1
|
Ripoll JG, Chang MG, Nabzdyk CS, Balakrishna A, Ortoleva J, Bittner EA. Should Obesity Be an Exclusion Criterion for Extracorporeal Membrane Oxygenation Support? A Scoping Review. Anesth Analg 2024; 139:300-312. [PMID: 38009837 DOI: 10.1213/ane.0000000000006745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Obesity is often considered a contraindication to extracorporeal membrane oxygenation (ECMO) candidacy due to technical challenges with vascular access, higher cardiac output requirements, and known associations between obesity and overall increased morbidity and mortality due to chronic health conditions. However, a growing body of literature suggests that ECMO may be as safe and efficacious in both obese and nonobese patients. This scoping review provides a synthesis of the available literature on the outcomes of obese patients supported with (1) venovenous (VV)-ECMO in acute respiratory distress syndrome (ARDS) not due to coronavirus disease 2019 (COVID-19), (2) VV-ECMO in ARDS due to COVID-19, (3) venoarterial (VA)-ECMO for all indications, and (4) studies combining data of patients supported with VA- and VV-ECMO. A librarian-assisted search was performed using 4 primary electronic medical databases (PubMed, Web of Science, Excerpta Medica database [Embase], and Cochrane Library) from January 2003 to March 2023. Articles that reported outcomes of obese patients requiring ECMO support were included. Two reviewers independently screened titles, abstracts, and full text of articles to determine eligibility. Data extraction was performed using customized fields established a priori within a systematic review software system. A total of 354 publications were imported for screening on titles and abstracts, and 30 studies were selected for full-text review. A total of 26 publications met the inclusion criteria: 7 on VV-ECMO support in non-COVID-19 ARDS patients, 6 on ECMO in COVID-19 ARDS patients, 8 in patients supported with VA-ECMO, and 5 combining both VA- and VV-ECMO data. Although the included studies are limited to retrospective analyses and display a heterogeneity in definitions of obesity and comparison groups, the currently available literature suggests that outcomes and complications of ECMO therapy are equivalent in obese patients as compared to nonobese patients. Hence, obesity as measured by body mass index alone should not be considered an exclusion criterion in the decision to initiate ECMO.
Collapse
Affiliation(s)
- Juan G Ripoll
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Marvin G Chang
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Christoph S Nabzdyk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Aditi Balakrishna
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, Massachusetts
| | - Edward A Bittner
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
2
|
Trebuian CI, Popa D, Buleu F, Sutoi D, Williams CG, Crintea IN, Chioibas RD, Iancu A, Ciolac L, Mederle OA. COVID-19 Related Acute Respiratory Distress Syndrome versus Classical Acute Respiratory Distress Syndrome Patients: Inflammatory Biomarkers as Predictors of Mortality in Pulmonary Septic Shock. Int J Gen Med 2024; 17:3337-3347. [PMID: 39100723 PMCID: PMC11296509 DOI: 10.2147/ijgm.s464892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024] Open
Abstract
Introduction and Objectives Coronavirus disease-2019 (COVID-19)-related severe acute respiratory distress syndrome (ARDS) differs pathophysiological from other pulmonary septic shock-related ARDS. Thus, we assessed whether all-cause in-hospital mortality differs for severe COVID-19-related and classical severe ARDS and which inflammatory biomarkers can predict mortality among these patients. Material and Methods This single-center, retrospective, observational cohort study included pulmonary septic shock patients (n = 114) with COVID-19-related and classical severe ARDS admitted in the Intensive Care Unit. Results Patients with a mean age of 73 (IQR 62-82), predominantly male (63%), were divided into two groups based on outcomes: survivors (n = 50) and non-survivors (n = 64). COVID-19-related severe ARDS (n = 48) accounts for 75% of deaths. Present comorbidities like heart disease (p = 0.043), neurologic disorders (p = 0.018), and liver disease (p = 0.038) were associated with in-hospital mortality, as well. Regarding inflammatory biomarkers, the AUC/c-statistic was 0.656 (95% CI: 0.53-0.759) for leukocytes, 0.613 (95% CI: 0.509-0.717) C-reactive protein (CRP) and 0.651 (95% CI: 0.548-0.753) for procalcitonin in predicting all-cause in-hospital mortality among patients with pulmonary septic shock and severe ARDS. Conclusion Patients with pulmonary septic shock and with COVID-19-related severe ARDS had a higher incidence of in-hospital mortality than those with classical severe ARDS. The high value of leukocytes, C-reactive protein, and procalcitonin were predictive for all-cause in-hospital mortality in patients with pulmonary septic shock and ARDS. Infection with COVID-19 was an independent predictor of in-hospital mortality in the presence of ARDS.
