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Omidi F, Rahmannia M, Khalili F, Shahidi Bonjar AH, Nasiri MJ. Comparing higher-dose and single standard-dose influenza vaccines in preventing cardiovascular events: a meta-analysis with 68,713 patients. Public Health 2024; 235:71-75. [PMID: 39068775 DOI: 10.1016/j.puhe.2024.06.034] [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: 12/13/2023] [Revised: 05/14/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION This manuscript offers an in-depth comparative examination of the effectiveness of higher-dose (double standard-dose and high-dose) influenza vaccines in contrast to a single standard-dose vaccine when it comes to alleviating major cardiovascular events. STUDY DESIGN Meta-Analysis. METHODS To conduct this study, an exhaustive search was carried out in the medical English literature using databases such as PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL until 10 April 2024. The evaluation of associations was achieved through the calculation of pooled relative risks (RRs) accompanied by their corresponding 95% confidence intervals (CIs). RESULTS A meticulous analysis encompassed a comprehensive cohort of 68,713 patients. Among these participants, 34,430 individuals were randomly assigned to receive a higher-dose influenza vaccination, whereas 34,283 received the standard influenza vaccination. Contrary to initial expectations, a higher-dose influenza vaccine did not manifest elevated efficacy compared to the standard-dose vaccine in terms of mitigating major cardiovascular events. The computed pooled RR stood at 1.0, accompanied by a 95% CI ranging from 0.93 to 1.10. CONCLUSION While this systematic review and meta-analysis did not find a statistically significant advantage of higher-dose influenza vaccines over a single standard-dose vaccine in preventing major cardiovascular events, the observed trend towards risk reduction warrants continued investigation. These findings contribute to the ongoing dialogue surrounding vaccination strategies and their implications for cardiovascular outcomes.
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Affiliation(s)
- F Omidi
- Department of Cardiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Rahmannia
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Khalili
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A H Shahidi Bonjar
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M J Nasiri
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Brooke BS, Rosenfeld E, Horns JJ, Sarfati MR, Kraiss LW, Griffin CL, Das R, Longwolf KJ, Johnson CE. Increased Risk of Acute Aortic Events following COVID-19 and Influenza Respiratory Viral Infections. Ann Vasc Surg 2024; 109:225-231. [PMID: 39067853 DOI: 10.1016/j.avsg.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/13/2024] [Accepted: 06/02/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Acute respiratory viral infections have been associated with an increased incidence of adverse cardiovascular events. However, it is unclear whether severe respiratory viral infections are associated with an increased risk of acute aortic syndromes (AAS). This study was designed to assess whether Coronavirus disease 2019 (COVID-19) and Influenza illnesses are associated with an increased incidence of subsequent AAS in the US population. METHODS We used the MarketScan database (2011-2021) to identify patients 18-99 years of age without prior diagnosis of aortic pathology who were diagnosed with COVID-19 or Influenza. Identified patients were matched 1:1 by age and sex to control patients without COVID-19 or Influenza. The primary outcome was incidence of AAS (dissection, intramural hematoma, penetrating aortic ulcer, or aneurysm rupture) within 180-days of a viral infection. The association between infection and risk of developing an AAS was analyzed using multivariate Cox proportional hazards models. RESULTS We identified 1,775,698 patients, including 779,229 (44%) with mild COVID-19, 42,141 (2%) with severe COVID-19, and 66,479 (4%) with Influenza that were matched to 887,849 (50%) control patients without COVID-19 or Influenza illnesses. A total of 164 patients experienced AAS within 6-months after diagnosis, which was highest among those after severe COVID-19. The predicted incidence of AAS was significantly higher among patients after severe COVID-19 (14.1 events/100,000 person-years), mild COVID-19 (13.3 events/100,000), and influenza (13.3 events/100,000) when compared to control patients (2.6 events/100,000). In risk-adjusted Cox regression models, severe COVID-19 (HR:5.4, 95% CI:2.8-10.4; P < 0.01), mild COVID-19 (HR:5.1, 95% CI:3.3-7.7; P < 0.01) and influenza (HR:5.1, 95% CI:2.6-9.7; P < 0.01) diagnoses were associated with a significantly increased risk of AAS within 180-days when compared to matched controls. CONCLUSIONS There is an increased risk of developing acute aortic event in the months following illness with Influenza or COVID-19. These data highlight the need to closely monitor at-risk patients following a viral respiratory infection.
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Affiliation(s)
- Benjamin S Brooke
- Division of Vascular Surgery, University of Utah Health, Salt Lake City, UT; Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah Health, Salt Lake City, UT.
| | - Ethan Rosenfeld
- Division of Vascular Surgery, University of Utah Health, Salt Lake City, UT
| | - Joshua J Horns
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Mark R Sarfati
- Division of Vascular Surgery, University of Utah Health, Salt Lake City, UT
| | - Larry W Kraiss
- Division of Vascular Surgery, University of Utah Health, Salt Lake City, UT
| | - Claire L Griffin
- Division of Vascular Surgery, University of Utah Health, Salt Lake City, UT
| | - Rupam Das
- Surgical Population Analysis Research Core (SPARC), Department of Surgery, University of Utah Health, Salt Lake City, UT
| | | | - Cali E Johnson
- Division of Vascular Surgery, University of Utah Health, Salt Lake City, UT
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Krogulec D, Bieńkowski C, Kowalska JD, Bednarska A, Wojtycha-Kwaśnica B, Jurek N, Ząbek P, Czeszko-Paprocka H, Mrozińska M, Paciorek M, Pihowicz A, Horban A. Cardiovascular complications in the course of COVID-19 - lessons learned and implications for the future care of patients with viral respiratory diseases: Data from a single center retrospective observational study. Heart Lung 2024; 68:116-125. [PMID: 38944910 DOI: 10.1016/j.hrtlng.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/10/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Factors associated with cardiovascular complications of COVID-19 remain understudied. OBJECTIVES Here we investigate the occurrence and risk factors of arrythmias, myocardial infarction and/or stroke, and thromboembolism in the course of COVID-19. METHODS We have performed an observational study with prospectively designed data collection. Data of patients diagnosed with COVID-19 who were admitted from March 6th 2020 to November 30th 2021 in our Hospital were analyzed. Logistic regression was used to identify variables associated with the odds of early hospital death due to COVID-19. RESULTS Fourteen-point three percent of 1964 patients had cardiovascular complications, 6.36 % arrhythmias, 5.5 % thromboembolic events and 2.39 % myocardial infarction and/or stroke. Factors independently increasing the odds of arrhythmia were older age (OR=1.49 [95 % CI: 1.17-1.92], p = 0.02), longer time between admission and the first onset of symptoms (1.02 [0.99-1.05], p = 0.049), concomitant atrial fibrillation/flutter (2.84 [1.37-5.70], p = 0.004), nicotinism (2.49 [1.37-4.49], p = 0.002), and eGFR<60 ml/min/1.73m2 (2.44 [1.08-5.59], p = 0.033). Factors independently increasing the odds of myocardial infarction and/or stroke were dementia (4.55 [0.97-19.3], p = 0.044), hemiplegia (12.67 [3.12-46.1], p < 0.001), nicotinism (3.36 [1.30-10.4], p = 0.013) and higher C-reactive protein concentration (1.01 [1.00-1.01], p = 0.040). Factors independently increasing the odds of thromboembolic events were longer hospitalization (1.08 [1.05-1.10], p < 0.001) and higher d-dimers (1.04 [1.02-1.05], <0.001). CONCLUSIONS The risk of cardiovascular complications was especially pronounced in patients with older age, pre-existing cardiovascular disease and more sever pneumonia at presentation to care. This underlines the importance of close and careful clinical follow-up in the course of COVID-19 for specific patients' populations, including a pro-active approach in diagnosis.
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Affiliation(s)
- Dominika Krogulec
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Carlo Bieńkowski
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland.
| | - Justyna D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Agnieszka Bednarska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | | | - Natalia Jurek
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Piotr Ząbek
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | | | - Monika Mrozińska
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Marcin Paciorek
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Andrzej Pihowicz
- Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
| | - Andrzej Horban
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland; Hospital for Infectious Diseases in Warsaw, 01-201 Warsaw, Poland
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Camelo ALM, Zamora Obando HR, Rocha I, Dias AC, Mesquita ADS, Simionato AVC. COVID-19 and Comorbidities: What Has Been Unveiled by Metabolomics? Metabolites 2024; 14:195. [PMID: 38668323 PMCID: PMC11051775 DOI: 10.3390/metabo14040195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The COVID-19 pandemic has brought about diverse impacts on the global population. Individuals with comorbidities were more susceptible to the severe symptoms caused by the virus. Within the crisis scenario, metabolomics represents a potential area of science capable of providing relevant information for understanding the metabolic pathways associated with the intricate interaction between the viral disease and previous comorbidities. This work aims to provide a comprehensive description of the scientific production pertaining to metabolomics within the specific context of COVID-19 and comorbidities, while highlighting promising areas for exploration by those interested in the subject. In this review, we highlighted the studies of metabolomics that indicated a variety of metabolites associated with comorbidities and COVID-19. Furthermore, we observed that the understanding of the metabolic processes involved between comorbidities and COVID-19 is limited due to the urgent need to report disease outcomes in individuals with comorbidities. The overlap of two or more comorbidities associated with the severity of COVID-19 hinders the comprehension of the significance of each condition. Most identified studies are observational, with a restricted number of patients, due to challenges in sample collection amidst the emergent situation.
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Affiliation(s)
- André Luiz Melo Camelo
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Hans Rolando Zamora Obando
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Isabela Rocha
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Aline Cristina Dias
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Alessandra de Sousa Mesquita
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Ana Valéria Colnaghi Simionato
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
- National Institute of Science and Technology for Bioanalytics—INCTBio, Institute of Chemistry, Universidade Estadual de (UNICAMP), Campinas 13083-970, São Paulo, Brazil
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la Roi-Teeuw HM, van Smeden M, Bos M, de Wilde SM, Yang B, Rutten FH, Geersing GJ. Estimated causal effects of common respiratory infections on cardiovascular risk: a meta-analysis. Open Heart 2023; 10:e002501. [PMID: 38016788 PMCID: PMC10685931 DOI: 10.1136/openhrt-2023-002501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Literature supports associations between common respiratory tract infections (RTIs) and risk of cardiovascular diseases, yet the importance of RTIs for cardiovascular risk management remains less understood. This systematic review and meta-analysis aimed to estimate the causal effects of RTIs on occurrence of cardiovascular diseases in the general population. METHODS MEDLINE and EMBASE were systematically searched up to 4 November 2022. Eligible were all aetiological studies evaluating risk of cardiovascular outcomes after exposure to common RTIs within any follow-up duration. Evidence was pooled using random-effects models if data allowed. The ROBINS-E and GRADE approaches were used to rate risk of bias and certainty of evidence, respectively. All assessments were performed in duplicate. RESULTS We included 34 studies (65 678 650 individuals). Most studies had a high risk of bias. COVID-19 likely increases relative risk (RR (95% CI)) of myocardial infarction (3.3 (1.0 to 11.0)), stroke (3.5 (1.2 to 10)), pulmonary embolism (24.6 (13.5 to 44.9)) and deep venous thrombosis (7.8 (4.3 to 14.4)) within 30 days after infection (GRADE: moderate) and about twofold within 1 year (GRADE: low to moderate). Other RTIs also likely increase the RR of myocardial infarction (2.9 (95% CI 1.8 to 4.9)) and stroke (2.6 (95% CI 1.1 to 6.4)) within 30 days (GRADE: moderate), and to a lesser extent with longer follow-up. CONCLUSIONS RTIs likely increase the risk of cardiovascular diseases about 1.5-5 fold within 1 month after infection. RTIs may, therefore, have clinical relevance as target for cardiovascular risk management, especially in high-risk populations. PROSPERO REGISTRATION NUMBER CRD42023416277.
