CoV-2 unexposed and unvaccinated individuals, with decompensated liver cirrhosis undergoing assessment for liver transplantation, were screened using SARS-CoV-2 pseudoparticle and SARS-CoV-2 virus assays. The ability of serum to inhibit interferon (IFN) signalling was assessed using a cell-based reporter assay. Severity of liver disease was assessed using two clinical scoring systems, the Child-Pugh class and the MELD-Na score. In the presence of serum from SARS-CoV-2 unexposed patients with decompensated liver cirrhosis there was no association between SARS-CoV-2 pseudoparticle infection or live SARS-CoV-2 virus infection and severity of liver disease. Type I IFNs are a key component of the innate antiviral response. Serum from patients with decompensated liver cirrhosis contained elevated levels of auto-antibodies capable of binding IFN-α2b compared to healthy controls. High MELD-Na scores were associated with the ability of these auto-antibodies to neutralize type I IFN signalling by IFN-α2b but not IFN-β1a. Our results demonstrate that neutralizing auto-antibodies targeting IFN-α2b are increased in patients with high MELD-Na scores. The presence of neutralizing type I IFN-specific auto-antibodies may increase the likelihood of viral infections, including severe COVID-19, in patients with decompensated liver cirrhosis.
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Affiliation(s)
- Gordon Greville
- Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland
| | - Sinead Cremen
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Shauna O'Neill
- Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland
| | - Sarah Azarian
- Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland
| | - Gareth Brady
- Discipline of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - William McCormack
- Discipline of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Adam H Dyer
- Discipline of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Olivier Touzelet
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - David Courtney
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Ultan F Power
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Paul Dowling
- Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland
| | - Tom K Gallagher
- Department of Hepatopancreaticobiliary and Transplant Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Connor G G Bamford
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
- School of Biological Sciences and Institute for Global Food Security (IGFS), Queen's University Belfast, Belfast, Northern Ireland
| | - Mark W Robinson
- Department of Biology, Kathleen Lonsdale Institute for Human Health Research, Maynooth University, Maynooth, Ireland
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Theunissen MTM, van den Elsen RM, House TL, Crittenden B, van Doorn PA, van der Ploeg AT, Kruijshaar ME, van der Beek NAME. The impact of COVID-19 infection, the pandemic and its associated control measures on patients with Pompe disease. J Neurol 2024; 271:32-45. [PMID: 37982853 PMCID: PMC10769914 DOI: 10.1007/s00415-023-11999-2] [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: 07/28/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Patients with Pompe disease, a rare metabolic myopathy, were thought to be at increased risk of severe COVID-19 disease during the pandemic. In addition, the lockdown may have affected their regular treatment. OBJECTIVE To assess the perceived effect of COVID-19 infection and of the pandemic on the treatment, and physical and mental health of patients with Pompe disease. METHODS Patients with Pompe disease over 16 years of age participated in an international, cross-sectional, online survey (September 20, 2022-November 7, 2022). The questionnaire, available in eight languages, consisted of 89 questions divided into 3 parts: (A) severity of Pompe disease, (B) COVID-19 precautions and infection(s) and (C) effects of the COVID-19 pandemic. RESULTS Among 342 respondents, originating from 25 different countries, 47.6% experienced one or more COVID-19 infections. While most recovered within 4 weeks (69.7%) and only eight patients needed to be admitted to the hospital, 42.2% of patients experienced an impact of the infection on their overall condition, respiratory status and/or mobility status. More severely affected patients took more stringent control measures. The pandemic additionally caused interruptions in medical care in many patients (56.0%) and 17.2% of patients experienced interruptions of enzyme replacement therapy. The pandemic also affected many patients' disease severity (27.7%), mental health (55.4%) and feeling of loneliness (43.4%). CONCLUSION COVID-19 infection(s) and the pandemic affected the treatment, physical health and mental health of patients with Pompe disease, emphasizing the importance of continued patient centered care during a difficult time such as the COVID-19 pandemic.
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Affiliation(s)
- Maudy T M Theunissen
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Renee M van den Elsen
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | - Pieter A van Doorn
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Michelle E Kruijshaar
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadine A M E van der Beek
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Shakibfar S, Zhao J, Li H, Nordeng H, Lupattelli A, Pavlovic M, Sandve GK, Nyberg F, Wettermark B, Hajiebrahimi M, Andersen M, Sessa M. Machine learning-driven development of a disease risk score for COVID-19 hospitalization and mortality: a Swedish and Norwegian register-based study. Front Public Health 2023; 11:1258840. [PMID: 38146473 PMCID: PMC10749372 DOI: 10.3389/fpubh.2023.1258840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
Aims To develop a disease risk score for COVID-19-related hospitalization and mortality in Sweden and externally validate it in Norway. Method We employed linked data from the national health registries of Sweden and Norway to conduct our study. We focused on individuals in Sweden with confirmed SARS-CoV-2 infection through RT-PCR testing up to August 2022 as our study cohort. Within this group, we identified hospitalized cases as those who were admitted to the hospital within 14 days of testing positive for SARS-CoV-2 and matched them with five controls from the same cohort who were not hospitalized due to SARS-CoV-2. Additionally, we identified individuals who died within 30 days after being hospitalized for COVID-19. To develop our disease risk scores, we considered various factors, including demographics, infectious, somatic, and mental health conditions, recorded diagnoses, and pharmacological treatments. We also conducted age-specific analyses and assessed model performance through 5-fold cross-validation. Finally, we performed external validation using data from the Norwegian population with COVID-19 up to December 2021. Results During the study period, a total of 124,560 individuals in Sweden were hospitalized, and 15,877 individuals died within 30 days following COVID-19 hospitalization. Disease risk scores for both hospitalization and mortality demonstrated predictive capabilities with ROC-AUC values of 0.70 and 0.72, respectively, across the entire study period. Notably, these scores exhibited a positive correlation with the likelihood of hospitalization or death. In the external validation using data from the Norwegian COVID-19 population (consisting of 53,744 individuals), the disease risk score predicted hospitalization with an AUC of 0.47 and death with an AUC of 0.74. Conclusion The disease risk score showed moderately good performance to predict COVID-19-related mortality but performed poorly in predicting hospitalization when externally validated.
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Affiliation(s)
- Saeed Shakibfar
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
- Department of Drug Design and Pharmacology, Drug Safety Group, University of Copenhagen, Copenhagen, Denmark
| | - Jing Zhao
- Department of Pharmacy, Pharmacoepidemiology and Drug Safety Research Group, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- UiO: RealArt Convergence Environment, University of Oslo, Oslo, Norway
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hedvig Nordeng
- Department of Pharmacy, Pharmacoepidemiology and Drug Safety Research Group, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- UiO: RealArt Convergence Environment, University of Oslo, Oslo, Norway
| | - Angela Lupattelli
- Department of Pharmacy, Pharmacoepidemiology and Drug Safety Research Group, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- UiO: RealArt Convergence Environment, University of Oslo, Oslo, Norway
| | - Milena Pavlovic
- UiO: RealArt Convergence Environment, University of Oslo, Oslo, Norway
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Geir Kjetil Sandve
- UiO: RealArt Convergence Environment, University of Oslo, Oslo, Norway
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Wettermark
- Department of Pharmacy, Pharmacoepidemiology and Social Pharmacy, Uppsala University, Uppsala, Sweden
| | | | - Morten Andersen
- Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Maurizio Sessa
- Department of Drug Design and Pharmacology, Drug Safety Group, University of Copenhagen, Copenhagen, Denmark
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Giardiello D, Melotti R, Barbieri G, Gögele M, Weichenberger CX, Foco L, Bottigliengo D, Barin L, Lundin R, Pramstaller PP, Pattaro C. Determinants of SARS-CoV-2 nasopharyngeal testing in a rural community sample susceptible of first infection: the CHRIS COVID-19 study. Pathog Glob Health 2023; 117:744-753. [PMID: 36992656 PMCID: PMC10614704 DOI: 10.1080/20477724.2023.2191232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
To characterize COVID-19 epidemiology, numerous population-based studies have been undertaken to model the risk of SARS-CoV-2 infection. Less is known about what may drive the probability to undergo testing. Understanding how much testing is driven by contextual or individual conditions is important to delineate the role of individual behavior and to shape public health interventions and resource allocation. In the Val Venosta/Vinschgau district (South Tyrol, Italy), we conducted a population-representative longitudinal study on 697 individuals susceptible to first infection who completed 4,512 repeated online questionnaires at four-week intervals between September 2020 and May 2021. Mixed-effects logistic regression models were fitted to investigate associations of self-reported SARS-CoV-2 testing with individual characteristics (social, demographic, and biological) and contextual determinants. Testing was associated with month of reporting, reflecting the timing of both the pandemic intensity and public health interventions, COVID-19-related symptoms (odds ratio, OR:8.26; 95% confidence interval, CI:6.04-11.31), contacts with infected individuals within home (OR:7.47, 95%CI:3.81-14.62) or outside home (OR:9.87, 95%CI:5.78-16.85), and being retired (OR:0.50, 95%CI:0.34-0.73). Symptoms and next within- and outside-home contacts were the leading determinants of swab testing predisposition in the most acute phase of the pandemics. Testing was not associated with age, sex, education, comorbidities, or lifestyle factors. In the study area, contextual determinants reflecting the course of the pandemic were predominant compared to individual sociodemographic characteristics in explaining the SARS-CoV-2 probability of testing. Decision makers should evaluate whether the intended target groups were correctly prioritized by the testing campaign.