Collapse
Affiliation(s)
- Cosmin Iosif Trebuian
- Department of Surgery I, “victor Babes” University of Medicine and Pharmacy, Timișoara, Romania
- Emergency County Hospital, Reșita, Romania
| | - Daian Popa
- Emergency Clinical Municipal Hospital, Timisoara, Romania
- “victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Florina Buleu
- Emergency County Hospital “pius Brinzeu”, Timișoara, Romania
- Department of Cardiology “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Dumitru Sutoi
- Department of Surgery I, “victor Babes” University of Medicine and Pharmacy, Timișoara, Romania
- Emergency County Hospital “pius Brinzeu”, Timișoara, Romania
| | | | - Iulia Najette Crintea
- Department of Surgery I, “victor Babes” University of Medicine and Pharmacy, Timișoara, Romania
- Emergency Clinical Municipal Hospital, Timisoara, Romania
| | - Raul Daniel Chioibas
- Department of Surgery I, “victor Babes” University of Medicine and Pharmacy, Timișoara, Romania
| | - Aida Iancu
- Department of Radiology “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Livia Ciolac
- Clinic of Obstetrics and Gynecology, ”pius Brinzeu” County Clinical Emergency Hospital, Timisoara, Romania
| | - Ovidiu Alexandru Mederle
- Department of Surgery I, “victor Babes” University of Medicine and Pharmacy, Timișoara, Romania
- Emergency Clinical Municipal Hospital, Timisoara, Romania
| |
Collapse
|
3
|
Xue P, Merikanto I, Delale EA, Bjelajac A, Yordanova J, Chan RNY, Korman M, Mota-Rolim SA, Landtblom AM, Matsui K, Reis C, Penzel T, Inoue Y, Nadorff MR, Holzinger B, Morin CM, Espie CA, Plazzi G, De Gennaro L, Chung F, Bjorvatn B, Wing YK, Dauvilliers Y, Partinen M, Benedict C. Associations between obesity, a composite risk score for probable long COVID, and sleep problems in SARS-CoV-2 vaccinated individuals. Int J Obes (Lond) 2024:10.1038/s41366-024-01556-w. [PMID: 38849462 DOI: 10.1038/s41366-024-01556-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Preliminary data suggests that obesity might hasten the decline in mRNA vaccine-induced immunity against SARS-CoV-2. However, whether this renders individuals with obesity more susceptible to long COVID symptoms post-vaccination remains uncertain. Given sleep's critical role in immunity, exploring the associations between obesity, probable long COVID symptoms, and sleep disturbances is essential. METHODS We analyzed data from a survey of 5919 adults aged 18 to 89, all of whom received two SARS-CoV-2 mRNA vaccinations. Participants were categorized into normal weight, overweight, and obesity groups based on ethnicity-specific BMI cutoffs. The probability of long COVID was evaluated using the Post-Acute Sequelae of SARS-CoV-2 (PASC) score, as our survey did not permit confirmation of acute SARS-CoV-2 infection through methods such as antibody testing. Additionally, sleep patterns were assessed through questionnaires. RESULTS Participants with obesity exhibited a significantly higher adjusted odds ratio (OR) of having a PASC score of 12 or higher, indicative of probable long COVID in our study, compared to those with normal weight (OR: 1.55, 95% CI: 1.05, 2.28). No significant difference was observed for overweight individuals (OR: 0.92 [95% CI: 0.63, 1.33]). Both obesity and probable long COVID were associated with increased odds of experiencing a heightened sleep burden, such as the presence of obstructive sleep apnea or insomnia (P < 0.001). However, no significant interaction between BMI and probable long COVID status was found. CONCLUSIONS Even post-vaccination, individuals with obesity may encounter a heightened risk of experiencing prolonged COVID-19 symptoms. However, confirming our observations necessitates comprehensive studies incorporating rigorous COVID infection testing, such as antibody assays - unavailable in our anonymous survey. Additionally, it is noteworthy that the correlation between probable long COVID and sleep disturbances appears to be independent of BMI.