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Affiliation(s)
- Hannah M la Roi-Teeuw
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maureen Bos
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sophie M de Wilde
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Bada Yang
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of General Practice and Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Brown JP, Wing K, Leyrat C, Evans SJ, Mansfield KE, Wong AYS, Smeeth L, Galwey NW, Douglas IJ. Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection. JAMA Cardiol 2023; 8:865-870. [PMID: 37585175 PMCID: PMC10433140 DOI: 10.1001/jamacardio.2023.2418] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/16/2023] [Indexed: 08/17/2023]
Abstract
Importance Fluoroquinolone use has been associated with increased hospitalization with aortic aneurysm or dissection in noninterventional studies, but the reason for this observed association is unclear. Objective To determine the association between fluoroquinolone use and aortic aneurysm or dissection using multiple study designs and multiple databases to increase the robustness of findings. Design, Setting, and Participants Cohort and case-crossover studies were conducted separately in 2 databases of UK primary care records. Clinical Practice Research Datalink Aurum and GOLD primary care records were linked to hospital admissions data. Adults with a systemic fluoroquinolone or cephalosporin prescription between April 1997 and December 2019 were included in the cohort study. Adults hospitalized with aortic aneurysm or dissection within the eligibility period were included in the case-crossover study. Individuals meeting inclusion criteria in the case-crossover study were matched 1:3 to control individuals on age, sex, index date, and clinical practice to adjust for calendar trends in prescribing. Data were analyzed from January to July 2022. Exposures Systemic fluoroquinolone or comparator antibiotic. Main Outcomes and Measures Hazard ratios (HRs) were estimated in the cohort study for the association between prescription of fluoroquinolones and hospitalization with aortic aneurysm or dissection using stabilized inverse probability of treatment-weighted Cox regression. Odds ratios (OR) were estimated in the case-crossover study for the association between systemic fluoroquinolone use and hospitalization with aortic aneurysm or dissection using a conditional logistic regression model. Estimates were pooled across databases using fixed-effects meta-analysis. Results In the cohort study, we identified 3 134 121 adults in Aurum (mean [SD] age, 52.5 [20.3] years; 1 969 257 [62.8%] female) and 452 086 in GOLD (mean [SD] age, 53.9 [20.2] years; 286 502 [63.4%] female) who were prescribed fluoroquinolones or cephalosporins. In crude analyses, fluoroquinolone relative to cephalosporin use was associated with increased hospitalization with aortic aneurysm or dissection (pooled HR, 1.28; 95% CI, 1.13-1.44; P < .001) but after adjustment for potential confounders, this association disappeared (pooled adjusted HR, 1.03; 95% CI, 0.91-1.17; P = .65). In the case-crossover study, we identified 84 841 individuals hospitalized with aortic aneurysm or dissection in Aurum (mean [SD] age, 75.5 [10.9]; 23 551 [27.8%] female) and 10 357 in GOLD (mean [SD] age, 75.6 [10.5]; 2809 [27.1%] female). Relative to nonuse, fluoroquinolone use was associated with an increase in hospitalization with aortic aneurysm or dissection, but no association was found relative to other antibiotics (vs cephalosporin pooled OR, 1.05; 95% CI, 0.87-1.27; vs trimethoprim, 0.89; 95% CI, 0.75-1.06; vs co-amoxiclav, 0.98; 95% CI, 0.82-1.18). Conclusions and Relevance The results in this study suggest that estimates of association of fluoroquinolones with aortic aneurysm or dissection may be affected by confounding. When such confounding is accounted for, no association was evident, providing reassurance on the safety of fluoroquinolones with respect to aortic aneurysm or dissection.
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Affiliation(s)
- Jeremy P. Brown
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin Wing
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clémence Leyrat
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen J. Evans
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn E. Mansfield
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Angel Y. S. Wong
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nicholas W. Galwey
- Research and Development, GSK Medicines Research Centre, GSK, Stevenage, United Kingdom
| | - Ian J. Douglas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Alsaidan AA, Al‐Kuraishy HM, Al‐Gareeb AI, Alexiou A, Papadakis M, Alsayed KA, Saad HM, Batiha GE. The potential role of SARS‐CoV‐2 infection in acute coronary syndrome and type 2 myocardial infarction (T2MI): Intertwining spread. Immun Inflamm Dis 2023; 11:e798. [PMID: 36988260 PMCID: PMC10022425 DOI: 10.1002/iid3.798] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/19/2023] Open
Abstract
Coronavirus disease 2019 (COVID‐19) is a novel pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). It has been shown that SARS‐CoV‐2 infection‐induced inflammatory and oxidative stress and associated endothelial dysfunction may lead to the development of acute coronary syndrome (ACS). Therefore, this review aimed to ascertain the link between severe SARS‐CoV‐2 infection and ACS. ACS is a spectrum of acute myocardial ischemia due to a sudden decrease in coronary blood flow, ranging from unstable angina to myocardial infarction (MI). Primary or type 1 MI (T1MI) is mainly caused by coronary plaque rupture and/or erosion with subsequent occlusive thrombosis. Secondary or type 2 MI (T2MI) is due to cardiac and systemic disorders without acute coronary atherothrombotic disruption. Acute SARS‐CoV‐2 infection is linked with the development of nonobstructive coronary disorders such as coronary vasospasm, dilated cardiomyopathy, myocardial fibrosis, and myocarditis. Furthermore, SARS‐CoV‐2 infection is associated with systemic inflammation that might affect coronary atherosclerotic plaque stability through augmentation of cardiac preload and afterload. Nevertheless, major coronary vessels with atherosclerotic plaques develop minor inflammation during COVID‐19 since coronary arteries are not initially and primarily targeted by SARS‐CoV‐2 due to low expression of angiotensin‐converting enzyme 2 in coronary vessels. In conclusion, SARS‐CoV‐2 infection through hypercytokinemia, direct cardiomyocyte injury, and dysregulation of the renin‐angiotensin system may aggravate underlying ACS or cause new‐onset T2MI. As well, arrhythmias induced by anti‐COVID‐19 medications could worsen underlying ACS.
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Affiliation(s)
- Aseel Awad Alsaidan
- Department of Family and Community Medicine, College of MedicineJouf UniversitySakakaSaudi Arabia
| | - Hayder M. Al‐Kuraishy
- Department of Clinical Pharmacology and Medicine, College of MedicineALmustansiriyia UniversityBaghdadIraq
| | - Ali I. Al‐Gareeb
- Department of Clinical Pharmacology and Medicine, College of MedicineALmustansiriyia UniversityBaghdadIraq
| | - Athanasios Alexiou
- Department of Science and EngineeringNovel Global Community Educational FoundationHebershamNew South WalesAustralia,Department of Research and DevelopmentAFNP MedWienAustria
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten‐Herdecke, Heusnerstrasse 40University of Witten‐HerdeckeWuppertalGermany
| | - Khalid Adel Alsayed
- Department of Family and Community MedicineSecurity Forces Hospital ProgramRiyadhSaudi Arabia
| | - Hebatallah M. Saad
- Department of Pathology, Faculty of Veterinary MedicineMatrouh UniversityMatrouhEgypt
| | - Gaber El‐Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary MedicineDamanhour UniversityAlBeheiraEgypt
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Barbosa HC, Martins MAP, de Jesus JC, Meira KC, Passaglia LG, Sacioto MF, Bezerra AFB, Schwarzbold AV, Maurílio ADO, Farace BL, da Silva CTCA, Cimini CCR, Silveira DV, Carazai DDR, Ponce D, Costa EVA, Manenti ERF, Cenci EPDA, Bartolazzi F, Madeira GCDC, Nascimento GF, Velloso IVP, Batista JDL, de Morais JDP, Carvalho JDSN, Ruschel KB, Martins KPMP, Zandoná LB, Menezes LSM, Kopittke L, de Castro LC, Nasi LA, Floriani MA, Souza MD, Carneiro M, Bicalho MAC, Lima MCPB, de Godoy MF, Guimarães-Júnior MH, Mendes PM, Delfino-Pereira P, Ribeiro RJE, Finger RG, Menezes RM, Francisco SC, Araújo SF, Oliveira TF, de Oliveira TC, Polanczyk CA, Marcolino MS. Myocardial Injury and Prognosis in Hospitalized COVID-19 Patients in Brazil: Results From The Brazilian COVID-19 Registry. Arq Bras Cardiol 2023; 120:e20220151. [PMID: 36856237 PMCID: PMC10263463 DOI: 10.36660/abc.20220151] [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: 04/04/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Cardiovascular complications of COVID-19 are important aspects of the disease's pathogenesis and prognosis. Evidence on the prognostic role of troponin and myocardial injury in Latin American hospitalized COVID-19 patients is still scarce. OBJECTIVES To evaluate myocardial injury as independent predictor of in-hospital mortality and invasive mechanical ventilation support in hospitalized patients, from the Brazilian COVID-19 Registry. METHODS This cohort study is a substudy of the Brazilian COVID-19 Registry, conducted in 31 Brazilian hospitals of 17 cities, March-September 2020. Primary outcomes included in-hospital mortality and invasive mechanical ventilation support. Models for the primary outcomes were estimated by Poisson regression with robust variance, with statistical significance of p<0.05. RESULTS Of 2,925 patients (median age of 60 years [48-71], 57.1% men), 27.3% presented myocardial injury. The proportion of patients with comorbidities was higher among patients with cardiac injury (median 2 [1-2] vs. 1 [0-2]). Patients with myocardial injury had higher median levels of brain natriuretic peptide, lactate dehydrogenase, creatine phosphokinase, N-terminal pro-brain natriuretic peptide, and C-reactive protein than patients without myocardial injury. As independent predictors, C-reactive protein and platelet counts were related to the risk of death, and neutrophils and platelet counts were related to the risk of invasive mechanical ventilation support. Patients with high troponin levels presented a higher risk of death (RR 2.03, 95% CI 1.60-2.58) and invasive mechanical ventilation support (RR 1.87, 95% CI 1.57-2.23), when compared to those with normal troponin levels. CONCLUSION Cardiac injury was an independent predictor of in-hospital mortality and the need for invasive mechanical ventilation support in hospitalized COVID-19 patients.