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Affiliation(s)
- Daniele Giardiello
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Roberto Melotti
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Giulia Barbieri
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Martin Gögele
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | | | - Luisa Foco
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Daniele Bottigliengo
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Laura Barin
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Rebecca Lundin
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
| | - Peter P. Pramstaller
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
- Department of Neurology, General Central Hospital, Bolzano, Italy
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine (affiliated to the University of Lübeck), Bolzano, Italy
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Cárdenas-Fuentes G, Bosch de Basea M, Cobo I, Subirana I, Ceresa M, Famada E, Gimeno-Santos E, Delgado-Ortiz L, Faner R, Molina-Molina M, Agustí À, Muñoz X, Sibila O, Gea J, Garcia-Aymerich J. Validity of prognostic models of critical COVID-19 is variable. A systematic review with external validation. J Clin Epidemiol 2023; 159:274-288. [PMID: 37142168 PMCID: PMC10152752 DOI: 10.1016/j.jclinepi.2023.04.011] [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: 07/28/2022] [Revised: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To identify prognostic models which estimate the risk of critical COVID-19 in hospitalized patients and to assess their validation properties. STUDY DESIGN AND SETTING We conducted a systematic review in Medline (up to January 2021) of studies developing or updating a model that estimated the risk of critical COVID-19, defined as death, admission to intensive care unit, and/or use of mechanical ventilation during admission. Models were validated in two datasets with different backgrounds (HM [private Spanish hospital network], n = 1,753, and ICS [public Catalan health system], n = 1,104), by assessing discrimination (area under the curve [AUC]) and calibration (plots). RESULTS We validated 18 prognostic models. Discrimination was good in nine of them (AUCs ≥ 80%) and higher in those predicting mortality (AUCs 65%-87%) than those predicting intensive care unit admission or a composite outcome (AUCs 53%-78%). Calibration was poor in all models providing outcome's probabilities and good in four models providing a point-based score. These four models used mortality as outcome and included age, oxygen saturation, and C-reactive protein among their predictors. CONCLUSION The validity of models predicting critical COVID-19 by using only routinely collected predictors is variable. Four models showed good discrimination and calibration when externally validated and are recommended for their use.
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Affiliation(s)
- Gabriela Cárdenas-Fuentes
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; School of Health Sciences, Blanquerna-Universitat Ramon Llull, Barcelona, Spain.
| | - Magda Bosch de Basea
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Inés Cobo
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isaac Subirana
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), ISCIII, Spain
| | - Mario Ceresa
- BCNMedTech, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Elena Gimeno-Santos
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Respiratory Institute, Hospital Clinic, Barcelona, Spain
| | - Laura Delgado-Ortiz
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Rosa Faner
- Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - María Molina-Molina
- CIBER Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Servicio de Neumología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Àlvar Agustí
- Respiratory Institute, Hospital Clinic, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Xavier Muñoz
- CIBER Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Servicio de Neumología, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Departamento de Biología celular, fisiología e inmunología, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Sibila
- Respiratory Institute, Hospital Clinic, Barcelona, Spain; Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Joaquim Gea
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Servicio de Neumología, Hospital del Mar-IMIM, Barcelona, Spain; Fundació Barcelona Respiratory Network (BRN), Barcelona, Spain
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Karuna S, Gallardo-Cartagena JA, Theodore D, Hunidzarira P, Montenegro-Idrogo J, Hu J, Jones M, Kim V, De La Grecca R, Trahey M, Karg C, Takalani A, Polakowski L, Hutter J, Miner MD, Erdmann N, Goepfert P, Maboa R, Corey L, Gill K, Li SS. Post-COVID symptom profiles and duration in a global convalescent COVID-19 observational cohort: Correlations with demographics, medical history, acute COVID-19 severity and global region. J Glob Health 2023; 13:06020. [PMID: 37352144 PMCID: PMC10289480 DOI: 10.7189/jogh.13.06020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
Background Post-COVID conditions are characterised by persistent symptoms that negatively impact quality of life after SARS-CoV-2 diagnosis. While post-COVID risk factors and symptoms have been extensively described in localised regions, especially in the global north, post-COVID conditions remain poorly understood globally. The global, observational cohort study HVTN 405/HPTN 1901 characterises the convalescent course of SARS-CoV-2 infection among adults in North and South America and Africa. Methods We categorised the cohort by infection severity (asymptomatic, symptomatic, no oxygen requirement (NOR), non-invasive oxygen requirement (NIOR), invasive oxygen requirement (IOR)). We applied a regression model to assess correlations of demographics, co-morbidities, disease severity, and concomitant medications with COVID-19 symptom persistence and duration across global regions. Results We enrolled 759 participants from Botswana, Malawi, South Africa, Zambia, Zimbabwe, Peru, and the USA a median of 51 (interquartile range (IQR) = 35-66) days post-diagnosis, from May 2020 to March 2021. 53.8% were female, 69.8% were 18-55 years old (median (md) = 44 years old, IQR = 33-58). Comorbidities included obesity (42.8%), hypertension (24%), diabetes (14%), human immunodeficiency virus (HIV) infection (11.6%) and lung disease (7.5%). 76.2% were symptomatic (NOR = 47.4%; NIOR = 22.9%; IOR = 5.8%). Median COVID-19 duration among symptomatic participants was 20 days (IQR = 11-35); 43.4% reported symptoms after COVID-19 resolution, 33.6% reported symptoms ≥30 days, 9.9% reported symptoms ≥60 days. Symptom duration correlated with disease severity (P < 0.001, NIOR vs NOR; P = 0.003, IOR vs NOR), lung disease (P = 0.001), race (P < 0.05, non-Hispanic Black vs White), and global region (P < 0.001). Prolonged viral shedding correlated with persistent abdominal pain (odds ratio (OR) = 5.51, P < 0.05) and persistent diarrhoea (OR = 6.64, P < 0.01). Conclusions Post-COVID duration varied with infection severity, race, lung disease, and region. Better understanding post-COVID conditions, including regionally-diverse symptom profiles, may improve clinical assessment and management globally. Registration Clinicaltrials.gov (#NCT04403880).