Collapse
Affiliation(s)
- Pei Xue
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
| | - Ilona Merikanto
- Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eva A Delale
- Institute for Anthropological Research, Zagreb, Croatia
| | - Adrijana Bjelajac
- Institute for Medical Research and Occupational Health, Zagreb, Croatia
| | - Juliana Yordanova
- Institute of Neurobiology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Rachel N Y Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Maria Korman
- Department of Occupational Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | | | - Anne-Marie Landtblom
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Kentaro Matsui
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Catia Reis
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Faculdade de Ciências Humanas, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Thomas Penzel
- Sleep Medicine Center, Charite University Hospital Berlin, Berlin, Germany
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Mississippi, MI, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Baylor, TX, USA
| | - Brigitte Holzinger
- Medical University of Vienna, Postgraduate, Schlafcoaching, Vienna, Austria
| | - Charles M Morin
- Centre de recherche CERVO/Brain Research Center, École de psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, QC, UK
| | - Giuseppe Plazzi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Roma, Lazio, Italy
- IRCCS Fondazione Santa Lucia, Roma, Italy
| | - Frances Chung
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
- INM, University Montpellier, INSERM, Montpellier, France
| | - Markku Partinen
- Department of Clinical Neurosciences, University of Helsinki Clinicum Unit, Helsinki, Finland
- Helsinki Sleep Clinic, Terveystalo Healthcare Services, Helsinki, Finland
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
4
|
Casal-Guisande M, Comesaña-Campos A, Núñez-Fernández M, Torres-Durán M, Fernández-Villar A. Proposal and Definition of an Intelligent Clinical Decision Support System Applied to the Prediction of Dyspnea after 12 Months of an Acute Episode of COVID-19. Biomedicines 2024; 12:854. [PMID: 38672208 PMCID: PMC11047904 DOI: 10.3390/biomedicines12040854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Long COVID is a condition that affects a significant proportion of patients who have had COVID-19. It is characterised by the persistence of associated symptoms after the acute phase of the illness has subsided. Although several studies have investigated the risk factors associated with long COVID, identifying which patients will experience long-term symptoms remains a complex task. Among the various symptoms, dyspnea is one of the most prominent due to its close association with the respiratory nature of COVID-19 and its disabling consequences. This work proposes a new intelligent clinical decision support system to predict dyspnea 12 months after a severe episode of COVID-19 based on the SeguiCovid database from the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain). The database is initially processed using a CART-type decision tree to identify the variables with the highest predictive power. Based on these variables, a cascade of expert systems has been defined with Mamdani-type fuzzy-inference engines. The rules for each system were generated using the Wang-Mendel automatic rule generation algorithm. At the output of the cascade, a risk indicator is obtained, which allows for the categorisation of patients into two groups: those with dyspnea and those without dyspnea at 12 months. This simplifies follow-up and the performance of studies aimed at those patients at risk. The system has produced satisfactory results in initial tests, supported by an AUC of 0.75, demonstrating the potential and usefulness of this tool in clinical practice.
Collapse
Affiliation(s)
- Manuel Casal-Guisande
- Fundación Pública Galega de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain;
| | - Alberto Comesaña-Campos
- Department of Design in Engineering, University of Vigo, 36208 Vigo, Spain;
- Design, Expert Systems and Artificial Intelligent Solutions Group (DESAINS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | - Marta Núñez-Fernández
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
| | - María Torres-Durán
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
| | - Alberto Fernández-Villar
- NeumoVigo I+i Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (M.N.-F.); (A.F.-V.)