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Affiliation(s)
- Hannah Cardoso Barbosa
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
| | - Maria Auxiliadora Parreiras Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
| | - Jordana Cristina de Jesus
- Universidade Federal do Rio Grande do NorteNatalRNBrasilUniversidade Federal do Rio Grande do Norte,Natal, RN – Brasil
| | - Karina Cardoso Meira
- Universidade Federal do Rio Grande do NorteNatalRNBrasilUniversidade Federal do Rio Grande do Norte,Natal, RN – Brasil
| | - Luiz Guilherme Passaglia
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
| | - Manuela Furtado Sacioto
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil
| | - Adriana Falangola Benjamin Bezerra
- Hospital das ClínicasUniversidade Federal de PernambucoRecifePEBrasilHospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE – Brasil
| | - Alexandre Vargas Schwarzbold
- Hospital Universitário de Santa MariaSanta MariaRSBrasilHospital Universitário de Santa Maria,Santa Maria, RS – Brasil
| | | | - Barbara Lopes Farace
- Hospital Risoleta Tolentino NevesBelo HorizonteMGBrasilHospital Risoleta Tolentino Neves,Belo Horizonte, MG – Brasil
| | | | - Christiane Corrêa Rodrigues Cimini
- Hospital Santa RosáliaTeófilo OtoniMGBrasilHospital Santa Rosália,Teófilo Otoni, MG – Brasil
- Universidade Federal dos Vales do Jequitinhonha e MucuriTeófilo OtoniMGBrasilUniversidade Federal dos Vales do Jequitinhonha e Mucuri, Teófilo Otoni, MG – Brasil
| | | | - Daniela do Reis Carazai
- Hospital Nossa Senhora da ConceiçãoPorto AlegreRSBrasilHospital Nossa Senhora da Conceição, Cristo Redentor, Porto Alegre, RS – Brasil
| | - Daniela Ponce
- Universidade Estadual PaulistaBotucatuSPBrasilUniversidade Estadual Paulista, Botucatu, SP – Brasil
| | - Emanuel Victor Alves Costa
- Centro Universitário de Belo HorizonteBelo HorizonteMGBrasilCentro Universitário de Belo Horizonte (UniBH),Belo Horizonte, MG – Brasil
| | | | | | - Frederico Bartolazzi
- Hospital Santo AntônioCurveloMGBrasilHospital Santo Antônio,Curvelo, MG – Brasil
| | - Glícia Cristina de Castro Madeira
- Faculdade Ciências Médicas de Minas GeraisBelo HorizonteMGBrasilFaculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG – Brasil
| | | | | | - Joanna d’Arc Lyra Batista
- Universidade Federal da Fronteira SulChapecóSCBrasilUniversidade Federal da Fronteira Sul, Chapecó, SC – Brasil
- Hospital Regional do OesteChapecóSCBrasilHospital Regional do Oeste, Chapecó, SC – Brasil
| | | | - Juliana da Silva Nogueira Carvalho
- Hospital das ClínicasUniversidade Federal de PernambucoRecifePEBrasilHospital das Clínicas da Universidade Federal de Pernambuco, Recife, PE – Brasil
| | - Karen Brasil Ruschel
- Hospital Mãe de DeusPorto AlegreRSBrasilHospital Mãe de Deus,Porto Alegre, RS – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | - Karina Paula Medeiros Prado Martins
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | | | - Luanna Silva Monteiro Menezes
- Hospital LuxemburgoBelo HorizonteMGBrasilHospital Luxemburgo, Belo Horizonte, MG – Brasil
- Hospital Municipal Odilon BehrensBelo HorizonteMGBrasilHospital Municipal Odilon Behrens,Belo Horizonte, MG – Brasil
| | - Luciane Kopittke
- Hospital Nossa Senhora da ConceiçãoPorto AlegreRSBrasilHospital Nossa Senhora da Conceição, Cristo Redentor, Porto Alegre, RS – Brasil
| | | | - Luiz Antônio Nasi
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento,Porto Alegre, RS – Brasil
| | - Maiara Anschau Floriani
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento,Porto Alegre, RS – Brasil
| | - Maíra Dias Souza
- Hospital Municipal Odilon BehrensBelo HorizonteMGBrasilHospital Municipal Odilon Behrens,Belo Horizonte, MG – Brasil
| | - Marcelo Carneiro
- Hospital Santa CruzSanta Cruz do SulRSBrasilHospital Santa Cruz,Santa Cruz do Sul, RS – Brasil
| | | | | | - Mariana Frizzo de Godoy
- Hospital São LucasPUCRSPorto AlegreRSBrasilHospital São Lucas (PUCRS),Porto Alegre, RS – Brasil
| | | | - Paulo Mascarenhas Mendes
- Hospitais da Rede Mater DeiBelo HorizonteMGBrasilHospitais da Rede Mater Dei,Belo Horizonte, MG – Brasil
| | - Polianna Delfino-Pereira
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | | | - Renan Goulart Finger
- Hospital Regional do OesteChapecóSCBrasilHospital Regional do Oeste, Chapecó, SC – Brasil
| | - Rochele Mosmann Menezes
- Hospital Santa CruzSanta Cruz do SulRSBrasilHospital Santa Cruz,Santa Cruz do Sul, RS – Brasil
| | - Saionara Cristina Francisco
- Hospital Metropolitano Doutor Célio de CastroBelo HorizonteMGBrasilHospital Metropolitano Doutor Célio de Castro,Belo Horizonte, MG – Brasil
| | | | - Talita Fischer Oliveira
- Hospital Municipal Odilon BehrensBelo HorizonteMGBrasilHospital Municipal Odilon Behrens,Belo Horizonte, MG – Brasil
| | | | - Carisi Anne Polanczyk
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
| | - Milena Soriano Marcolino
- Hospital das ClínicasUniversidade Federal de Minas GeraisBelo HorizonteMGBrasilHospital das Clínicas - Universidade Federal de Minas Gerais,Belo Horizonte, MG – Brasil
- IATSCNPqPorto AlegreRSBrasilInstituto de Avaliação de Tecnologia em Saúde (IATS/ CNPq),Porto Alegre, RS – Brasil
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9
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Caldeira D, Nogueira-Garcia B. Myocardial infarction and viral triggers: what do we know by now? Eur Heart J Suppl 2023; 25:A12-A16. [PMID: 36937373 PMCID: PMC10021489 DOI: 10.1093/eurheartjsupp/suac122] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Myocardial infarction (MI) is an acute clinical manifestation ischaemic heart disease, which is the leading cause of death worldwide. Infections also have an important burden worldwide, with lower respiratory infections being the worldwide leading cause of death due to communicable diseases. The relationship of MI with viral respiratory infections (including influenza and SARS-CoV-2) as a trigger has been well documented with significant associations. These infections can lead to Type 1 MI, where inflammation and vascular dysfunction, as well as the increased prothrombotic environment lead to atherothrombosis. Type 2 MI may also occur due to an imbalance of oxygen/blood supply and myocardial demand (hypoxaemia, fever, and tachycardia). The data from randomized controlled trials showing a potential benefit of influenza vaccination in coronary artery disease patients should not be ignored. This can be considered a further argument for the association of viral infections (influenza in particular) and MI.
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Affiliation(s)
- Daniel Caldeira
- Corresponding author. Tel: +351 210 517 285 | Ext: 48301, Fax: +351 217 985 114,
| | - Beatriz Nogueira-Garcia
- Faculdade de Medicina, Centro Cardiovascular da Universidade de Lisboa—CCUL, CAML, Universidade de Lisboa, Lisboa, Portugal
- Cardiology Department, Hospital Universitário de Santa Maria—CHULN, Lisboa, Portugal
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10
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Cardiovascular Complications of Viral Respiratory Infections and COVID-19. Biomedicines 2022; 11:biomedicines11010071. [PMID: 36672579 PMCID: PMC9856218 DOI: 10.3390/biomedicines11010071] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022] Open
Abstract
Viral respiratory infections (VRI) are the most prevalent type of infectious diseases and constitute one of the most common causes of contact with medical care. Regarding the pathophysiology of the cardiovascular system, VRI can not only exacerbate already existing chronic cardiovascular disease (such as coronary artery disease or heart failure) but also trigger new adverse events or complications (e.g., venous thromboembolism), the latter particularly in subjects with multimorbidity or disease-related immobilization. In the current paper, we provide a narrative review of diverse cardiovascular complications of VRI as well as summarize available data on the pathology of the circulatory system in the course of coronavirus disease 2019 (COVID-19).
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11
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Association between COVID-19 and subsequent vascular events in primary care patients in Germany. Public Health 2022; 213:107-113. [PMID: 36403399 PMCID: PMC9574461 DOI: 10.1016/j.puhe.2022.10.005] [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: 07/19/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between COVID-19 diagnosis and the risk of developing a first-ever vascular event (VE) compared with the same risk in those with respiratory tract infection (RTI). STUDY DESIGN This was a retrospective cohort study. METHODS This study using data from Disease Analyzer Database (IQVIA) included patients aged ≥18 years with at least one visit to a German practice during the index period. VEs were defined as cardiovascular or cerebrovascular events. Two cohorts were created: patients with a diagnosis of COVID-19 and those diagnosed with RTI. These were matched using propensity scores. Kaplan-Meier curves were created for the purposes of time to event analysis. A Poisson model was used to calculate incidence rates and derive incidence rate ratios (IRRs). RESULTS A total of 58,904 patients were matched. There was no significant association between COVID-19 diagnosis and increased incidence of VE events among females (IRR [95% confidence interval (CI)]: 0.96 [0.82-1.11] and 1.30 [0.88-1.81]) or males (IRR, 95% CI: 0.91 [0.78-1.05] and 1.13 [0.80-1.62]). Overall, no significant association between COVID-19 diagnosis and incidence of VE was observed across age categories except for cardiovascular vascular events in the age category ≥70 years (IRR [95% CI]: 0.78 [0.67-0.94]). CONCLUSIONS Overall, our study suggests that COVID-19 diagnosis was not associated with an increased risk of developing VE compared with RTI diagnosis. However, further research in a variety of healthcare settings and regions is needed to confirm these preliminary findings from our cohort, which is a good reflection of routine clinical practice in Germany.