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Affiliation(s)
- Shelly Karuna
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Jorge A Gallardo-Cartagena
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Deborah Theodore
- Columbia University Physicians & Surgeons, New York, New York, USA
| | - Portia Hunidzarira
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Juan Montenegro-Idrogo
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Jiani Hu
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Megan Jones
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Vicky Kim
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Meg Trahey
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Carissa Karg
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Azwi Takalani
- Hutchinson Centre for Research in South Africa, Johannesburg, Republic of South Africa
| | | | | | | | | | | | - Rebone Maboa
- Ndlovu Research Centre, Elandsdoorn, Limpopo, Republic of South Africa
| | | | - Katherine Gill
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, Republic of South Africa
| | | | - HVTN 405/HPTN 1901 Study Team
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Columbia University Physicians & Surgeons, New York, New York, USA
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
- Hutchinson Centre for Research in South Africa, Johannesburg, Republic of South Africa
- National Institute of Allergy and Infectious Disease, Bethesda, Maryland, USA University of Alabama at Birmingham, Birmingham, Alabama, USA
- Ndlovu Research Centre, Elandsdoorn, Limpopo, Republic of South Africa
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, Republic of South Africa
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9
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Su N, Donders MCHCM, Ho JPTF, Vespasiano V, de Lange J, Loos BG. Development and external validation of prediction models for critical outcomes of unvaccinated COVID-19 patients based on demographics, medical conditions and dental status. Heliyon 2023; 9:e15283. [PMID: 37064437 PMCID: PMC10084632 DOI: 10.1016/j.heliyon.2023.e15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 03/18/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023] Open
Abstract
Background Multiple prediction models were developed for critical outcomes of COVID-19. However, prediction models using predictors which can be easily obtained in clinical practice and on dental status are scarce. Aim The study aimed to develop and externally validate prediction models for critical outcomes of COVID-19 for unvaccinated adult patients in hospital settings based on demographics, medical conditions, and dental status. Methods A total of 285 and 352 patients from two hospitals in the Netherlands were retrospectively included as derivation and validation cohorts. Demographics, medical conditions, and dental status were considered potential predictors. The critical outcomes (death and ICU admission) were considered endpoints. Logistic regression analyses were used to develop two models: for death alone and for critical outcomes. The performance and clinical values of the models were determined in both cohorts. Results Age, number of teeth, chronic kidney disease, hypertension, diabetes, and chronic obstructive pulmonary diseases were the significant independent predictors. The models showed good to excellent calibration with observed: expected (O:E) ratios of 0.98 (95%CI: 0.76 to 1.25) and 1.00 (95%CI: 0.80 to 1.24), and discrimination with shrunken area under the curve (AUC) values of 0.85 and 0.79, based on the derivation cohort. In the validation cohort, the models showed good to excellent discrimination with AUC values of 0.85 (95%CI: 0.80 to 0.90) and 0.78 (95%CI: 0.73 to 0.83), but an overestimation in calibration with O:E ratios of 0.65 (95%CI: 0.49 to 0.85) and 0.67 (95%CI: 0.52 to 0.84). Conclusion The performance of the models was acceptable in both derivation and validation cohorts. Number of teeth was an additive important predictor of critical outcomes of COVID-19. It is an easy-to-apply tool in hospitals for risk stratification of COVID-19 prognosis.
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Affiliation(s)
- Naichuan Su
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marie-Chris H C M Donders
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Isala Zwolle, Zwolle, the Netherlands
| | - Jean-Pierre T F Ho
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Northwest Clinics, Alkmaar, the Netherlands
| | - Valeria Vespasiano
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Isala Zwolle, Zwolle, the Netherlands
| | - Bruno G Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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10
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Bader G, Itan M, Edry-Botzer L, Cohen H, Haskin O, Mozer-Glassberg Y, Harel L, Munitz A, Mandelblit NM, Gerlic M. Adaptive immune response to BNT162b2 mRNA vaccine in immunocompromised adolescent patients. Front Immunol 2023; 14:1131965. [PMID: 37051242 PMCID: PMC10084476 DOI: 10.3389/fimmu.2023.1131965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Protective immunity against COVID-19 is orchestrated by an intricate network of innate and adaptive anti-viral immune responses. Several vaccines have been rapidly developed to combat the destructive effects of COVID-19, which initiate an immunological cascade that results in the generation of neutralizing antibodies and effector T cells towards the SARS-CoV-2 spike protein. Developing optimal vaccine-induced anti-SARS- CoV-2 protective immunity depends on a fully competent immune response. Some evidence was gathered on the effects of vaccination outcomes in immunocompromised adult individuals. Nonetheless, protective immunity elicited by the Pfizer Biontech BNT162b2 vaccine in immunocompromised adolescents received less attention and was mainly focused on the antibody response and their neutralization potential. The overall immune response, including T-cell activities, was largely understudied. In this study, we characterized the immune response of vaccinated immunocompromised adolescents. We found that immunocompromised adolescents, which may fail to elicit a humoral response and develop antibodies, may still develop cellular T-cell immunity towards SARS-CoV-2 infections. Furthermore, most immunocompromised adolescents due to genetic disorders or drugs (Kidney and liver transplantation) still develop either humoral, cellular or both arms of immunity towards SARS-CoV-2 infections. We also demonstrate that most patients could mount a cellular or humoral response even after six months post 2nd vaccination. The findings that adolescents immunocompromised patients respond to some extent to vaccination are promising. Finally, they question the necessity for additional vaccination boosting regimens for this population who are not at high risk for severe disease, without further testing of their post-vaccination immune status.
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Affiliation(s)
- Guy Bader
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Michal Itan
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Liat Edry-Botzer
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Hadar Cohen
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Orly Haskin
- Sackler School, Medicine Tel Aviv University, Tel Aviv, Israel
- Nephrology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Yael Mozer-Glassberg
- Sackler School, Medicine Tel Aviv University, Tel Aviv, Israel
- Gastroenterology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Liora Harel
- Sackler School, Medicine Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Ariel Munitz
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Ariel Munitz, ; Nufar Marcus Mandelblit, ; Motti Gerlic,
| | - Nufar Marcus Mandelblit
- Sackler School, Medicine Tel Aviv University, Tel Aviv, Israel
- Kipper Institute of Immunology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
- *Correspondence: Ariel Munitz, ; Nufar Marcus Mandelblit, ; Motti Gerlic,
| | - Motti Gerlic
- Department of Clinical Microbiology and Immunology, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Ariel Munitz, ; Nufar Marcus Mandelblit, ; Motti Gerlic,
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11
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Gatto NM, Freund D, Ogata P, Diaz L, Ibarrola A, Desai M, Aspelund T, Gluckstein D. Correlates of Coronavirus Disease 2019 Inpatient Mortality at a Southern California Community Hospital With a Predominantly Hispanic/Latino Adult Population. Open Forum Infect Dis 2023; 10:ofad011. [PMID: 36726553 PMCID: PMC9887269 DOI: 10.1093/ofid/ofad011] [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: 12/15/2022] [Accepted: 12/06/2023] [Indexed: 01/11/2023] Open
Abstract
Background Studies of inpatient coronavirus disease 2019 (COVID-19) mortality risk factors have mainly used data from academic medical centers or large multihospital databases and have not examined populations with large proportions of Hispanic/Latino patients. In a retrospective cohort study of 4881 consecutive adult COVID-19 hospitalizations at a single community hospital in Los Angeles County with a majority Hispanic/Latino population, we evaluated factors associated with mortality. Methods Data on demographic characteristics, comorbidities, laboratory and clinical results, and COVID-19 therapeutics were abstracted from the electronic medical record. Cox proportional hazards regression modeled statistically significant, independently associated predictors of hospital mortality. Results Age ≥65 years (hazard ratio [HR] = 2.66; 95% confidence interval [CI] = 1.90-3.72), male sex (HR = 1.31; 95% CI = 1.07-1.60), renal disease (HR = 1.52; 95% CI = 1.18-1.95), cardiovascular disease (HR = 1.45; 95% CI = 1.18-1.78), neurological disease (HR = 1.84; 95% CI = 1.41-2.39), D-dimer ≥500 ng/mL (HR = 2.07; 95% CI = 1.43-3.0), and pulse oxygen level <88% (HR = 1.39; 95% CI = 1.13-1.71) were independently associated with increased mortality. Patient household with (1) multiple COVID-19 cases and (2) Asian, Black, or Hispanic compared with White non-Hispanic race/ethnicity were associated with reduced mortality. In hypoxic COVID-19 inpatients, remdesivir, tocilizumab, and convalescent plasma were associated with reduced mortality, and corticosteroid use was associated with increased mortality. Conclusions We corroborate several previously identified mortality risk factors and find evidence that the combination of factors associated with mortality differ between populations.