- Pulmonary Department, Hospital Álvaro Cunqueiro, 36312 Vigo, Spain
- Centro de Investigación Biomédica en Red, CIBERES ISCIII, 28029 Madrid, Spain
| |
Collapse
|
5
|
Ripoll JG, ElSaban M, Nabzdyk CS, Balakrishna A, Villavicencio MA, Calderon-Rojas RD, Ortoleva J, Chang MG, Bittner EA, Ramakrishna H. Obesity and Extracorporeal Membrane Oxygenation (ECMO): Analysis of Outcomes. J Cardiothorac Vasc Anesth 2024; 38:285-298. [PMID: 37953169 DOI: 10.1053/j.jvca.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
Traditionally, patients with obesity have been deemed ineligible for extracorporeal life support (ELS) therapies such as extracorporeal membrane oxygenation (ECMO), given the association of obesity with chronic health conditions that contribute to increased morbidity and mortality. Nevertheless, a growing body of literature suggests the feasibility, efficacy, and safety of ECMO in the obese population. This review provides an in-depth analysis of the current literature assessing the effects of obesity on outcomes among patients supported with ECMO (venovenous [VV] ECMO in noncoronavirus disease 2019 and coronavirus disease 2019 acute respiratory distress syndrome, venoarterial [VA] ECMO, and combined VV and VA ECMO), offer a possible explanation of the current findings on the basis of the obesity paradox phenomenon, provides a framework for future studies addressing the use of ELS therapies in the obese patient population, and provides guidance from the literature for many of the challenges related to initiating, maintaining, and weaning ELS therapy in patients with obesity.
Collapse
Affiliation(s)
- Juan G Ripoll
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Mariam ElSaban
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Christoph S Nabzdyk
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA
| | - Aditi Balakrishna
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, MA
| | - Marvin G Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
6
|
Balasubramanian P, Isha S, Hanson AJ, Jenkins A, Satashia P, Balavenkataraman A, Huespe IA, Bansal V, Caples SM, Khan SA, Jain NK, Kashyap R, Cartin-Ceba R, Nates JL, Reddy DRS, Milian RD, Farres H, Martin AK, Patel PC, Smith MA, Shapiro AB, Bhattacharyya A, Chaudhary S, Kiley SP, Quinones QJ, Patel NM, Guru PK, Moreno Franco P, Sanghavi DK. Association of plasma volume status with outcomes in hospitalized Covid-19 ARDS patients: A retrospective multicenter observational study. J Crit Care 2023; 78:154378. [PMID: 37479551 DOI: 10.1016/j.jcrc.2023.154378] [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: 03/13/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To evaluate the association of estimated plasma volume (ePV) and plasma volume status (PVS) on admission with the outcomes in COVID-19-related acute respiratory distress syndrome (ARDS) patients. MATERIALS AND METHODS We performed a retrospective multi-center study on COVID-19-related ARDS patients who were admitted to the Mayo Clinic Enterprise health system. Plasma volume was calculated using the formulae for ePV and PVS, and these variables were analyzed for correlation with patient outcomes. RESULTS Our analysis included 1298 patients with sequential organ failure assessment (SOFA) respiratory score ≥ 2 (PaO2/FIO2 ≤300 mmHg) and a mortality rate of 25.96%. A Cox proportional multivariate analysis showed PVS but not ePV as an independent correlation with 90-day mortality after adjusting for the covariates (HR: 1.015, 95% CI: 1.005-1.025, p = 0.002 and HR 1.054, 95% CI 0.958-1.159, p = 0.278 respectively). CONCLUSION A lower PVS on admission correlated with a greater chance of survival in COVID-19-related ARDS patients. The role of PVS in guiding fluid management should be investigated in future prospective studies.