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12
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Saade EA, Abul Y, McConeghy K, Edward Davidson H, Han L, Joyce N, Canaday DH, Hsueh L, Bosco E, Gravenstein S. High-dose influenza vaccines for the prevention of hospitalization due to cardiovascular events in older adults in the nursing home: Post-hoc analysis of a cluster-randomized trial. Vaccine 2022; 40:6700-6705. [PMID: 36244879 DOI: 10.1016/j.vaccine.2022.09.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 01/22/2023]
Abstract
Older adults are at high risk of major acute cardiovascular events (MACE) linked to influenza illness andpreventable by influenza vaccination. It is unknown whether high-dose vaccine might incrementally reduce the risk of MACE.We conducted a post-hoc analysis of data collected from a pragmatic cluster randomized study of 823 nursing homes (NH) randomized to standard-dose (SD) or high-dose (HD) influenza vaccine in the 2013-14 season. Adults age 65 year or older who are Medicare-enrolled long-stay residents were included in the analysis.There were no statistically significant differences in hospitalization for MACE, acute coronary syndromes (ACS), stroke or heart failure between the HD and SD arms. However, in the fee-for-service group, participants in the HD arm had significantly decreased risk of hospitalization for respiratory problems, which was not observed in the Medicare Advantage group.High-dose influenza vaccine was not shown to be incrementally protective against MACE relative to standard-dose vaccine.
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Affiliation(s)
- Elie A Saade
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University, Cleveland, OH, United States.
| | - Yasin Abul
- School of Public Health, Brown University, Providence, RI, United States; Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, RI, United States
| | - Kevin McConeghy
- School of Public Health, Brown University, Providence, RI, United States; Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, RI, United States
| | | | - Lisa Han
- Insight Therapeutics, LLC, Norfolk, VA, United States
| | - Nina Joyce
- School of Public Health, Brown University, Providence, RI, United States
| | - David H Canaday
- Case Western Reserve University, Cleveland, OH, United States; Veterans Administration Medical Center, Cleveland, OH, United States
| | - Leon Hsueh
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Elliott Bosco
- School of Public Health, Brown University, Providence, RI, United States
| | - Stefan Gravenstein
- School of Public Health, Brown University, Providence, RI, United States; Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, RI, United States; Warren Alpert Medical School of Brown University, Providence, RI, United States.
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13
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Kahlon N, Shazadeh Safavi P, Abuhelwa Z, Sheikh T, Burmeister C, Doddi S, Assaly R, Barnett W. Prevalence and Clinical Significance of Antiphospholipid Antibodies in Hospitalized Patients With COVID-19 Infection. Cureus 2022; 14:e27862. [PMID: 36110457 PMCID: PMC9462592 DOI: 10.7759/cureus.27862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/05/2022] Open
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14
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Wang G, Liu J, Xu R, Liu X. Elevated plasma D-dimer levels are associated with the poor prognosis of critically ill children. Front Pediatr 2022; 10:1001893. [PMID: 36210933 PMCID: PMC9537732 DOI: 10.3389/fped.2022.1001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND D-dimer has been shown as a valuable predictor for the prognosis of sepsis. But the prognostic association of an elevated D-dimer with adverse outcomes of all critical illnesses in pediatric intensive care unit (PICU) has received far less emphasis. METHODS This was a single-center retrospective study, including 7,648 critical patients aged between 28 days and 18 years from the pediatric intensive care (PIC) database from 2010 to 2018. The primary outcome was the in-hospital mortality rate. RESULTS Higher levels of D-dimer, INR, PT, APTT, and lower Fib were observed in the non-survivor group (all P < 0.001). D-dimer, INR, PT and APTT were independent risk factors for prognosis in critically ill children. There was the highest AUROC in D-dimer for predicting in-hospital mortality of critically ill patients compared with INR, PT, APTT, and Fib (D-dimer: 0.77 vs. INR: 0.73 vs. PT: 0.73 vs. APTT: 0.64 vs. Fib: 0.60). The cut-off value, sensitivity, and specificity of D-dimer were 1.53, 0.65, and 0.77, respectively. Subgroup analysis showed a stable evaluation effectiveness of D-dimer for predicting in-hospital mortality of critically ill patients in the age and gender groups. CONCLUSIONS We found poorer coagulation function in the non-survivors compared with the survivors. Among the coagulation indicators, D-dimer was most strongly associated with in-hospital mortality of unselected critically ill children.
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Affiliation(s)
- Guan Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Junhui Liu
- Qilu Hospital of Shandong University, Jinan, China
| | - Rui Xu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Xinjie Liu
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
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15
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Hu Y, Yu C, Guo Y, Bian Z, Han Y, Yang L, Chen Y, Du H, Pang Y, Sun D, Jin J, Zhang J, Wang J, Shao C, Tang YD, Chen J, Chen Z, Lv J, Li L. Pneumonia hospitalizations and the subsequent risk of incident ischaemic cardiovascular disease in Chinese adults. Int J Epidemiol 2021; 50:1698-1707. [PMID: 33826715 DOI: 10.1093/ije/dyab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Acute respiratory infections have been associated with a transient increase in cardiovascular risk. However, whether such an association persists beyond 1 month and the potential modifying effect of cardiovascular risk factors on such an association are less well established. METHODS The China Kadoorie Biobank enrolled 512 726 participants aged 30-79 years from 10 areas across China during 2004-2008. By the end of 2017, a total of 5444 participants with new-onset ischaemic heart disease (IHD) and 4846 with ischaemic stroke (IS) who also had at least a record of hospitalization for pneumonia during follow-up were included. We used a self-controlled case-series method and calculated the age- and season-adjusted relative incidences (RIs) and 95% confidence intervals (CIs) for ischaemic cardiovascular disease (CVD) after pneumonia. RESULTS The risk of ischaemic CVD increased during days 1-3 after pneumonia hospitalization, with an RI (95% CI) of 4.24 (2.92-6.15) for IHD and 1.85 (1.02-3.35) for IS. The risk gradually reduced with longer duration since pneumonia hospitalization but remained elevated until days 92-365 for IHD (1.23, 1.12-1.35) and days 29-91 for IS (1.25, 1.05-1.48). Pre-existing cardiovascular risk factors amplified the associations between pneumonia and ischaemic CVD risks, such as chronic obstructive pulmonary disease for both IHD and IS, and diabetes and smoking for IHD (all Pinteraction < 0.05). Besides, the risk of ischaemic CVD was also higher among the participants aged ≥70 years (Pinteraction < 0.001 for IHD and 0.033 for IS). CONCLUSION Among middle-aged and older Chinese adults, pneumonia hospitalization was associated with both short- and long-term increases in ischaemic CVD risk for ≤1 year.
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Affiliation(s)
- Yizhen Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Bian
- Chinese Academy of Medical Sciences, Beijing, China
| | - Yuting Han
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jianrong Jin
- Wuzhong District Center for Disease Control and Prevention, Jiangsu, China
| | - Jun Zhang
- Suzhou Center for Disease Control and Prevention, Jiangsu, China
| | - Jingjia Wang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunli Shao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Da Tang
- Department of Cardiology, Third Hospital, Peking University, Beijing, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing, China
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16
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Ma J, Mena M, Mandania RA, Ghosh A, Dodoo C, Dwivedi AK, Mukherjee D. Associations between Combined Influenza and Pneumococcal Pneumonia Vaccination and Cardiovascular Outcomes. Cardiology 2021; 146:772-780. [PMID: 34521082 DOI: 10.1159/000519469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In 2017, the CDC listed heart disease as the leading cause of death, with pneumonia and influenza being the eighth cause of death. Several studies have suggested the protective effects of influenza vaccination on myocardial infarction (MI). Available evidence supports the use of influenza vaccination in decreasing cardiovascular events, and the Joint Commission considers influenza vaccination a metric of quality care for hospitalized patients. Our specific aim was to evaluate the combined use of pneumococcal pneumonia vaccine (PPV) and influenza vaccine on cardiovascular outcomes and mortality. METHODS A retrospective observational study was conducted using the 2012-2015 US National Inpatient Sample (NIS) database, to compare cardiovascular events in adult patients who did and did not receive vaccination during their hospitalization. ICD-9 codes were used to extract data for specific variables. The outcomes included MI, transient ischemic attacks, cardiac arrest, stroke, heart failure, and death. Adjusted relative risks (RR) were calculated using survey-weighted generalized linear models after adjusting for gender, race, socioeconomic status, diabetes, hypertension, hyperlipidemia, smoking status, prior coronary artery disease, and cerebrovascular disease. The effect of vaccination on in-hospital mortality was assessed in each subgroup of cardiovascular events using RR regressions. RESULTS This study included 22,634,643 hospitalizations, of which 21,929,592 did not receive immunization. Vaccination solely against influenza was associated with lower MI (RR = 0.84, 95% CI: 0.82-0.87, p < 0.001), TIA (RR = 0.93, 95% CI: 0.9-0.96, p < 0.001), cardiac arrest (RR = 0.36, 95% CI: 0.33-0.39, p < 0.001), stroke (RR = 0.94, 95% CI: 0.91-0.97, p < 0.001), and mortality (RR = 0.38, 95% CI: 0.36-0.4, p < 0.001). Vaccination with PPV alone was associated with MI (RR = 1.13, 95% CI: 1.11-1.16, p < 0.001), TIA (RR = 1.28, 95% CI: 1.26-1.31, p < 0.001), stroke (RR = 1.21, 95% CI: 1.18-1.24, p < 0.001), and lower mortality (RR = 0.47, 95% CI: 0.45-0.49, p < 0.001). Combined PPV and influenza vaccine was associated with lower mortality (2.21% vs. 1.03%, p < 0.001) and lower cardiac arrest (0.61% vs. 0.51%, p < 0.001). In the adjusted analysis, the RR was 0.46 (95% CI: 0.43, 0.49) for mortality in the combined vaccinated cohort. The combined vaccination group also had a significantly reduced risk of mortality among those admitted with MI (RR = 0.46), transient ischemic attacks (RR = 0.58), and stroke (RR = 0.42) compared to the nonvaccinated group. CONCLUSIONS Our study shows a significantly reduced risk of mortality with influenza vaccine and PPV and with combined pneumococcal and influenza vaccination. These data suggest that in-hospital administration of pneumonia and influenza vaccines appears safe and supports the use of combined vaccination during hospitalization due to their cardiovascular benefits.