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Affiliation(s)
- Nicole M Gatto
- Correspondence: Nicole M. Gatto, MPH, PhD, Adjunct Research Assistant Professor Department of Population and Public Health Sciences Keck School of Medicine University of Southern California 1845 N Soto St, Los Angeles, CA 90032, USA ()
| | - Debbie Freund
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA,Department of Economic Sciences, Claremont Graduate University, Claremont, California, USA,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Pamela Ogata
- School of Community and Global Health, Claremont Graduate University, Claremont, California, USA
| | - Lisa Diaz
- Pomona Valley Hospital and Medical Center, Pomona, California, USA
| | - Ace Ibarrola
- Pomona Valley Hospital and Medical Center, Pomona, California, USA
| | - Mamta Desai
- Pomona Valley Hospital and Medical Center, Pomona, California, USA
| | - Thor Aspelund
- Center for Public Health Sciences, University of Iceland, Reykjavik, Iceland
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12
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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13
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Ninan KF, Iyadurai R, Varghese J, Jeevan JJA, Gunasekaran K, Karuppusami R, Chacko B, Johnson KJ, Mandal A, David N. Can clinical parameters at admission predict severity and intensive care unit mortality outcomes in patients with COVID-19? CURRENT MEDICAL ISSUES 2023; 21:168. [DOI: 10.4103/cmi.cmi_6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
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14
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Tutal Gursoy G, Yuksel H, Mulkem Simsek I, Oral S, Erdogan Kucukdagli F, Karaman A, Akinci E, Bastug A, Guner HR, Bektas H. Neurological Presentations in Patients with COVID-19 in Cytokine Storm. Can J Neurol Sci 2023; 50:89-95. [PMID: 34866562 PMCID: PMC8649405 DOI: 10.1017/cjn.2021.247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) infection causes a wide variety of neurological disorders by affecting both central and peripheral nervous systems. The cytokine storm (CS) has been blamed for the development of severe neurological disorders in COVID-19. However, the relationship between COVID-19 CS and neurological manifestations has not been adequately studied. Thus, we aimed to investigate the neurological presentations in patients with COVID-19 CS. METHODS The study population consisted of hospitalized moderate-to-severe COVID-19 patients. It was divided into two groups CS (36 patients, 29.3%) and non-CS (87 patients, 70.7%) based on significant clinical symptoms, elevated inflammatory marker levels, radiological findings, and interleukin-6 levels (IL-6). RESULTS The three most common neurological symptoms in the CS group were altered level of consciousness, headache, and unsteadiness. Altered level of consciousness was higher in the CS group (69.4%) than the non-CS group (25.3%) (p:0.001). The frequency of headache was comparable in both groups (p:0.186). The number of patients requiring intensive care unit and intubation was higher in the CS group (p:0.005 and p:0.001). The mortality rate in the CS group (38.9%) was higher than the non-CS group (8.0%) (p:0.001). IL-6, CRP, ferritin, neutrophil-lymphocyte ratio, procalcitonin, and D-dimer levels were higher in the CS group (for all p:0.001) while lymphocyte count was lower (p:0.003). CONCLUSION The most common neurological presentation in patients with CS was altered level of consciousness. The presence of CS was an independent risk factor for high mortality.
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Affiliation(s)
| | - Hatice Yuksel
- Department of Neurology, Ankara City Hospital, Cankaya, Turkey
| | | | - Saniye Oral
- Department of Neurology, Ankara City Hospital, Cankaya, Turkey
| | | | - Ayberk Karaman
- Department of Neurosurgery, Ankara City Hospital, Cankaya, Turkey
| | - Esragul Akinci
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Cankaya, Turkey
| | - Aliye Bastug
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Cankaya, Turkey
| | - Hatice Rahmet Guner
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Cankaya, Turkey
| | - Hesna Bektas
- Department of Neurology, Ankara City Hospital, Cankaya, Turkey
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15
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Ng RWY, Boon SS, Chen Z, Ho WCS, Fung KSC, Wong BKC, Yeung ACM, Wong MCS, Chan PKS. Cross-Clade Memory Immunity in Adults Following SARS-CoV-1 Infection in 2003. JAMA Netw Open 2022; 5:e2247723. [PMID: 36538327 PMCID: PMC9856533 DOI: 10.1001/jamanetworkopen.2022.47723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Knowledge of the longevity and breath of immune response to coronavirus infection is crucial for the development of next-generation vaccines to control the COVID-19 pandemic. OBJECTIVES To determine the profile of SARS-CoV-2 antibodies among persons infected with the closely related virus, SARS-CoV-1, in 2003 (SARS03 survivors) and to characterize their antibody response soon after the first and second doses of COVID-19 vaccines. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study examined SARS-CoV-2 antibodies among SARS03 survivors compared with sex- and age-matched infection-naive controls. Participants received the COVID-19 vaccines between March 1 and September 30, 2021. INTERVENTIONS One of the 2 COVID-19 vaccines (inactivated [CoronaVac] or messenger RNA [BNT162b2]) available in Hong Kong. Two doses were given according to the recommended schedule. The vaccine type administered was known to both participants and observers. MAIN OUTCOMES AND MEASURES SARS-CoV-2 antibodies were measured prevaccination, 7 days after the first dose, and 14 days after the second dose. RESULTS Eighteen SARS03 adult survivors (15 women and 3 men; median age, 46.5 [IQR, 40.0-54.3] years) underwent prevaccination serologic examination. The vast majority retained a detectable level of antibodies that cross-reacted with SARS-CoV-2 (16 of 18 [88.9%] with nucleocapsid protein antibodies and 17 of 18 [94.4%] with receptor-binding domain of spike protein antibodies); a substantial proportion (11 of 18 [61.1%]) had detectable cross-neutralizing antibodies. Twelve SARS03 adult survivors (10 women and 2 men) underwent postvaccination serologic examination. At 7 days after the first dose of vaccine, SARS03 survivors mounted significantly higher levels of neutralizing antibodies compared with controls (median inhibition: 89.5% [IQR, 77.1%-93.7%] vs 13.9% [IQR, 11.8%-16.1%] for BNT162b2; 64.9% [IQR, 60.8%-69.5%] vs 13.4% [IQR, 9.5%-16.8%] for CoronaVac; P < .001 for both). At 14 days after the second dose, SARS03 survivors generated a broader antibody response with significantly higher levels of neutralizing antibodies against variants of concern compared with controls (eg, median inhibition against Omicron variant, 52.1% [IQR, 35.8%-66.0%] vs 14.7% [IQR, 2.5%-20.7%]; P < .001). CONCLUSIONS AND RELEVANCE The findings of this prospective cohort study suggest that infection with SARS-CoV-1 was associated with detectable levels of antibodies that cross-react and cross-neutralize SARS-CoV-2, which belongs to a distinct clade under the same subgenus Sarbecovirus. These findings support the development of broadly protective vaccines to cover sarbecoviruses that caused 2 devastating zoonotic outbreaks in humans over the last 2 decades.
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Affiliation(s)
- Rita W. Y. Ng
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Siaw S. Boon
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Zigui Chen
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Wendy C. S. Ho
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | | | | | - Apple C. M. Yeung
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
| | - Martin C. S. Wong
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
| | - Paul K. S. Chan
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong
- Stanley Ho Centre for Emerging Infectious Diseases, Faulty of Medicine, Chinese University of Hong Kong, Hong Kong
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16
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Sikhosana ML, Jassat W, Makatini Z. Characteristics of hospitalised COVID-19 patients during the first two pandemic waves, Gauteng. S Afr J Infect Dis 2022; 37:434. [PMID: 36254313 PMCID: PMC9557933 DOI: 10.4102/sajid.v37i1.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
Abstract
Background Gauteng province (GP) was one of the most affected provinces in the country during the first two pandemic waves in South Africa. We aimed to describe the characteristics of coronavirus disease 2019 (COVID-19) patients admitted in one of the largest quaternary hospitals in GP during the first two waves. Objectives Study objectives were to determine factors associated with hospital admission during the second wave and to describe factors associated with in-hospital COVID-19 mortality. Method Data from a national hospital-based surveillance system of COVID-19 hospitalisations were used. Multivariable logistic regression models were conducted to compare patients hospitalised during wave 1 and wave 2, and to determine factors associated with in-hospital mortality. Results The case fatality ratio was the highest (39.95%) during wave 2. Factors associated with hospitalisation included age groups 40–59 years (adjusted odds ratio [aOR]: 2.14, 95% confidence interval [CI]: 1.08–4.27), 60–79 years (aOR: 2.49, 95% CI: 1.23–5.02) and ≥ 80 years (aOR: 3.39, 95% CI: 1.35–8.49). Factors associated with in–hospital mortality included age groups 60–79 years (aOR: 2.55, 95% CI: 1.11–5.84) and ≥ 80 years (aOR: 5.66, 95% CI: 2.12–15.08); male sex (aOR: 1.56, 95% CI: 1.22–1.99); presence of an underlying comorbidity (aOR: 1.76, 95% CI: 1.37–2.26), as well as being admitted during post–wave 2 (aOR: 2.42, 95% CI: 1.33–4.42). Conclusion Compared to the recent omicron-driven pandemic waves characterised by lower admission rates and less disease severity among younger patients, COVID-19 in-hospital mortality during the earlier waves was associated with older age, being male and having an underlying comorbidity. Contribution This study showed how an active surveillance system can contribute towards identifying changes in disease trends.