Collapse
Affiliation(s)
- Prasanth Balasubramanian
- Department of Pulmonary and Critical Care, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Shahin Isha
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Abby J Hanson
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Anna Jenkins
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America; Mayo Clinic Alix School of Medicine, Jacksonville, Florida, United States of America
| | - Parthkumar Satashia
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Arvind Balavenkataraman
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Iván A Huespe
- Critical Care Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vikas Bansal
- Department of Critical Care Medicine, Mayo Clinic Rochester, Minnesota, United States of America
| | - Sean M Caples
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System in Mankato, Minnesota, United States of America
| | - Nitesh K Jain
- Department of Critical Care Medicine, Mayo Clinic Health System in Mankato, Minnesota, United States of America
| | - Rahul Kashyap
- Department of Anesthesia and Critical Care Medicine, Mayo Clinic Rochester, Minnesota, United States of America
| | - Rodrigo Cartin-Ceba
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix, Arizona, United States of America
| | - Joseph L Nates
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Dereddi R S Reddy
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Ricardo Diaz Milian
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Houssam Farres
- Department of Surgery, Division of Vascular Surgery, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Archer K Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Parag C Patel
- Department of Transplantation, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Michael A Smith
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Anna B Shapiro
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Anirban Bhattacharyya
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Sean P Kiley
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Quintin J Quinones
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Neal M Patel
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Pablo Moreno Franco
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, United States of America.
| |
Collapse
|
7
|
Johnson RM, Ardanuy J, Hammond H, Logue J, Jackson L, Baracco L, McGrath M, Dillen C, Patel N, Smith G, Frieman M. Diet-induced obesity and diabetes enhance mortality and reduce vaccine efficacy for SARS-CoV-2. J Virol 2023; 97:e0133623. [PMID: 37846985 PMCID: PMC10688338 DOI: 10.1128/jvi.01336-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 10/18/2023] Open
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a wide spectrum of diseases in the human population, from asymptomatic infections to death. It is important to study the host differences that may alter the pathogenesis of this virus. One clinical finding in coronavirus disease 2019 (COVID-19) patients is that people with obesity or diabetes are at increased risk of severe illness from SARS-CoV-2 infection. We used a high-fat diet model in mice to study the effects of obesity and type 2 diabetes on SARS-CoV-2 infection as well as how these comorbidities alter the response to vaccination. We find that diabetic/obese mice have increased disease after SARS-CoV-2 infection and they have slower clearance of the virus. We find that the lungs of these mice have increased neutrophils and that removing these neutrophils protects diabetic/obese mice from disease. This demonstrates why these diseases have increased risk of severe disease and suggests specific interventions upon infection.
Collapse
Affiliation(s)
- Robert M. Johnson
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jeremy Ardanuy
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Holly Hammond
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James Logue
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lian Jackson
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lauren Baracco
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marisa McGrath
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carly Dillen
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Matthew Frieman
- Center for Pathogen Research, Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Varillas-Delgado D, Jimenez-Antona C, Lizcano-Alvarez A, Cano-de-la-Cuerda R, Molero-Sanchez A, Laguarta-Val S. Predictive Factors and ACE-2 Gene Polymorphisms in Susceptibility to Long COVID-19 Syndrome. Int J Mol Sci 2023; 24:16717. [PMID: 38069039 PMCID: PMC10705995 DOI: 10.3390/ijms242316717] [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: 10/22/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Long COVID-19 syndrome is present in 5-10% of patients infected with SARS-CoV-2, and there is still little information on the predisposing factors that lead to its development. The purpose of the study was to evaluate the predictive factors in early symptoms, clinical features and the role of Angiotensin-Converting Enzyme-2 (ACE-2) c.513-1451G>A (rs2106806) and c.15643279T>C (rs6629110) polymorphisms in the susceptibility to developing Long COVID-19 syndrome subsequent to COVID-19 infectionA total of 29 patients who suffered COVID-19 were recruited in a descriptive longitudinal study of two groups: Long COVID-19 (n = 16) and non-Long COVID-19 (n = 13). Early symptoms and clinical features during COVID-19 were classified by a medical service. ACE-2 polymorphisms were genotyped by using a Single Nucleotide Primer Extension (SNPE). Of the early symptoms, fatigue, myalgia and headache showed a high risk of increasing Long COVID-19 susceptibility. Clinical features such as emergency care, SARS-CoV-2 reinfection, previous diseases, respiratory disease and brain fog also had a high risk of increasing Long COVID-19 susceptibility. The A allele in the rs2106806 variant was associated with an odds ratio (OR) of 4.214 (95% CI 2.521-8.853; p < 0.001), and the T allele in the rs6629110 variant was associated with an OR of 3.754 (95% CI 1.785-6.105; p = 0.002) of increasing Long COVID-19 susceptibility. This study shows the risk of ACE-2 polymorphisms, different early symptoms and clinical features during SARS-CoV-2 infection in susceptibility to Long COVID-19.