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Affiliation(s)
- Jennifer Ma
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Miguel Mena
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Roshni A Mandania
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Arjab Ghosh
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Christopher Dodoo
- Biostatistics Epidemiology Consulting Lab, Office of the Vice President, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Alok K Dwivedi
- Biostatistics Epidemiology Consulting Lab, Office of the Vice President, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Debabrata Mukherjee
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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17
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Africano HF, Serrano-Mayorga CC, Ramirez-Valbuena PC, Bustos IG, Bastidas A, Vargas HA, Gómez S, Rodriguez A, Orihuela CJ, Reyes LF. Major Adverse Cardiovascular Events During Invasive Pneumococcal Disease Are Serotype Dependent. Clin Infect Dis 2021; 72:e711-e719. [PMID: 32964223 DOI: 10.1093/cid/ciaa1427] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Up to 30% of patients admitted to hospitals with invasive pneumococcal disease (IPD) experience major adverse cardiovascular event (MACE) including new/worsening heart failure, new/worsening arrhythmia, and/or myocardial infarction. Streptococcus pneumoniae (Spn) is the most frequently isolated bacterial pathogen among community-acquired pneumonia (CAP) patients and the only etiological agent linked independently to MACE. Nevertheless, no clinical data exist identifying which serotypes of Spn are principally responsible for MACE. METHODS This was an observational multicenter retrospective study conducted through the Public Health Secretary of Bogotá, Colombia. We included patients with a confirmed clinical diagnosis of IPD with record of pneumococcal serotyping and clinical information between 2012 and 2019. Spn were serotyped using the quellung method by the National Center of Microbiology. MACE were determined by a retrospective chart review. RESULTS The prevalence of MACE was 23% (71/310) in IPD patients and 28% (53/181) in patients admitted for CAP. The most prevalent S. pneumoniae serotype identified in our study was the 19A, responsible for the 13% (42/310) of IPD in our cohort, of which 21% (9/42) presented MACE. Serotypes independently associated with MACE in IPD patients were serotype 3 (odds ratio [OR] 1, 48; 95% confidence interval [CI] [1.21-2.27]; P = .013) and serotype 9n (OR 1.29; 95% CI [1.08-2.24]; P = .020). Bacteremia occurred in 87% of patients with MACE. Moreover, serum concentrations of C-reactive protein were elevated in patients with MACE versus in non-MACE patients (mean [standard deviation], 138 [145] vs 73 [106], P = .01). CONCLUSIONS MACE are common during IPD with serotype 3 and 9n independently of frequency.
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Affiliation(s)
| | | | | | | | | | - Hernan A Vargas
- Grupo Laboratorio de Salud Pública de Bogotá; Secretaría de Salud de Bogotá, Colombia.,Laboratorio de salud pública del Tolima, Secretaria de salud del Tolima, Gobernación del Tolima
| | - Sandra Gómez
- Grupo Laboratorio de Salud Pública de Bogotá; Secretaría de Salud de Bogotá, Colombia
| | - Alejandro Rodriguez
- Hospital Universitari Joan XXIII, Critical Care Medicine, Rovira and Virgili University and CIBERES (Biomedical Research Network of Respiratory Disease), Tarragona, Spain
| | | | - Luis F Reyes
- Universidad de la Sabana, Chía, Colombia.,Clínica Universidad de La Sabana, Chía, Colombia
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18
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Aghbash PS, Eslami N, Shirvaliloo M, Baghi HB. Viral coinfections in COVID-19. J Med Virol 2021; 93:5310-5322. [PMID: 34032294 PMCID: PMC8242380 DOI: 10.1002/jmv.27102] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/21/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
The most consequential challenge raised by coinfection is perhaps the inappropriate generation of recombinant viruses through the exchange of genetic material among different strains. These genetically similar viruses can interfere with the replication process of each other and even compete for the metabolites required for the maintenance of the replication cycle. Due to the similarity in clinical symptoms of most viral respiratory tract infections, and their coincidence with COVID-19, caused by SARS-CoV-2, it is recommended to develop a comprehensive diagnostic panel for detection of respiratory and nonrespiratory viruses through the evaluation of patient samples. Given the resulting changes in blood markers, such as coagulation factors and white blood cell count following virus infection, these markers can be of diagnostic value in the detection of mixed infection in individuals already diagnosed with a certain viral illness. In this review, we seek to investigate the coinfection of SARS-CoV-2 with other respiratory and nonrespiratory viruses to provide novel insights into the development of highly sensitive diagnostics and effective treatment modalities.
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Affiliation(s)
- Parisa S Aghbash
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Narges Eslami
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Milad Shirvaliloo
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Drug Applied Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein B Baghi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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19
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Khamis F, Memish Z, Bahrani MA, Dowaiki SA, Pandak N, Bolushi ZA, Salmi IA, Al-Zakwani I. Prevalence and predictors of in-hospital mortality of patients hospitalized with COVID-19 infection. J Infect Public Health 2021; 14:759-765. [PMID: 34022734 PMCID: PMC8053361 DOI: 10.1016/j.jiph.2021.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The severity and mortality from COVID-19 infection vary among populations. The aim of this study was to determine the prevalence and predictors of mortality among patients hospitalized with COVID-19 infection in a tertiary care hospital in Oman. METHODS We conducted a retrospective study using database that included: demographic, clinical characteristics, laboratory parameters, medications and clinical outcomes of all patients hospitalized in Royal Hospital, Muscat, Oman, between March 12, 2020 and December 1st 2020. Univariate and multivariate logistic regression was performed to investigate the relationship between each variable and the risk of death of COVID-19 infected patients. RESULTS In total,1002 patients with COVID-19 infection with mean age of the cohort was 54±16 years (65% (n=650) male) were included, with an overall and intensive care unit (ICU) mortalities of 26% (n=257) and 42% (n=199/473), respectively. The prevalence of ICU admission was 47% (n=473) and the need for mechanical ventilation was 41% (n=413). The overall length of stay in the ICU was 13 (9-21) days. Adjusting for other factors in the model, the multivariable logistic regression demonstrated that in-hospital mortality in admitted COVID-19 patients was associated with old age (p<0.001), heart diseases (adjusted odds ratio (aOR), 1.84; 95% confidence interval (CI): 1.11-3.03; p=0.018), liver diseases (aOR, 4.48; 95% CI: 1.04-19.3; p=0.044), those with higher ferritin levels (aOR, 1.00; 95% CI: 1.00-1.00; p=0.006), acute respiratory distress syndrome (ARDS) (aOR, 3.20; 95% CI: 1.65-6.18; p=0.001), sepsis (aOR, 1.77; 95% CI: 1.12-2.80; p=0.022), and those that had ICU admission (aOR, 2.22; 95% CI: 1.12-4.38; p=0.022). CONCLUSION In this cohort, mortality in hospitalized COVID-19 patients was high and was associated with advanced age, heart diseases, liver disease, high ferritin, ARDS, sepsis and ICU admission. These high-risk groups should be prioritized for COVID-19 vaccinations.
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Affiliation(s)
- Faryal Khamis
- Adult Infectious Diseases, Department of Medicine, Royal Hospital, Ministry of Health, Muscat Oman.
| | - Ziad Memish
- Director Research & Innovation Centre, King Saud Medical City, Ministry of Health & College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Maher Al Bahrani
- Department of Anaesthesia and Critical Care, Department of Medicine, Ministry of Health, Muscat Oman
| | - Samata Al Dowaiki
- Adult Infectious Diseases, Department of Medicine, Royal Hospital, Ministry of Health, Muscat Oman
| | - Nenad Pandak
- Adult Infectious Diseases, Department of Medicine, Royal Hospital, Ministry of Health, Muscat Oman
| | - Zakaryia Al Bolushi
- Adult Infectious Diseases, Department of Medicine, Royal Hospital, Ministry of Health, Muscat Oman
| | - Issa Al Salmi
- Nephrology, Department of Medicine, Royal Hospital, Ministry of Health, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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20
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Han T, Yuan H, Ye L, Jiang X, Bai L, Wang C. [Impact of cardiovascular metabolic diseases on COVID-19: review of recent progress]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:628-632. [PMID: 33963726 DOI: 10.12122/j.issn.1673-4254.2021.04.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The high comorbidity between cardiovascular and metabolic diseases (CVMD) and coronavirus disease 2019 (COVID-19) and the consequent high mortality and the potential risk of cardiovascular damage have brought great challenges to the clinical diagnosis and treatment of the condition. The latest studies found that advanced age, immune function defects, inflammatory factor storms and oxidative stress damage all potentially contribute to the high comorbidity of the two. Direct virus invasion, myocardial oxygen supply and demand imbalance and vascular endothelial and coagulation dysfunction may be important mechanisms for cardiovascular injury in COVID-19 patients. In addition, the expression level of ACE2 (the cell membrane receptor of SARS-CoV-2) in various organs and the peripheral blood not only mediates the direct invasion and damage of the organs, but also participates in regulation of the balance of systematic inflammation and oxidative stress, thus affecting the susceptibility and outcomes of the patients. Herein we review the recent research progress in the comorbidity between COVID-19 and CVMD and explore the mechanisms of cardiovascular damage caused by SARS-CoV-2, thus to provide a theoretical basis for the clinical diagnosis and treatment of COVID-19 with underlying CVMD.
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Affiliation(s)
- T Han
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - H Yuan
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, 710061, China
| | - L Ye
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, 710061, China
| | - X Jiang
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, 710061, China
| | - L Bai
- School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, 710061, China
| | - C Wang
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
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21
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Pabbaraju K, Wong AA, Ma R, Zelyas N, Tipples GA. Development and validation of a multiplex reverse transcriptase-PCR assay for simultaneous testing of influenza A, influenza B and SARS-CoV-2. J Virol Methods 2021; 293:114151. [PMID: 33839186 PMCID: PMC8028604 DOI: 10.1016/j.jviromet.2021.114151] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 01/16/2023]
Abstract
In the current pandemic of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the co-circulation of SARS-CoV-2 and other respiratory viruses during the upcoming fall and winter seasons may present an unprecedented burden of respiratory disease in the population. Important respiratory viruses that will need to be closely monitored during this time include SARS-CoV-2, influenza A and influenza B. The epidemiology of these viruses is very similar in terms of susceptible populations, mode of transmission, and the clinical syndromes, thus the etiological agent will be difficult to differentiate without target specific assays. The availability of a sensitive and specific multiplex assay that can simultaneously detect all these targets will be valuable. Here we report the validation of a real-time reverse transciptase-PCR assay for the simultaneous detection of SARS-CoV-2, influenza A and influenza B. This multiplex assay is comparable to its singleplex counterparts with a limit-of-detection being less than 5 copies/reaction, 100 % specificity, over seven logs of dynamic range, less than 1 % coefficientof variation showing high precision, and equivalent accuracy using patient samples. It also offers the added benefits of savings in reagents and technologist time while improving testing efficiency and turn-around-times in order to respond effectively to the ongoing pandemic.
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Affiliation(s)
- Kanti Pabbaraju
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada.
| | - Anita A Wong
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada
| | - Raymond Ma
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada
| | - Nathan Zelyas
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada; Alberta Precision Laboratories, Public Health Laboratory, Edmonton, Alberta, Canada; Department Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Graham A Tipples
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta, Canada; Alberta Precision Laboratories, Public Health Laboratory, Edmonton, Alberta, Canada; Department Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
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22
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Vrints CJM, Krychtiuk KA, Van Craenenbroeck EM, Segers VF, Price S, Heidbuchel H. Endothelialitis plays a central role in the pathophysiology of severe COVID-19 and its cardiovascular complications. Acta Cardiol 2021; 76:109-124. [PMID: 33208052 PMCID: PMC7682384 DOI: 10.1080/00015385.2020.1846921] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023]
Abstract
This clinical review paper discusses the pathophysiology of the pulmonary and cardiovascular manifestations of a SARS-CoV-2 infection and the ensuing implications on acute cardiovascular care in patients presenting with a severe COVID-19 syndrome admitted to an intensive acute cardiac care unit. The high prevalence of old age, obesity, diabetes, hypertension, heart failure, and ischaemic heart disease in patients who develop a severe to critical COVID-19 syndrome suggests shared pathophysiological mechanisms. Pre-existing endothelial dysfunction and an impaired innate immune response promote the development by the viral infection of an acute endothelialitis in the pulmonary microcirculation complicated by abnormal vasoconstrictor responses, luminal plugging by inflammatory cells, and intravascular thrombosis. This endothelialitis extends into the systemic circulation what may lead to acute myocardial injury, myocarditis, and thromboembolic complications both in the arterial and venous circulation.