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Affiliation(s)
- Mpho L. Sikhosana
- Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Waasila Jassat
- Department of Public Health and Outbreak Response, National Institute of Communicable Diseases, Johannesburg, South Africa
| | - Zinhle Makatini
- Department of Virology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cyrille TM, Serge SM, Brice TMJ, Alain TNP, Grace N, Joseph F, Achta H, Gisèle N, Julius N, Marcel T, Melissa S, Lucy N, Ronald P, Claire OAM, Walter PYE, Alain EMG, Richard N, Sara E. Clinical presentation of COVID-19 at the time of testing and factors associated with pre-symptomatic cases in Cameroon. IJID REGIONS 2022; 4:33-41. [PMID: 35720960 PMCID: PMC9148624 DOI: 10.1016/j.ijregi.2022.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 05/29/2023]
Abstract
Objectives To describe the clinical features at time of testing and explore factors associated with SARS-CoV-2 infection and pre-symptomatic cases in Cameroon. Methods Data was collected on people in Cameroon who participated in COVID-19 testing by real-time reverse transcriptase-polymerase chain reaction between 1 March and 5 October 2020. After descriptive analysis, multivariate logistic regression was used to identify factors associated with SARS-CoV-2 infection and pre-symptomatic cases. Results Of 85 206 test participants, 14 863 (17.4%) were infected with SARS-CoV-2. The median age for cases was 38.4 years (interquartile range 29.6-49.4); 6.1% were aged <19 years, and 6.3% were ≥65 years. Of these cases, 46.5% had at least one symptom/sign with a median time from illness onset to testing of 6 days (interquartile range 3-9). Cough (64.2%), headache (46.5%), fatigue/malaise (46.0%), shortness of breath (30.6%) and myalgia/arthralgia (25.6%) were the most commonly observed symptoms/signs. Pre-symptomatic SARS-CoV-2 infection was associated with age <50 years, being male and absence of comorbidities. Conclusion This study provides a comprehensive summary of the early clinical profile of SARS-CoV-2 infection during the first wave of COVID-19 in Cameroon, which was dominated by pre-symptomatic illness. These findings would be helpful for SARS-CoV-2 surveillance and control at a regional level.
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Affiliation(s)
| | | | | | | | - Ngondi Grace
- Virology Laboratory, Laquintinie Hospital, Douala, Cameroon
| | - Fokam Joseph
- Chantal BIYA International Reference Centre for research on HIV/AIDS prevention and management, Yaoundé, Cameroon
| | - Hamadou Achta
- Epidemiology and Public Health Service, Pasteur Centre in Cameroon, Yaoundé, Cameroon
| | | | | | - Tongo Marcel
- Emerging and Reemerging Diseases Research Centre, IMPM, Yaoundé, Cameroon
| | - Sander Melissa
- Tuberculosis Reference Laboratory Bamenda, Bamenda, Cameroon
| | - Ndip Lucy
- Laboratory of Emerging Infectious Diseases, University of Buea, Buea, Cameroon
| | - Perraut Ronald
- Pasteur Centre in Cameroon, Annex of Garoua, Garoua, Cameroon
| | | | | | - Etoundi Mballa Georges Alain
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
- Department for the Control of Disease, Epidemics, and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Njouom Richard
- Virology Service, Pasteur Centre in Cameroon, Yaoundé, Cameroon
| | - Eyangoh Sara
- Public Health Emergency Operations Coordination Centre, Yaoundé, Cameroon
- Scientific Department, Pasteur Centre in Cameroon, Yaoundé
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18
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Funk T, Innocenti F, Gomes Dias J, Nerlander L, Melillo T, Gauci C, Melillo JM, Lenz P, Sebestova H, Slezak P, Vlckova I, Berild JD, Mauroy C, Seppälä E, Tønnessen R, Vergison A, Mossong J, Masi S, Huiart L, Cullen G, Murphy N, O'Connor L, O'Donnell J, Mook P, Pebody RG, Bundle N. Age-specific associations between underlying health conditions and hospitalisation, death and in-hospital death among confirmed COVID-19 cases: a multi-country study based on surveillance data, June to December 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 36052721 PMCID: PMC9438397 DOI: 10.2807/1560-7917.es.2022.27.35.2100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Underlying conditions are risk factors for severe COVID-19 outcomes but evidence is limited about how risks differ with age. Aim We sought to estimate age-specific associations between underlying conditions and hospitalisation, death and in-hospital death among COVID-19 cases. Methods We analysed case-based COVID-19 data submitted to The European Surveillance System between 2 June and 13 December 2020 by nine European countries. Eleven underlying conditions among cases with only one condition and the number of underlying conditions among multimorbid cases were used as exposures. Adjusted odds ratios (aOR) were estimated using 39 different age-adjusted and age-interaction multivariable logistic regression models, with marginal means from the latter used to estimate probabilities of severe outcome for each condition–age group combination. Results Cancer, cardiac disorder, diabetes, immunodeficiency, kidney, liver and lung disease, neurological disorders and obesity were associated with elevated risk (aOR: 1.5–5.6) of hospitalisation and death, after controlling for age, sex, reporting period and country. As age increased, age-specific aOR were lower and predicted probabilities higher. However, for some conditions, predicted probabilities were at least as high in younger individuals with the condition as in older cases without it. In multimorbid patients, the aOR for severe disease increased with number of conditions for all outcomes and in all age groups. Conclusion While supporting age-based vaccine roll-out, our findings could inform a more nuanced, age- and condition-specific approach to vaccine prioritisation. This is relevant as countries consider vaccination of younger people, boosters and dosing intervals in response to vaccine escape variants.
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Affiliation(s)
- Tjede Funk
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Francesco Innocenti
- Epidemiology Unit, Regional Health Agency of Tuscany, Florence, Italy.,European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana Gomes Dias
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Lina Nerlander
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Tanya Melillo
- Infectious Disease Prevention and Control Unit, Superintendence of Public Health, Gwardamanġa, Malta
| | | | - Jackie M Melillo
- Infectious Disease Prevention and Control Unit, Superintendence of Public Health, Gwardamanġa, Malta
| | - Patrik Lenz
- Department of Biostatistics, National Institute of Public Health, Prague, Czechia
| | - Helena Sebestova
- Department of Biostatistics, National Institute of Public Health, Prague, Czechia
| | - Pavel Slezak
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Prague, Czechia
| | - Iva Vlckova
- Department of Biostatistics, National Institute of Public Health, Prague, Czechia
| | - Jacob Dag Berild
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Camilla Mauroy
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Elina Seppälä
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ragnhild Tønnessen
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | | | | | - Gillian Cullen
- HSE - Health Protection Surveillance Centre, Dublin, Ireland
| | - Niamh Murphy
- HSE - Health Protection Surveillance Centre, Dublin, Ireland
| | - Lois O'Connor
- HSE - Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- HSE - Health Protection Surveillance Centre, Dublin, Ireland
| | - Piers Mook
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Richard G Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Nick Bundle
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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19
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De Freitas VM, Chiloff DM, Bosso GG, Teixeira JOP, Hernandes ICDG, Padilha MDP, Moura GC, De Andrade LGM, Mancuso F, Finamor FE, Serodio AMDB, Arakaki JSO, Sartori MGF, Ferreira PRA, Rangel ÉB. A Machine Learning Model for Predicting Hospitalization in Patients with Respiratory Symptoms during the COVID-19 Pandemic. J Clin Med 2022; 11:jcm11154574. [PMID: 35956189 PMCID: PMC9369854 DOI: 10.3390/jcm11154574] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 12/28/2022] Open
Abstract
A machine learning approach is a useful tool for risk-stratifying patients with respiratory symptoms during the COVID-19 pandemic, as it is still evolving. We aimed to verify the predictive capacity of a gradient boosting decision trees (XGboost) algorithm to select the most important predictors including clinical and demographic parameters in patients who sought medical support due to respiratory signs and symptoms (RAPID RISK COVID-19). A total of 7336 patients were enrolled in the study, including 6596 patients that did not require hospitalization and 740 that required hospitalization. We identified that patients with respiratory signs and symptoms, in particular, lower oxyhemoglobin saturation by pulse oximetry (SpO2) and higher respiratory rate, fever, higher heart rate, and lower levels of blood pressure, associated with age, male sex, and the underlying conditions of diabetes mellitus and hypertension, required hospitalization more often. The predictive model yielded a ROC curve with an area under the curve (AUC) of 0.9181 (95% CI, 0.9001 to 0.9361). In conclusion, our model had a high discriminatory value which enabled the identification of a clinical and demographic profile predictive, preventive, and personalized of COVID-19 severity symptoms.