Collapse
Affiliation(s)
- David Varillas-Delgado
- Department of Exercise and Sport Science, Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo, 28223 Madrid, Spain;
| | - Carmen Jimenez-Antona
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (C.J.-A.); (R.C.-d.-l.-C.); (A.M.-S.); (S.L.-V.)
| | - Angel Lizcano-Alvarez
- Department of Nursing and Stomatology, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (C.J.-A.); (R.C.-d.-l.-C.); (A.M.-S.); (S.L.-V.)
| | - Alberto Molero-Sanchez
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (C.J.-A.); (R.C.-d.-l.-C.); (A.M.-S.); (S.L.-V.)
| | - Sofia Laguarta-Val
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922 Madrid, Spain; (C.J.-A.); (R.C.-d.-l.-C.); (A.M.-S.); (S.L.-V.)
| |
Collapse
|
9
|
Yao S, Zeng L, Wang F, Chen K. Obesity Paradox in Lung Diseases: What Explains It? Obes Facts 2023; 16:411-426. [PMID: 37463570 PMCID: PMC10601679 DOI: 10.1159/000531792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Obesity is a globally increasing health problem that impacts multiple organ systems and a potentially modifiable risk factor for many diseases. Obesity has a significant impact on lung function and is strongly linked to the pathophysiology that contributes to lung diseases. On the other hand, reports have emerged that obesity is associated with a better prognosis than for normal weight individuals in some lung diseases, including pneumonia, acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, and lung cancer. The lesser mortality and better prognosis in patients with obesity is known as obesity paradox. While obesity paradox is both recognized and disputed in epidemiological studies, recent research has suggested possible mechanisms. SUMMARY In this review, we attempted to explain and summarize these factors and mechanisms, including immune response, pulmonary fibrosis, lung function, microbiota, fat and muscle reserves, which are significantly altered by obesity and may contribute to the obesity paradox in lung diseases. We also discuss contrary literature that attributes the "obesity paradox" to confounding. KEY MESSAGES The review will illustrate the possible role of obesity in the prognosis or course of lung diseases, leading to a better understanding of the obesity paradox and provide hints for further basic and clinical research in lung diseases.