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Affiliation(s)
- Christiaan J. M. Vrints
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Konstantin A. Krychtiuk
- Department of Internal Medicine II - Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Emeline M. Van Craenenbroeck
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Vincent F. Segers
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Susanna Price
- Department of Cardiology and Department of Adult Critical Care, Royal Brompton Hospital, London, UK
| | - Hein Heidbuchel
- Research Group Cardiovascular Diseases, Department GENCOR, University of Antwerp, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
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23
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Alzahrani SH, Al-Rabia MW. Cardiac Injury Biomarkers and the Risk of Death in Patients with COVID-19: A Systematic Review and Meta-Analysis. Cardiol Res Pract 2021; 2021:9363569. [PMID: 33815838 PMCID: PMC7977983 DOI: 10.1155/2021/9363569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/18/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiac complications may develop in a proportion of patients with the novel coronavirus disease (COVID-19), which may influence their prognosis. OBJECTIVES To assess the role of cardiac injury biomarkers measured on admission and during hospitalization as risk factors for subsequent death in COVID-19 patients. METHODS A systematic review and meta-analysis was carried out involving cohort studies that compared the levels of cardiac injury biomarkers in surviving and dead COVID-19 patients. Cardiac injury is defined as an elevation of the definitive markers (cardiac troponin (cTnI and cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) above the 99th percentile upper reference limit. Secondary markers included creatine kinase-myocardial bound (CK-MB), myoglobin, interleukin-6 (IL-6), and C-reactive protein (CRP). The risk of death and the differences in marker concentrations were analyzed using risk ratios (RRs) and standardized mean differences (SMDs), respectively. RESULTS Nine studies met the inclusion criteria (1799 patients, 53.36% males, 20.62% with cardiac injury). The risk of death was significantly higher in patients with elevated cTn than those with normal biomarker levels (RR = 5.28, P < 0.0001). Compared to survivors, dead patients had higher levels of cTn (SMD = 2.15, P=0.001), IL-6 (SMD = 3.13, P=0.03), hs-CRP (SMD = 2.78, P < 0.0001), and CK-MB (SMD = 0.97, P < 0.0001) on admission and a significant rise of plasma cTnT during hospitalization. CONCLUSION COVID-19 patients with elevated cTn on admission, possibly due to immune-mediated myocardial injury, are at increased risk for mortality. This requires further radiographic investigations, close monitoring, and aggressive care to reduce the risk of severe complications and death.
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Affiliation(s)
- Sami H. Alzahrani
- Family Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed W. Al-Rabia
- Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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24
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Elfarargy MS, Al-Ashmawy GM, Abu-Risha S, Khattab H. Novel predictor markers for early differentiation between transient tachypnea of newborn and respiratory distress syndrome in neonates. Int J Immunopathol Pharmacol 2021; 35:20587384211000554. [PMID: 33722097 PMCID: PMC7970176 DOI: 10.1177/20587384211000554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Neonatal Respiratory Distress Syndrome (RDS) and Transient Tachypnea of newborn
(TTN) are common similar neonatal respiratory diseases. Study the early
predictor markers in differentiation between TTN and RDS in neonates. A
prospective case control study which was done in Neonatal Intensive Care Unit
(NICU) of Tanta University Hospital (TUH) from September 2016 to March 2018.
Three groups of neonates were included in the study: RDS group (45 neonates),
TTN group (45 neonates), and control group (45 healthy neonates). There were
statistically significant difference (SSD) between our studied three groups as
regard serum Malondialdehyde (MDA), Superoxide dismutase SOD, Lactate
dehydrogenase (LDH), and blood PH and P-values were 0.001* for
these comparative parameters. The ROC curve of RDS cases revealed that the serum
MDA Cut off, sensitivity and specificity were 1.87 mmol/L, 98%, 96%,
respectively which had the highest sensitivity and specificity followed by the
serum SOD then the serum LDH and lastly the blood PH while in TTN cases, the
serum MDA Cut off, sensitivity and specificity were 0.74 mmol/L, 96%, 93%,
respectively then the serum SOD then the serum LDH and lastly the blood PH.
Serum MDA, SOD, LDH, and PH had a beneficial role as early predictors in
differentiation between TTN and RDS in neonates.
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Affiliation(s)
| | - Ghada M Al-Ashmawy
- Department of Biochemistry, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Sally Abu-Risha
- Department of Pharmacology& Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
| | - Haidy Khattab
- Department of Physiology, Faculty of Medicine, Tanta University, Tanta, Egypt
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25
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Xia G, Fan D, Ma C, He Y, Wang M, Zhu Y, Zheng Q. Hyper-Inflammatory Response Involves in Cardiac Injury Among Patients With Coronavirus Disease 2019. Am J Med Sci 2021; 361:718-724. [PMID: 33582156 PMCID: PMC7879031 DOI: 10.1016/j.amjms.2021.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/27/2020] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammation can facilitate development of coronavirus disease 2019 (COVID-19) and cardiac injury is associated with worse clinical outcomes. However, data are relatively scarce on the association between hyper-inflammatory response and cardiac injury among COVID-19 patients. METHODS The study was designed based on severe and critically ill patients with COVID-19. Information on clinical characteristics and laboratory examinations was collected from the electronic medical records and analyzed. RESULTS There were 32.4% (n = 107) of patients with cardiac injury. The median age was 67 years, and 48.8% (n = 161) of patients were men. Hypertension was the most common in 161 (48.8%) patients, followed by diabetes (16.7%, n = 55) and coronary heart disease (13.3%, n = 44). Compared to cases without cardiac injury, those with cardiac injury were older, had higher proportions of coronary heart disease, and leukocyte counts, significantly elevated concentrations of N-terminal pro-B-Type natriuretic peptide, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6, and IL-8, but lower lymphocyte counts. A significant positive correlation was observed between high-sensitivity troponin I and inflammatory cytokines. Logistic regression analysis showed that hs-CRP, TNF-α and IL-6 were independent risk factors for cardiac injury. CONCLUSIONS Cardiac injury was associated with elevated levels of inflammatory cytokines among severe and critically ill patients with COVID-19, suggesting that hyper-inflammatory response may involve in cardiac injury.
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Affiliation(s)
- Guozhi Xia
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West 5th Road, Xi'an 710004, Shaanxi, China.
| | - Di Fan
- Department of Radiology, Shaanxi Mineral Hospital, Xi'an, Shaanxi, China
| | - Chaoran Ma
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Yanru He
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West 5th Road, Xi'an 710004, Shaanxi, China
| | - Ming Wang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yaowu Zhu
- Department of Laboratory Medicine, Tongji Hospital of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiangsun Zheng
- Department of Cardiology, Second Affiliated Hospital of Xi'an Jiaotong University, No. 157 West 5th Road, Xi'an 710004, Shaanxi, China
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26
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Abstract
The current, global situation regarding the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic and its potentially devastating clinical manifestations, i.e. coronavirus disease 2019 (COVID-19), took the world by storm, as millions of people have been infected worldwide and more than 1,600,000 patients have succumbed. Infection induced by various respiratory viruses may lead to thrombotic complications. Infection-elicited thrombosis may involve a repertoire of distinct, yet interconnected pathophysiological mechanisms, implicating a hyperinflammatory response, platelet activation and triggering of the coagulation cascade. In the present review, we present current knowledge on the pathophysiological mechanisms that may underlie thrombotic complications in SARS-CoV-2 infection. Furthermore, we provide clinical data regarding the incidence rate of thrombotic events in several viral respiratory infections that cause acute respiratory distress syndrome, including SARS-CoV-2 infection and finally we summarize current recommendations concerning thromboprophylaxis and antithrombotic therapy in patients with thrombotic complications related to SARS-CoV-2 infection.
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27
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Nomogram prediction of severe risk in patients with COVID-19 pneumonia. Epidemiol Infect 2021. [PMCID: PMC8692843 DOI: 10.1017/s0950268821002545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) elicits a range of different responses in patients and can manifest into mild to very severe cases in different individuals, depending on many factors. We aimed to establish a prediction model of severe risk in COVID-19 patients, to help clinicians achieve early prevention, intervention and aid them in choosing effective therapeutic strategy. We selected confirmed COVID-19 patients who were admitted to First Hospital of Changsha city between 29 January and 15 February 2020 and collected their clinical data. Multivariate logical regression was used to identify the factors associated with severe risk. These factors were incorporated into the nomogram to establish the model. The ROC curve, calibration plot and decision curve were used to assess the performance of the model. A total of 228 patients were enrolled and 33 (14.47%) patients developed severe pneumonia. Univariate and multivariate analysis showed that shortness of breath, fatigue, creatine kinase, lymphocytes and h CRP were independent factors for severe risk in COVID-19 patients. Incorporating age, chronic obstructive pulmonary disease (COPD) and these factors, the nomogram achieved good concordance indexes of 0.89 [95% confidence interval (CI) 0.832–0.949] and well-fitted calibration plot curves (Hosmer–Lemeshow test: P = 0.97). The model provided superior net benefit when clinical decision thresholds were between 15% and 85% predicted risk. Using the model, clinicians can intervene early, improve therapeutic effects and reduce the severity of COVID-19, thus ensuring more targeted and efficient use of medical resources.
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28
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Baptista AF, Baltar A, Okano AH, Moreira A, Campos ACP, Fernandes AM, Brunoni AR, Badran BW, Tanaka C, de Andrade DC, da Silva Machado DG, Morya E, Trujillo E, Swami JK, Camprodon JA, Monte-Silva K, Sá KN, Nunes I, Goulardins JB, Bikson M, Sudbrack-Oliveira P, de Carvalho P, Duarte-Moreira RJ, Pagano RL, Shinjo SK, Zana Y. Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19. Front Neurol 2020; 11:573718. [PMID: 33324324 PMCID: PMC7724108 DOI: 10.3389/fneur.2020.573718] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.