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Affiliation(s)
- Victor Muniz De Freitas
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Daniela Mendes Chiloff
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Giulia Gabriella Bosso
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | | | | | - Maira do Patrocínio Padilha
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Giovanna Corrêa Moura
- Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | | | - Frederico Mancuso
- Discipline of Emergency Medicine, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Francisco Estivallet Finamor
- Discipline of Emergency Medicine, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Aluísio Marçal de Barros Serodio
- Sector of Bioethics, Department of Surgery, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Jaquelina Sonoe Ota Arakaki
- Pneumology Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Marair Gracio Ferreira Sartori
- Department of Obstetrics, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Paulo Roberto Abrão Ferreira
- Infectious Disease Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
| | - Érika Bevilaqua Rangel
- Nephrology Division, Department of Medicine, Paulista School of Medicine, Hospital São Paulo, Federal University of São Paulo, São Paulo 04038-901, Brazil
- Correspondence:
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20
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Szabó M, Kardos Z, Oláh C, Tamáska P, Hodosi K, Csánky E, Szekanecz Z. Severity and prognostic factors of SARS-CoV-2-induced pneumonia: The value of clinical and laboratory biomarkers and the A-DROP score. Front Med (Lausanne) 2022; 9:920016. [PMID: 35935801 PMCID: PMC9353138 DOI: 10.3389/fmed.2022.920016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Numerous clinical and laboratory scores that include C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase (LDH), interleukin 6 (IL-6), procalcitonin (PCT), blood urea nitrogen (BUN), creatinine levels and oxygenation (PaO2 and SaO2) have been used for the prognosis of COVID-19. In addition, composite scores have been developed for the assessment of general state and risk in community-acquired pneumonia (CAP) that may be applied for COVID-19 as well. In this study, we assessed severity and potential prognostic risk factors for unfavorable outcome among hospitalized COVID-19 patients. We also applied the A-DROP general scoring system used in CAP to COVID-19. Patients and methods Altogether 233 patients admitted to our center with COVID-19 were included in the study. Clinical status, several laboratory biomarkers described above, indicators of oxygenation were determined at hospital admission. We also applied the A-DROP composite scoring system that includes Age (≥ 70 years in males and ≥ 75 years in females), Dehydration (BUN ≥ 7.5 mmol/l), Respiratory failure (SaO2 ≤ 90% or PaO2 ≤ 60 mmHg), Orientation disturbance (confusion) and low blood Pressure (systolic BP ≤ 90 mmHg) to COVID-19. Results At the time of admission, most patients had elevated CRP, LDH, ferritin, D-dimer, and IL-6 levels indicating multisystemic inflammatory syndrome (MIS). Altogether 49 patients (21.2%) required admission to ICU, 46 (19.7%) needed ventilation and 40 patients (17.2%) died. In the binary analysis, admission to ICU, the need for ventilation and death were all significantly associated with the duration of hospitalization, history of hypertension or obesity, confusion/dizziness, as well as higher absolute leukocyte and neutrophil and lower lymphocyte counts, elevated CRP, PCT, LDH, ferritin, IL-6, BUN, and creatinine levels, low PaO2 and SaO2 and higher A-DROP score at the time of admission (p < 0.05). Conclusion Numerous laboratory biomarkers in addition to obesity, dizziness at the time of admission and the history of hypertension may predict the need for ICU admission and ventilation, as well as mortality in COVID-19. Moreover, A-DROP may be a suitable scoring system for the assessment of general health and disease outcome in COVID-19.
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Affiliation(s)
- Miklós Szabó
- Department of Pulmonology, Borsod Academic County Hospital, Miskolc, Hungary
| | - Zsófia Kardos
- Department of Rheumatology, Borsod Academic County Hospital, Miskolc, Hungary
- Faculty of Health Sciences, University of Miskolc, Miskolc, Hungary
| | - Csaba Oláh
- Department of Neurosurgery, Borsod Academic County Hospital, Miskolc, Hungary
| | - Péter Tamáska
- Department of Radiology, Borsod Academic County Hospital, Miskolc, Hungary
| | - Katalin Hodosi
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eszter Csánky
- Department of Pulmonology, Borsod Academic County Hospital, Miskolc, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- *Correspondence: Zoltán Szekanecz,
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21
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Morales Chacón LM, Galán García L, Cruz Hernández TM, Pavón Fuentes N, Maragoto Rizo C, Morales Suarez I, Morales Chacón O, Abad Molina E, Rocha Arrieta L. Clinical Phenotypes and Mortality Biomarkers: A Study Focused on COVID-19 Patients with Neurological Diseases in Intensive Care Units. Behav Sci (Basel) 2022; 12:234. [PMID: 35877304 PMCID: PMC9312189 DOI: 10.3390/bs12070234] [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: 06/01/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: To identify clinical phenotypes and biomarkers for best mortality prediction considering age, symptoms and comorbidities in COVID-19 patients with chronic neurological diseases in intensive care units (ICUs). Subjects and Methods: Data included 1252 COVID-19 patients admitted to ICUs in Cuba between January and August 2021. A k-means algorithm based on unsupervised learning was used to identify clinical patterns related to symptoms, comorbidities and age. The Stable Sparse Classifiers procedure (SSC) was employed for predicting mortality. The classification performance was assessed using the area under the receiver operating curve (AUC). Results: Six phenotypes using a modified v-fold cross validation for the k-means algorithm were identified: phenotype class 1, mean age 72.3 years (ys)-hypertension and coronary artery disease, alongside typical COVID-19 symptoms; class 2, mean age 63 ys-asthma, cough and fever; class 3, mean age 74.5 ys-hypertension, diabetes and cough; class 4, mean age 67.8 ys-hypertension and no symptoms; class 5, mean age 53 ys-cough and no comorbidities; class 6, mean age 60 ys-without symptoms or comorbidities. The chronic neurological disease (CND) percentage was distributed in the six phenotypes, predominantly in phenotypes of classes 3 (24.72%) and 4 (35,39%); χ² (5) 11.0129 p = 0.051134. The cerebrovascular disease was concentrated in classes 3 and 4; χ² (5) = 36.63, p = 0.000001. The mortality rate totaled 325 (25.79%), of which 56 (17.23%) had chronic neurological diseases. The highest in-hospital mortality rates were found in phenotypes 1 (37.22%) and 3 (33.98%). The SSC revealed that a neurological symptom (ageusia), together with two neurological diseases (cerebrovascular disease and Parkinson's disease), and in addition to ICU days, age and specific symptoms (fever, cough, dyspnea and chilliness) as well as particular comorbidities (hypertension, diabetes and asthma) indicated the best prediction performance (AUC = 0.67). Conclusions: The identification of clinical phenotypes and mortality biomarkers using practical variables and robust statistical methodologies make several noteworthy contributions to basic and experimental investigations for distinguishing the COVID-19 clinical spectrum and predicting mortality.
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Affiliation(s)
| | | | | | - Nancy Pavón Fuentes
- International Center for Neurological Restoration, Havana 11300, Cuba; (N.P.F.); (C.M.R.); (E.A.M.)
| | - Carlos Maragoto Rizo
- International Center for Neurological Restoration, Havana 11300, Cuba; (N.P.F.); (C.M.R.); (E.A.M.)
| | | | - Odalys Morales Chacón
- Languages Center, Technological University of Havana Jose Antonio Echeverria, La Habana 3H3M+XJ6, Cuba;
| | - Elianne Abad Molina
- International Center for Neurological Restoration, Havana 11300, Cuba; (N.P.F.); (C.M.R.); (E.A.M.)