Collapse
Affiliation(s)
- Surui Yao
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Lei Zeng
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| | - Fengyuan Wang
- College of Animal and Veterinary Sciences, Southwest Minzu University, Chengdu, PR China
| | - Kejie Chen
- School of Public Health, Chengdu Medical College, Chengdu, PR China
| |
Collapse
|
10
|
Johnson R, Ardunay J, Hammond H, Logue J, Jackson L, Baracco L, McGrath M, Dillen C, Patel N, Smith G, Frieman M. Diet Induced Obesity and Diabetes Enhance Mortality and Reduces Vaccine Efficacy for SARS-CoV-2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2022.10.15.512291. [PMID: 36299426 PMCID: PMC9603822 DOI: 10.1101/2022.10.15.512291] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative agent of Coronavirus disease 2019 (COVID-19), emerged in Wuhan, China, in December 2019. As of October 2022, there have been over 625 million confirmed cases of COVID-19, including over 6.5 million deaths. Epidemiological studies have indicated that comorbidities of obesity and diabetes mellitus are associated with increased morbidity and mortality following SARS-CoV-2 infection. We determined how the comorbidities of obesity and diabetes affect morbidity and mortality following SARS-CoV-2 infection in unvaccinated and adjuvanted spike nanoparticle (NVX-CoV2373) vaccinated mice. We find that obese/diabetic mice infected with SARS-CoV-2 have increased morbidity and mortality compared to age matched normal mice. Mice fed a high-fat diet (HFD) then vaccinated with NVX-CoV2373 produce equivalent neutralizing antibody titers to those fed a normal diet (ND). However, the HFD mice have reduced viral clearance early in infection. Analysis of the inflammatory immune response in HFD mice demonstrates a recruitment of neutrophils that was correlated with increased mortality and reduced clearance of the virus. Depletion of neutrophils in diabetic/obese vaccinated mice reduced disease severity and protected mice from lethality. This model recapitulates the increased disease severity associated with obesity and diabetes in humans with COVID-19 and is an important comorbidity to study with increasing obesity and diabetes across the world.
Collapse
|
11
|
Long-COVID in Patients with Cancer Previously Treated with Early Anti-SARS-CoV-2 Therapies in an Out-of-Hospital Setting: A Single-Center Experience. Cancers (Basel) 2023; 15:cancers15041269. [PMID: 36831611 PMCID: PMC9953958 DOI: 10.3390/cancers15041269] [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: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The incidence of long COVID in a cohort of patients with cancer with or without previous treatment with early therapies anti-SARS-CoV-2 in an out-of-hospital setting have to be elucidated. We prospectively enrolled all patients treated for a solid tumor at the department of Medical Oncology of the Fondazione IRCCS Policlinico San Matteo with a positive SARS-CoV-2 antigen or polymerase chain reaction test from January to September 2022 (Omicron surge). Ninety-seven patients answered the survey questions by telephone at least 12 weeks after COVID-19 diagnosis in order to evaluate the incidence of long COVID symptoms. Only twelve patients (12.4%) reported long COVID. No significant difference between early therapies anti-SARS-CoV-2 31 and long COVID (p = 0.443) was seen. The female sex (p = 0.024) and diabetes mellitus (p = 0.014) are significantly associated with long COVID. No statistically significant difference between the two groups (Long COVID vs. No Long COVID) according to the time to nasal swab viral clearance (p = 0.078). The overlap between the symptoms related to the oncological disease/oncological treatment and the symptoms of long COVID is one of the main future challenges that oncologists will have to manage.
Collapse
|
12
|
Inflammation as Prognostic Hallmark of Clinical Outcome in Patients with SARS-CoV-2 Infection. Life (Basel) 2023; 13:life13020322. [PMID: 36836679 PMCID: PMC9966655 DOI: 10.3390/life13020322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often characterized by a life-threatening interstitial pneumonia requiring hospitalization. The aim of this retrospective cohort study is to identify hallmarks of in-hospital mortality in patients affected by Coronavirus Disease 19 (COVID-19). A total of 150 patients admitted for COVID-19 from March to June 2021 to "F. Perinei" Murgia Hospital in Altamura, Italy, were divided into survivors (n = 100) and non-survivors groups (n = 50). Blood counts, inflammation-related biomarkers and lymphocyte subsets were analyzed into two groups in the first 24 h after admission and compared by Student's t-test. A multivariable logistic analysis was performed to identify independent risk factors associated with in-hospital mortality. Total lymphocyte count and CD3+ and CD4+ CD8+ T lymphocyte subsets were significantly lower in non-survivors. Serum levels of interleukin-6 (IL-6), lactate dehydrogenase (LDH), C-reactive protein (CRP) and procalcitonin (PCT) were significantly higher in non-survivors. Age > 65 years and presence of comorbidities were identified as independent risk factors associated with in-hospital mortality, while IL-6 and LDH showed a borderline significance. According to our results, markers of inflammation and lymphocytopenia predict in-hospital mortality in COVID-19.
Collapse
|