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Affiliation(s)
- Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Adriana Baltar
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Specialized Neuromodulation Center—Neuromod, Recife, Brazil
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Brazilian Institute of Neuroscience and Neurotechnology Centros de Pesquisa, Investigação e Difusão - Fundação de Amparo à Pesquisa do Estado de São Paulo (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, Brazil
- Graduate Program in Physical Education, State University of Londrina, Londrina, Brazil
| | - Alexandre Moreira
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | | | - Ana Mércia Fernandes
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - André Russowsky Brunoni
- Serviço Interdisciplinar de Neuromodulação, Laboratório de Neurociências (LIM-27), Instituto Nacional de Biomarcadores em Neuropsiquiatria, São Paulo, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Clarice Tanaka
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Daniel Ciampi de Andrade
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Centro de Dor, LIM-62, Departamento de Neurologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Edgard Morya
- Edmond and Lily Safra International Neuroscience Institute, Santos Dumont Institute, Macaiba, Brazil
| | - Eduardo Trujillo
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Jaiti K. Swami
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | - Joan A. Camprodon
- Laboratory for Neuropsychiatry and Neuromodulation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Katia Monte-Silva
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
| | - Katia Nunes Sá
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Isadora Nunes
- Department of Physiotherapy, Pontifícia Universidade Católica de Minas Gerais, Betim, Brazil
| | - Juliana Barbosa Goulardins
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
- Laboratory of Medical Investigations 54 (LIM-54), São Paulo University, São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Universidade Cruzeiro do Sul (UNICSUL), São Paulo, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY, United States
| | | | - Priscila de Carvalho
- Instituto Central, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rafael Jardim Duarte-Moreira
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
- NAPeN Network (Rede de Núcleos de Assistência e Pesquisa em Neuromodulação), Brazil
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Yossi Zana
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Possible Correlations between Atherosclerosis, Acute Coronary Syndromes and COVID-19. J Clin Med 2020; 9:jcm9113746. [PMID: 33233333 PMCID: PMC7700642 DOI: 10.3390/jcm9113746] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
An outbreak of SARS-CoV-2 infection in December 2019 became a major global concern in 2020. Since then, several articles analyzing the course, complications and mechanisms of the infection have appeared. However, there are very few papers explaining the possible correlations between COVID-19, atherosclerosis and acute coronary syndromes. We performed an analysis of PubMed, Cochrane, Google Scholar, and MEDLINE databases. As of September 15, 2020, the results were as follows: for "COVID-19" and "cardiovascular system" we obtained 687 results; for "COVID-19" and "myocardial infarction" together with "COVID-19" and "acute coronary syndrome" we obtained 328 results; for "COVID-19" and "atherosclerosis" we obtained 57 results. Some of them did not fulfill the search criteria or concerned the field of neurology. Only articles written in English, German and Polish were analyzed for a total number of 432 papers. While the link between inflammatory response, COVID- 19 and atherosclerosis still remains unclear, there is evidence that suggests a more likely correlation between them. Practitioners' efforts should be focused on the prevention of excessive inflammatory response and possible complications, while there are limited specific therapeutic options against SARS-CoV-2. Furthermore, special attention should be paid to cardioprotection during the pandemic.
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30
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Cornejo-Pareja IM, Gómez-Pérez AM, Fernández-García JC, Barahona San Millan R, Aguilera Luque A, de Hollanda A, Jiménez A, Jimenez-Murcia S, Munguia L, Ortega E, Fernandez-Aranda F, Fernández Real JM, Tinahones F. Coronavirus disease 2019 (COVID-19) and obesity. Impact of obesity and its main comorbidities in the evolution of the disease. EUROPEAN EATING DISORDERS REVIEW 2020; 28:799-815. [PMID: 32974994 DOI: 10.1002/erv.2770] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/22/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic is posing a great challenge worldwide. Its rapid progression has caused thousands of deaths worldwide. Although multiple aspects remain to be clarified, some risk factors associated with a worse prognosis have been identified. These include obesity and some of its main complications, such as diabetes and high blood pressure. Furthermore, although the possible long-term complications and psychological effects that may appear in survivors of COVID-19 are not well known yet, there is a concern that those complications may be greater in obese patients. In this manuscript, we review some of the data published so far and the main points that remain to be elucidated are emphasized.
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Affiliation(s)
- Isabel M Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - Ana M Gómez-Pérez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - José C Fernández-García
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain
| | - Rebeca Barahona San Millan
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain
| | - Alexandre Aguilera Luque
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain
| | - Ana de Hollanda
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Amanda Jiménez
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Susana Jimenez-Murcia
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Lucero Munguia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, August Pi i Sunyer Biomedical Research Institute-IDIBAPS, Hospital Clínic of Barcelona, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Fernando Fernandez-Aranda
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain.,Department of Psychiatry, University Hospital of Bellvitge-IDIBELL and Department of Clinical Sciences, School of Medicine and Health Sciences. University of Barcelona, Barcelona, Spain
| | - José M Fernández Real
- Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta, 17007, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona, and Department of Medical Sciences, University of Girona, Girona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
| | - Francisco Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Virgen de la Victoria University Hospital, Málaga, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), ISCIII, Madrid, Spain
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31
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Wang A, Gao G, Wang S, Chen M, Qian F, Tang W, Xu Y, Song R, Zhuang L, Ma X, Zhao T, Guo X, Li W, Wang X, Li B, Hu C, Chen Z, Zhang F. Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study. Med Sci Monit 2020; 26:e925974. [PMID: 32973126 PMCID: PMC7523414 DOI: 10.12659/msm.925974] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a new infectious disease, and acute respiratory syndrome (ARDS) plays an important role in the process of disease aggravation. The detailed clinical course and risk factors of ARDS have not been well described. Material/Methods We retrospectively investigated the demographic, clinical, and laboratory data of adult confirmed cases of COVID-19 in Beijing Ditan Hospital from Jan 20 to Feb 29, 2020 and compared the differences between ARDS cases and non-ARDS cases. Univariate and multivariate logistic regression methods were employed to explore the risk factors associated with ARDS. Results Of the 130 adult patients enrolled in this study, the median age was 46.5 (34–62) years and 76 (58.5%) were male. ARDS developed in 26 (20.0%) and 1 (0.8%) death occurred. Fever occurred in 114 patients, with a median highest temperature of 38.5 (38–39)°C and median fever duration of 8 (3–11) days. The median time from illness onset to ARDS was 10 (6–13) days, the median time to chest CT improvement was 17 (14–21) days, and median time to negative nucleic acid test result was 27 (17–33) days. Multivariate regression analysis showed increasing odds of ARDS associated with age older than 65 years (OR=4.75, 95% CL1.26–17.89, P=0.021), lymphocyte counts [0.5–1×109/L (OR=8.80, 95% CL 2.22–34.99, P=0.002); <0.5×109/L(OR=36.23, 95% CL 4.63–2083.48, P=0.001)], and temperature peak ≥39.1°C (OR=5.35, 95% CL 1.38–20.76, P=0.015). Conclusions ARDS tended to occur in the second week of the disease course. Potential risk factors for ARDS were older age (>65 years), lymphopenia (≤1.0×109/L), and temperature peak (≥39.1°C). These findings could help clinicians to predict which patients will have a poor prognosis at an early stage.
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Affiliation(s)
- Aibin Wang
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Guiju Gao
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Sa Wang
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Meiling Chen
- Medical Record Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Fang Qian
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Weiming Tang
- University of North Carolina Project-China, Chapel Hill, NC, USA
| | - Yanli Xu
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Rui Song
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Liwei Zhuang
- Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xiaoyang Ma
- Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Tianwei Zhao
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xiaodi Guo
- Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Wei Li
- Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Xudong Wang
- Surgical Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Baoliang Li
- Surgical Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Chun Hu
- Surgical Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Zhihai Chen
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Fujie Zhang
- Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland)
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32
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Parohan M, Yaghoubi S, Seraji A. Cardiac injury is associated with severe outcome and death in patients with Coronavirus disease 2019 (COVID-19) infection: A systematic review and meta-analysis of observational studies. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2020; 9:665-677. [PMID: 32567326 PMCID: PMC7678334 DOI: 10.1177/2048872620937165] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic impacting 213 countries/territories and more than 5,934,936 patients worldwide. Cardiac injury has been reported to occur in severe and death cases. This meta-analysis was done to summarize available findings on the association between cardiac injury and severity of COVID-19 infection. Online databases including Scopus, PubMed, Web of Science, Cochrane Library and Google Scholar were searched to detect relevant publications up to 20 May 2020, using relevant keywords. To pool data, a fixed- or random-effects model was used depending on the heterogeneity between studies. In total, 22 studies with 3684 COVID-19 infected patients (severe cases=1095 and death cases=365) were included in this study. Higher serum levels of lactate dehydrogenase (weighted mean difference (WMD) =108.86 U/L, 95% confidence interval (CI)=75.93-141.79, p<0.001) and creatine kinase-MB (WMD=2.60 U/L, 95% CI=1.32-3.88, p<0.001) were associated with a significant increase in the severity of COVID-19 infection. Furthermore, higher serum levels of lactate dehydrogenase (WMD=213.44 U/L, 95% CI=129.97-296.92, p<0.001), cardiac troponin I (WMD=26.35 pg/mL, 95% CI=14.54-38.15, p<0.001), creatine kinase (WMD=48.10 U/L, 95% CI=0.27-95.94, p = 0.049) and myoglobin (WMD=159.77 ng/mL, 95% CI=99.54-220.01, p<0.001) were associated with a significant increase in the mortality of COVID-19 infection. Cardiac injury, as assessed by serum analysis (lactate dehydrogenase, cardiac troponin I, creatine kinase (-MB) and myoglobin), was associated with severe outcome and death from COVID-19 infection.
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Affiliation(s)
- Mohammad Parohan
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Iran
| | - Sajad Yaghoubi
- Department of Clinical Microbiology, Iranshahr University of Medical Sciences, Iran
| | - Asal Seraji
- Department of Nursing, Damavand Branch, Islamic Azad University, Iran
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Benedetti C, Waldman M, Zaza G, Riella LV, Cravedi P. COVID-19 and the Kidneys: An Update. Front Med (Lausanne) 2020; 7:423. [PMID: 32793615 PMCID: PMC7385132 DOI: 10.3389/fmed.2020.00423] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
The new coronavirus disease 2019 (COVID-19) has become a world health emergency. The disease predominantly effects individuals between 30 and 79 years of age with 81% of cases being classified as mild. Despite the majority of the general population displaying symptoms similar to the common cold, COVID-19 has also induced alveolar damage resulting in progressive respiratory failure with fatalities noted in 6.4% of cases. Direct viral injury, uncontrolled inflammation, activation of coagulation, and complement cascades are thought to participate in disease pathogenesis. Patients with COVID-19 have displayed kidney damage through acute kidney injury, mild proteinuria, hematuria, or slight elevation in creatinine possibly as consequence of kidney tropism of the virus and multiorgan failure. The impact of COVID-19 on patients with pre-existing kidney impairment, including those with chronic kidney disease, kidney transplant recipients, and individuals on hemodialysis (HD) has not yet been clearly established. No specific treatments for COVID-19 have been found yet. Research has revealed several agents that may have potential efficacy against COVID-19, and many of these molecules have demonstrated preliminary efficacy against COVID-19 and are currently being tested in clinical trials.