| | - Luisa Rocha Arrieta
- Center for Research and Advanced Studies México, Ciudad de México 14330, Mexico;
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22
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Lee B, Ashcroft T, Agyei-Manu E, Farfan de los Godos E, Leow A, Krishan P, Kulkarni D, Nundy M, Hartnup K, Shi T, McSwiggan E, Nair H, Theodoratou E, McQuillan R. Clinical features of COVID-19 for integration of COVID-19 into influenza surveillance: A systematic review. J Glob Health 2022; 12:05012. [PMID: 35567582 PMCID: PMC9107308 DOI: 10.7189/jogh.12.05012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In November 2020, the World Health Organization (WHO) created interim guidance on how to integrate testing for SARS-CoV-2 into existing influenza surveillance systems. Influenza-like illness (ILI) and severe acute respiratory illness (SARI) case definitions have been used to specify the case definition of COVID-19 for surveillance purposes. This review aims to assess whether the common clinical features of COVID-19 have changed to the point that the criteria used to identify both COVID-19 and influenza in surveillance programs needs to be altered. Methods A systematic review of reviews following PRISMA-P guidelines was conducted using the "COVID-19 evidence review" database from August 19, 2020, to August 19, 2021. Reviews providing pooled estimates of the prevalence of clinical features of COVID-19 within the general population, diagnosed by polymerase chain reaction or rapid diagnostic test, were included. These were critically appraised and sensitivity analysis was undertaken to examine potential causes of bias. Results Fourteen reviews were identified, including three on adults only and three on children only. For all reviews, combined fever (median prevalence = 73.0%, IQR = 58.3-78.7) and cough (45.1%, IQR = 28.9-54.0) were the most common features. These were followed by loss of taste or smell (45.1%, IQR = 28.9-54.0), hypoxemia (33%, one review), fatigue (26.4%, IQR = 9.0-39.4) and expectoration (23.9%, IQR = 23.3-25.5). Fever and cough continued to be the most prevalent features for adults and children, with subsequent symptoms being similar for adults only. However, the pattern differed for children, with headache (34.3%, IQR = 18-50.7) and nasal congestion (20%, one review) being the third and fourth commonest symptoms. Conclusions The prevalent features found in this recent review were the same as the ones identified at the beginning of the pandemic. Therefore, the current approach of using the ILI and SARI criteria which incorporate fever and cough will identify COVID-19 cases in addition to influenza. Interestingly, children may present with different features, as headaches and nasal congestion were more common in this group. Future research could examine this further and investigate whether symptomology changes with new variants of COVID-19.
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Affiliation(s)
- Bohee Lee
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland UK
| | - Thulani Ashcroft
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Eldad Agyei-Manu
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Emma Farfan de los Godos
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland UK
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Amanda Leow
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Prerna Krishan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Durga Kulkarni
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Madhurima Nundy
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Karen Hartnup
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ting Shi
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Emilie McSwiggan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Harish Nair
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ruth McQuillan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - the Usher Network for COVID-19 Evidence Reviews (UNCOVER) group
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, Scotland UK
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland, UK
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23
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Doroftei B, Ilie OD, Anton N, Timofte SI, Ilea C. Mathematical Modeling to Predict COVID-19 Infection and Vaccination Trends. J Clin Med 2022; 11:jcm11061737. [PMID: 35330062 PMCID: PMC8956009 DOI: 10.3390/jcm11061737] [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: 01/25/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background: COVID-19 caused by the Severe Acute Respiratory Syndrome Coronavirus 2 placed the health systems around the entire world in a battle against the clock. While most of the existing studies aimed at forecasting the infections trends, our study focuses on vaccination trend(s). Material and methods: Based on these considerations, we used standard analyses and ARIMA modeling to predict possible scenarios in Romania, the second-lowest country regarding vaccinations from the entire European Union. Results: With approximately 16 million doses of vaccine against COVID-19 administered, 7,791,250 individuals had completed the vaccination scheme. From the total, 5,058,908 choose Pfizer−BioNTech, 399,327 Moderna, 419,037 AstraZeneca, and 1,913,978 Johnson & Johnson. With a cumulative 2147 local and 17,542 general adverse reactions, the most numerous were reported in recipients of Pfizer−BioNTech (1581 vs. 8451), followed by AstraZeneca (138 vs. 6033), Moderna (332 vs. 1936), and Johnson & Johnson (96 vs. 1122). On three distinct occasions have been reported >50,000 individuals who received the first or second dose of a vaccine and >30,000 of a booster dose in a single day. Due to high reactogenicity in case of AZD1222, and time of launching between the Pfizer−BioNTech and Moderna vaccine could be explained differences in terms doses administered. Furthermore, ARIMA(1,1,0), ARIMA(1,1,1), ARIMA(0,2,0), ARIMA(2,1,0), ARIMA(1,2,2), ARI-MA(2,2,2), ARIMA(0,2,2), ARIMA(2,2,2), ARIMA(1,1,2), ARIMA(2,2,2), ARIMA(2,1,1), ARIMA(2,2,1), and ARIMA (2,0,2) for all twelve months and in total fitted the best models. These were regarded according to the lowest MAPE, p-value (p < 0.05, p < 0.01, and p < 0.001) and through the Ljung−Box test (p < 0.05, p < 0.01, and p < 0.001) for autocorrelations. Conclusions: Statistical modeling and mathematical analyses are suitable not only for forecasting the infection trends but the course of a vaccination rate as well.
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Affiliation(s)
- Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (N.A.); (C.I.)
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No. 20A, 700505 Iasi, Romania;
- Correspondence:
| | - Nicoleta Anton
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (N.A.); (C.I.)
| | - Sergiu-Ioan Timofte
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No. 20A, 700505 Iasi, Romania;
| | - Ciprian Ilea
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (B.D.); (N.A.); (C.I.)
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Martínez-Cuazitl A, Martínez-Salazar IN, Maza-De La Torre G, García-Dávila JA, Montelongo-Mercado EA, García-Ruíz A, Noyola-Villalobos HF, García-Araiza MG, Hernández-Díaz S, Villegas-Tapia DL, Cerda-Reyes E, Chávez-Velasco AS, García-Hernández JS. Burnout Syndrome in a Military Tertiary Hospital Staff during the COVID-19 Contingency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2229. [PMID: 35206414 PMCID: PMC8872413 DOI: 10.3390/ijerph19042229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Burnout syndrome (BOS) is defined as a psychological state of physical and mental fatigue associated with work. The COVID-19 pandemic greatly impacted the physical and mental wellbeing of health professionals. The objective of this work was to determine the impact on personnel, monitoring the frequency of BOS throughout the pandemic. (2) Methods: The Maslach Burnout Inventory (MBI) was self-applied in four periods of the pandemic according to sociodemographic and employment characteristics. In this study, all hospital personnel were included; the association of BOS with sex, age, type of participant (civilian or military), military rank and profession was analyzed. (3) Results: The frequency of BOS was 2.4% (start of the pandemic), 7.9% (peak of the first wave), 3.7% (end of the first wave) and 3.6% (peak of the third wave). Emotional exhaustion (EE) was the most affected factor, and the groups most affected were men under 30 years of age, civilians, chiefs and doctors, especially undergraduate medical doctors and specialty resident doctors, and nursing personnel were less affected. (4) Conclusions: The low BOS levels show that the containment measures and military training implemented by the hospital authorities were effective, although the chief personnel were more affected in the first wave. It is probable that this combination allowed the containment of BOS, which was not observed in civilians.
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Affiliation(s)
- Adriana Martínez-Cuazitl
- Research Department, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico; (A.M.-C.); (A.S.C.-V.); (J.S.G.-H.)
- Military School of Medicine (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico
| | - Iván Noé Martínez-Salazar
- Research Department, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico; (A.M.-C.); (A.S.C.-V.); (J.S.G.-H.)
| | | | - Jorge Arturo García-Dávila
- General Direction, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico;
| | | | - Antonio García-Ruíz
- Technic Deputy Direction, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico;
| | | | - Mayra Gabriela García-Araiza
- Teaching and Research Area, Military Central Hospital l (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico;
| | - Sergio Hernández-Díaz
- Medical Area, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico;
| | - Dora Luz Villegas-Tapia
- Psychology Subsection, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico;
| | - Eira Cerda-Reyes
- Academic Coordination Department, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico;
| | - Arleth Sarai Chávez-Velasco
- Research Department, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico; (A.M.-C.); (A.S.C.-V.); (J.S.G.-H.)
| | - Juan Salvador García-Hernández
- Research Department, Military Central Hospital (Ministry of National Defense of Mexico-SEDENA), Mexico City 11200, Mexico; (A.M.-C.); (A.S.C.-V.); (J.S.G.-H.)