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Affiliation(s)
- Claudia Benedetti
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Meryl Waldman
- Kidney Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Leonardo V. Riella
- Renal Division, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Paolo Cravedi
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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34
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Is there a role for lung perfusion [ 99mTc]-MAA SPECT/CT to rule out pulmonary embolism in COVID-19 patients with contraindications for iodine contrast? Eur J Nucl Med Mol Imaging 2020; 47:2062-2063. [PMID: 32350559 PMCID: PMC7190372 DOI: 10.1007/s00259-020-04837-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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35
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Yang Q, Zhou Y, Wang X, Gao S, Xiao Y, Zhang W, Hu Y, Wang Y. Effect of hypertension on outcomes of adult inpatients with COVID-19 in Wuhan, China: a propensity score-matching analysis. Respir Res 2020; 21:172. [PMID: 32631365 PMCID: PMC7336415 DOI: 10.1186/s12931-020-01435-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have shown that Coronavirus Disease 2019 (COVID-19) patients with underlying comorbidities can have worse outcomes. However, the effect of hypertension on outcomes of COVID-19 patients remains unclear. Research question The aim of this study was to explore the effect of hypertension on the outcomes of patients with COVID-19 by using propensity score–matching (PSM) analysis. Study design and methods Participants enrolled in this study were patients with COVID-19 who had been hospitalized at the Central Hospital of Wuhan, China. Chronic comorbidities and laboratory and radiological data were reviewed; patient outcomes and lengths of stay were obtained from discharge records. We used the Cox proportional-hazard model (CPHM) to analyze the effect of hypertension on these patients’ outcomes and PSM analysis to further validate the abovementioned effect. Results A total of 226 patients with COVID-19 were enrolled in this study, of whom 176 survived and 50 died. The proportion of patients with hypertension among non-survivors was higher than that among survivors (26.70% vs. 74.00%; P < 0.001). Results obtained via CPHM showed that hypertension could increase risk of mortality in COVID-19 patients (hazard ratio 3.317; 95% CI [1.709–6.440]; P < 0.001). Increased D-dimer levels and higher ratio of neutrophils to lymphocytes (N/L) were also found to increase these patients’ mortality risk. After matching on propensity score, we still came to similar conclusions. After we applied the same method in critically ill patients, we found that hypertension also increased risk of death in patients with severe COVID-19. Conclusion Hypertension, increased D-dimer and the ratio of neutrophil to lymphocyte increased mortality in patients with COVID-19, with hypertension in particular.
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Affiliation(s)
- Qing Yang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Ying Zhou
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Xinrong Wang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Shan Gao
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Yang Xiao
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Weiming Zhang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Yi Hu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China
| | - Yafei Wang
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26 Shengli Street, Wuhan, 430014, China.
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36
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Ma S, Lai X, Chen Z, Tu S, Qin K. Clinical characteristics of critically ill patients co-infected with SARS-CoV-2 and the influenza virus in Wuhan, China. Int J Infect Dis 2020; 96:683-687. [PMID: 32470606 PMCID: PMC7250072 DOI: 10.1016/j.ijid.2020.05.068] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To delineate the clinical characteristics of critically ill COVID-19 patients co-infected with influenza. METHODS This study included adult patients with laboratory-confirmed COVID-19 form Tongji Hospital (Wuhan, China), with or without influenza, and compared their clinical characteristics. RESULTS Among 93 patients, 44 died and 49 were discharged. Forty-four (47.3%) were infected with influenza virus A and two (2.2%) with influenza virus B. Twenty-two (50.0%) of the non-survivors and 24 (49.0%) of the survivors were infected with the influenza virus. Critically ill COVID-19 patients with influenza were more prone to cardiac injury than those without influenza. For the laboratory indicators at admission the following were higher in non-survivors with influenza than in those without influenza: white blood cell counts, neutrophil counts, levels of tumor necrosis factor-α, D-dimer value, and proportion of elevated creatinine. CONCLUSION The results showed that a high proportion of COVID-19 patients were co-infected with influenza in Tongji Hospital, with no significant difference in the proportion of co-infection between survivors and non-survivors. The critically ill COVID-19 patients with influenza exhibited more severe inflammation and organ injury, indicating that co-infection with the influenza virus may induce an earlier and more frequently occurring cytokine storm.
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Affiliation(s)
- Simin Ma
- Department of Nosocomial Infection Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoquan Lai
- Department of Nosocomial Infection Management, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Chen
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shenghao Tu
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Qin
- Department of Integrated Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Schiavone M, Gobbi C, Biondi-Zoccai G, D’Ascenzo F, Palazzuoli A, Gasperetti A, Mitacchione G, Viecca M, Galli M, Fedele F, Mancone M, Forleo GB. Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties. J Clin Med 2020; 9:E1683. [PMID: 32498230 PMCID: PMC7356537 DOI: 10.3390/jcm9061683] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Since an association between myocardial infarction (MI) and respiratory infections has been described for influenza viruses and other respiratory viral agents, understanding possible physiopathological links between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and acute coronary syndromes (ACS) is of the greatest importance. The initial data suggest an underestimation of ACS cases all over the world, but acute MI still represents a major cause of morbidity and mortality worldwide and should not be overshadowed during the coronavirus disease (Covid-19) pandemic. No common consensus regarding the most adequate healthcare management policy for ACS is currently available. Indeed, important differences have been reported between the measures employed to treat ACS in China during the first disease outbreak and what currently represents clinical practice across Europe and the USA. This review aims to discuss the pathophysiological links between MI, respiratory infections, and Covid-19; epidemiological data related to ACS at the time of the Covid-19 pandemic; and learnings that have emerged so far from several catheterization labs and coronary care units all over the world, in order to shed some light on the current strategies for optimal management of ACS patients with confirmed or suspected SARS-CoV-2 infection.
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Affiliation(s)
- Marco Schiavone
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy;
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Fabrizio D’Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin, 10126 Turin, Italy;
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Department of Medical Sciences, AOUS Le Scotte Hospital, University of Siena, 53100 Siena, Italy;
| | - Alessio Gasperetti
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Gianfranco Mitacchione
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Maurizio Viecca
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
| | - Massimo Galli
- Department of Infectious Diseases, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Francesco Fedele
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Massimo Mancone
- Department of Clinical Internal, Anesthesiological and Cardiovascular Science, Sapienza University of Rome, 00161 Rome, Italy;
| | - Giovanni Battista Forleo
- Department of Cardiology, ASST-Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (M.S.); (A.G.); (G.M.); (M.V.); (G.B.F.)
- University of Milan, 20122 Milan, Italy;
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Benussi A, Pilotto A, Premi E, Libri I, Giunta M, Agosti C, Alberici A, Baldelli E, Benini M, Bonacina S, Brambilla L, Caratozzolo S, Cortinovis M, Costa A, Cotti Piccinelli S, Cottini E, Cristillo V, Delrio I, Filosto M, Gamba M, Gazzina S, Gilberti N, Gipponi S, Imarisio A, Invernizzi P, Leggio U, Leonardi M, Liberini P, Locatelli M, Masciocchi S, Poli L, Rao R, Risi B, Rozzini L, Scalvini A, Schiano di Cola F, Spezi R, Vergani V, Volonghi I, Zoppi N, Borroni B, Magoni M, Pezzini A, Padovani A. Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology 2020; 95:e910-e920. [DOI: 10.1212/wnl.0000000000009848] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023] Open
Abstract
ObjectiveTo report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19).MethodsIn this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period.ResultsOne hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0–83.8 years vs 70.1 years, IQR 52.9–78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7–1.1 vs 0.5, IQR 0.4–0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0–6.0 vs 2.0, IQR 1.0–3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21–16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97–0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00–1.03, p = 0.009) on admission.ConclusionsPatients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054-1062. [PMID: 32171076 PMCID: PMC7270627 DOI: 10.1016/s0140-6736(20)30566-3] [Citation(s) in RCA: 17533] [Impact Index Per Article: 4383.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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Affiliation(s)
- Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ting Yu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Ronghui Du
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ying Liu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Xiang
- Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Lulu Guan
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuan Wei
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xudong Wu
- GCP Center, Jinyintan Hospital, Wuhan, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Shengjin Tu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China.
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. LANCET (LONDON, ENGLAND) 2020. [PMID: 32171076 DOI: 10.1016/s0140-6736(20)30566-3,] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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Affiliation(s)
- Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ting Yu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Ronghui Du
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ying Liu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Xiang
- Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Lulu Guan
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuan Wei
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xudong Wu
- GCP Center, Jinyintan Hospital, Wuhan, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Shengjin Tu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China.
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H, Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. LANCET (LONDON, ENGLAND) 2020. [PMID: 32171076 DOI: 10.1016/s0140-6736(20)30566-3;] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. METHODS In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. FINDINGS 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. INTERPRETATION The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. FUNDING Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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Affiliation(s)
- Fei Zhou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ting Yu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Ronghui Du
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Guohui Fan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Ying Liu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Zhibo Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Xiang
- Department of Clinical Laboratory, Jinyintan Hospital, Wuhan, China
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Bin Song
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Lulu Guan
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Yuan Wei
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xudong Wu
- GCP Center, Jinyintan Hospital, Wuhan, China
| | - Jiuyang Xu
- Tsinghua University School of Medicine, Beijing, China
| | - Shengjin Tu
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China
| | - Yi Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Tuberculosis and Respiratory Disease, Jinyintan Hospital, Wuhan, China.
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China; Tsinghua University School of Medicine, Beijing, China.
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Alemzadeh-Ansari M. Coronavirus disease 2019 (COVID-19) and cardiovascular events. Res Cardiovasc Med 2020. [DOI: 10.4103/rcm.rcm_9_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhyvotovska A, Yusupov D, Foronjy R, Nakeshbandi M, McFarlane SI, Salifu M. Insights into Potential Mechanisms of Injury and Treatment Targets in COVID-19, SARS-Cov-2 Infection. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2020; 5:147. [PMID: 32676542 PMCID: PMC7365577 DOI: 10.15344/2456-8007/2020/147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2, SARS-CoV-2, is the most serious pandemic in modern times. The disease was first reported in January of 2020 in China's city of Wuhan, Hubei province, and since then it has spread worldwide. Given the rapid spread of the virus and the burden it has taken on the healthcare systems it has swept through, there is the need for a concise description of current understanding of the pathogenesis of organ failure in SARS-CoV-2 infection while acknowledging that more is yet to be uncovered. This review will not only inform decision making at the bedside but will also help illustrate potential therapeutic targets for research. We searched the available literature to-date, and present the pathophysiology underlying increased morbidity and mortality of SARS-CoV-2 infection in the lungs, heart and kidneys in a highly illustrated presentation that is easy-to-understand for the clinician, researcher, and student alike.
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Affiliation(s)
| | | | | | | | - Samy I McFarlane
- Corresponding Author: Prof. Samy I. McFarlane, College of Medicine, Department of Medicine, Division of Endocrinology, Internal Medicine Residency Program Director, State University of New York, Downstate Medical Center, 450 Clarkson Ave, Box 50, Brooklyn, New York, USA, Tel: 718-270-6707, Fax: 718-270-4488;
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