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Müller K, Zwingmann K, Auerswald T, Berger I, Thomas A, Schultz AL, Wilhelm E, Weber RC, Kolb F, Wastlhuber A, Meder S, Stegbauer M. Rehabilitation and Return-to-Work of Patients Acquiring COVID-19 in the Workplace: A Study Protocol for an Observational Cohort Study. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:754468. [PMID: 36188830 PMCID: PMC9397694 DOI: 10.3389/fresc.2021.754468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/20/2021] [Indexed: 11/15/2022]
Abstract
Background In 2020, the novel coronavirus disease (COVID-19) developed into a worldwide pandemic. The course of COVID-19 is diverse, non-specific, and variable: Affected persons suffer from physical, cognitive, and psychological acute and long-term consequences. The symptoms influence everyday life activities, as well as work ability in the short or long-term. Healthcare professionals are considered particularly vulnerable to COVID-19 compared to the general population. In Germany, COVID-19 is recognized as an occupational disease or a work-related accident under certain conditions. Disease-specific rehabilitation is recommended for patients following acute COVID-19 to recover physical and neuropsychological performance and to improve work ability. Currently, there are limited findings on the short-term or long-term impact of COVID-19 as a recognized occupational disease or work-related accident, as well as on rehabilitation programs and associated influencing factors. Thus, the present research project will investigate these questions. Methods For this observational cohort study, post-acute patients with COVID-19 as a recognized occupational disease or work-related accident according to the insurance regulations for COVID-19 will be recruited at the BG Hospital for Occupational Disease in Bad Reichenhall, Germany. All participants will complete a comprehensive multimodal and interdisciplinary inpatient rehabilitation program for a duration of at least 3 weeks, beginning after their acute COVID-19 infection and depending on their individual indication and severity of disease. Participants will complete medical, functional, motor, psychological, and cognitive measurements at four time points (at the beginning (T1) and end (T2) of inpatient rehabilitation; 6 (T3) and 12 (T4) months after the beginning of inpatient rehabilitation). Discussion The present research project will help to assess and describe long-term effects of COVID-19 as a recognized occupational disease or work-related accident on physical and neuropsychological health, as well as on everyday activities and work ability of affected insured persons. In addition, this study will investigate influencing factors on severity and course of COVID-19. Furthermore, we will examine rehabilitation needs, measures, occurring specifics, and the feasibility of the rehabilitation procedure and disease development in the patients. The results of the intended study will further advance common recommendations for targeted and tailored rehabilitation management and participation in inpatient rehabilitation. Clinical Trial Registration www.drks.de, identifier: DRKS00022928.
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Affiliation(s)
- Katrin Müller
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Katharina Zwingmann
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Tina Auerswald
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Faculty of Behavioural and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Ivo Berger
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Andreas Thomas
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Anna-Lena Schultz
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Eva Wilhelm
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | | | - Franziska Kolb
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Alois Wastlhuber
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Sylvia Meder
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
| | - Michael Stegbauer
- BG Hospital for Occupational Disease Bad Reichenhall, Bad Reichenhall, Germany
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Zeijlon R, Hällgren P, Le V, Chamat J, Wågerman J, Enabtawi I, Rawshani A, Unenge S, Jha S, Omerovic E, Redfors B. The role of admission electrocardiogram in predicting outcome in patients hospitalized for COVID-19. J Electrocardiol 2022; 75:10-18. [PMID: 36272351 PMCID: PMC9575310 DOI: 10.1016/j.jelectrocard.2022.10.005] [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: 09/03/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Abnormal electrocardiogram (ECG) has been associated with poor outcome in patients hospitalized for COVID-19. However, the independent association between admission ECG and the risk of a poor outcome remains to be established. Our aim was to determine if abnormal admission ECG predicts treatment at intensive care unit or in-hospital death within 30 days in patients hospitalized for COVID-19. METHODS We analyzed the propensity weighted association between abnormal admission ECG and outcome in patients hospitalized for COVID-19 (March to May 2020). All adult patients hospitalized for COVID-19 at the three centers of Sahlgrenska University Hospital (Gothenburg, Sweden) were eligible for inclusion (N = 439). Patients with available admission ECG within six hours from admission were included. RESULTS 238 patients (age 62 ± 16 years, 74% male) were included. 103 patients had normal ECG and 135 patients had abnormal ECG. 99 patients were admitted to intensive care unit or died in-hospital within 30 days. Abnormal ECG was associated with increased risk of the outcome (odds ratio 2.11 [95% confidence interval 1.21-3.66]). CONCLUSIONS Abnormal admission ECG was associated with increased risk of treatment at intensive care unit or in-hospital death within 30 days; and could be considered a high-risk criterion in patients hospitalized for COVID-19.
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Affiliation(s)
- Rickard Zeijlon
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Corresponding author at: Department of Internal Medicine, Sahlgrenska University Hospital/S, 413 45 Gothenburg, Sweden
| | - Peter Hällgren
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Vina Le
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Jasmina Chamat
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Department of Cardiology, Sahlgrenska University Hospital/Ö, Gothenburg, Sweden
| | - Johan Wågerman
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Israa Enabtawi
- Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Araz Rawshani
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Sten Unenge
- Department of Internal Medicine, Sahlgrenska University Hospital/S, Gothenburg, Sweden
| | - Sandeep Jha
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Department of Internal Medicine, Kungälvs Hospital, Kungälv, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital/S, Gothenburg, Sweden,Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden,Clinical Trial Center, Cardiovascular Research Foundation, New York, USA,Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA
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AlKetbi LMB, Elharake JA, Memari SA, Mazrouei SA, Shehhi BA, Malik AA, McFadden SM, Galal B, Yildirim I, Khoshnood K, Omer SB, Memish ZA, AlZarouni AA, AlNeyadi AM, Hosani FA. COVID-19 vaccine acceptance among healthcare workers in the United Arab Emirates. IJID REGIONS 2021; 1:20-26. [PMID: 35721775 PMCID: PMC8505903 DOI: 10.1016/j.ijregi.2021.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022]
Abstract
Background COVID-19 vaccine hesitancy among healthcare workers (HCWs) is a threat to any healthcare system. Vaccine hesitancy can increase infection risk among HCWs and patients, while also impacting the patients' decision to accept the vaccine. Our study assessed COVID-19 vaccine acceptance among HCWs in United Arab Emirates (UAE). Methods Using purposive sampling, UAE HCWs registered in the Abu Dhabi Department of Health (DOH) email database were invited to complete an online questionnaire, between November 2020 and February 2021, to understand COVID-19 vaccine acceptance and hesitancy, and trust in sources of information. Simple logistic regression was used to assess the associations between demographic factors with COVID-19 vaccine acceptance. Results Of the 2832 HCWs who participated in the study, 1963 (69.9%) were aged between 25 and 44 years and 1748 (61.7%) were females. Overall, 2525 (89.2%) of the HCW population said they would accept a COVID-19 vaccine. HCWs who were 55+ years of age, male, and physicians/surgeons were more likely to accept a COVID-19 vaccine (OR 3.1, 95% CI 1.5-6.2, p = 0.002; OR 1.8, 95% CI 1.3-2.4, p < 0.001; and OR 1.8, 95% CI 1.1-2.9; p = 0.01, respectively). The most reliable sources for COVID-19 vaccine information were the UAE government (91.6%), healthcare providers (86.8%), health officials (86.3%), and the World Health Organization (WHO; 81.1%). Conclusions COVID-19 vaccine acceptance was high among the UAE HCW population. Several factors were identified as significant determinants of vaccine acceptance. UAE healthcare authorities can utilize these findings to develop public health messaging campaigns for HCWs to best address COVID-19 vaccine concerns - particularly when the government is vaccinating its general population.
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Affiliation(s)
| | - Jad A. Elharake
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, USA
| | - Shammah Al Memari
- Abu Dhabi Public Health Center, Health Promotion Department, Abu Dhabi, UAE
| | | | - Badreyya Al Shehhi
- Abu Dhabi Public Health Center, Communicable Disease Sector, Abu Dhabi, UAE
| | - Amyn A. Malik
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, USA
| | - SarahAnn M. McFadden
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, USA
| | - Bayan Galal
- Yale University, New Haven, Connecticut, 06520, USA
| | - Inci Yildirim
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, New Haven, Connecticut, 06510, USA
| | - Saad B. Omer
- Yale Institute for Global Health, New Haven, Connecticut 06510, USA
- Department of Internal Medicine, Infectious Disease, Yale School of Medicine, New Haven, Connecticut, 06510, USA
- Yale School of Public Health, New Haven, Connecticut, 06510, USA
- Yale School of Nursing, Orange, Connecticut, 06477, USA
| | - Ziad A. Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, the Kingdom of Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, the Kingdom of Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Amal A. AlZarouni
- Academic Affairs Department, Ambulatory Healthcare Services, Abu Dhabi Healthcare Services, Al Ain, UAE
| | - Amna M. AlNeyadi
- Academic Affairs Department, Ambulatory Healthcare Services, Abu Dhabi Healthcare Services, Al Ain, UAE
| | - Farida Al Hosani
- Abu Dhabi Public Health Center, Communicable Disease Sector, Abu Dhabi, UAE
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