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Nasir N, Tajuddin S, Akhtar A, Sheikh CF, Al Karim Manji A, Bhutto S, Khan N, Khan A, Khan MF, Mahmood SF, Jamil B, Khanum I, Habib K, Latif A, Samad Z, Haider AH. Risk factors for mortality in hospitalized COVID-19 patients across five waves in Pakistan. Sci Rep 2024; 14:20205. [PMID: 39215007 PMCID: PMC11364537 DOI: 10.1038/s41598-024-70662-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
This retrospective cohort study aims to describe the clinical characteristics and outcomes and assess risk factors for mortality across the epidemic waves in hospitalized COVID-19 patients in a major tertiary-care center in Pakistan. A total of 5368 patients with COVID-19, hospitalized between March 2020 and April 2022 were included. The median age was 58 years (IQR: 44-69), 41% were females, and the overall mortality was 12%. Comparative analysis of COVID-19 waves showed that the proportion of patients aged ≥ 60 years was highest during the post-wave 4 period (61.4%) and Wave 4 (Delta) (50%) (p < 0.001). Male predominance decreased from 65.2% in Wave 2 to 44.2% in Wave 5 (Omicron) (p < 0.001). Mortality rate was lowest at 9.4% in wave 5 and highest at 21.6% in the post-wave 4 period (p = 0.041). In multivariable analysis for risk factors of mortality, acute respiratory distress syndrome (ARDS) was most strongly associated with mortality (aOR 22.98, 95% CI 15.28-34.55, p < 0.001), followed by need for mechanical ventilation (aOR 6.81, 95% CI 5.13-9.05, p < 0.001). Other significant risk factors included acute kidney injury (aOR 3.05, 95% CI 2.38-3.91, p < 0.001), stroke (aOR 2.40, 95% CI 1.26-4.60, p = 0.008), pulmonary embolism (OR 2.07, 95% CI 1.28-3.35, p = 0.003), and age ≥ 60 years (aOR 2.45, 95% CI 1.95-3.09, p < 0.001). Enoxaparin use was associated with lower mortality odds (aOR 0.45, 95% CI 0.35-0.60, p < 0.001. Patients hospitalized during Wave 4 (aOR 2.22, 95% CI 1.39-3.56, p < 0.001) and the post-wave 4 period (aOR 2.82, 95% CI 1.37-5.80, p = 0.005) had higher mortality odds compared to other waves. The study identifies higher mortality risk in patients admitted in Delta wave and post-wave, aged ≥ 60 years, and with respiratory and renal complications, and lower risk with anticoagulation during COVID-19 waves.
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Affiliation(s)
- Nosheen Nasir
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Salma Tajuddin
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Afshan Akhtar
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Chanza Fahim Sheikh
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Naveera Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Adnan Khan
- Medical College, Aga Khan University, Karachi, Pakistan
| | | | - Syed Faisal Mahmood
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Bushra Jamil
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Iffat Khanum
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Kiren Habib
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Asad Latif
- Department of Anesthesiology, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Section of Adult Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil H Haider
- Medical College, Aga Khan University, Karachi, Pakistan
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Chung YS, Lam CY, Tan PH, Tsang HF, Wong SCC. Comprehensive Review of COVID-19: Epidemiology, Pathogenesis, Advancement in Diagnostic and Detection Techniques, and Post-Pandemic Treatment Strategies. Int J Mol Sci 2024; 25:8155. [PMID: 39125722 PMCID: PMC11312261 DOI: 10.3390/ijms25158155] [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: 06/14/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
At present, COVID-19 remains a public health concern due to the ongoing evolution of SARS-CoV-2 and its prevalence in particular countries. This paper provides an updated overview of the epidemiology and pathogenesis of COVID-19, with a focus on the emergence of SARS-CoV-2 variants and the phenomenon known as 'long COVID'. Meanwhile, diagnostic and detection advances will be mentioned. Though many inventions have been made to combat the COVID-19 pandemic, some outstanding ones include multiplex RT-PCR, which can be used for accurate diagnosis of SARS-CoV-2 infection. ELISA-based antigen tests also appear to be potential diagnostic tools to be available in the future. This paper also discusses current treatments, vaccination strategies, as well as emerging cell-based therapies for SARS-CoV-2 infection. The ongoing evolution of SARS-CoV-2 underscores the necessity for us to continuously update scientific understanding and treatments for it.
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Affiliation(s)
| | | | | | | | - Sze-Chuen Cesar Wong
- Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China; (Y.-S.C.); (C.-Y.L.); (P.-H.T.); (H.-F.T.)
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Dong W, Miao Y, Shen Z, Zhang W, Bai J, Zhu D, Ren R, Zhang J, Wu J, Tarimo CS, Ojangba T, Li Y. Quantifying Disparities in COVID-19 Vaccination Rates by Rural and Urban Areas: Cross-Sectional Observational Study. JMIR Public Health Surveill 2024; 10:e50595. [PMID: 39028548 PMCID: PMC11297372 DOI: 10.2196/50595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 04/04/2024] [Accepted: 05/16/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Vaccination plays an important role in preventing COVID-19 infection and reducing the severity of the disease. There are usually differences in vaccination rates between urban and rural areas. Measuring these differences can aid in developing more coordinated and sustainable solutions. This information also serves as a reference for the prevention and control of emerging infectious diseases in the future. OBJECTIVE This study aims to assess the current coverage rate and influencing factors of COVID-19 (second booster) vaccination among Chinese residents, as well as the disparities between urban and rural areas in China. METHODS This cross-sectional study used a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining), and northeast (Mudanjiang) Mainland China from February 1 to February 18, 2023. The questionnaires were developed by experienced epidemiologists and contained the following: sociodemographic information, health conditions, vaccine-related information, information related to the Protective Motivation Theory (PMT), and the level of trust in the health care system. Vaccination rates among the participants were evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants. Urban-rural disparities in the vaccination rate were assessed using propensity score matching (PSM). RESULTS A total of 5780 participants were included, with 53.04% (3066/5780) being female. The vaccination rate was 12.18% (704/5780; 95% CI 11.34-13.02) in the total sample, 13.76% (341/2478; 95% CI 12.40-15.12) among the rural participants, and 10.99% (363/3302; 95% CI 9.93-12.06) among the urban participants. For rural participants, self-reported health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the health care system were independent factors associated with vaccination (all P<.05). For urban participants, chronic conditions, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the health care system were independent factors associated with vaccination (all P<.05). PSM analysis uncovered a 3.42% difference in vaccination rates between urban and rural participants. CONCLUSIONS The fourth COVID-19 vaccination coverage rate (second booster) among the Chinese population was extremely low, significantly lower than the previous vaccine coverage rate. Given that COVID-19 infection is still prevalent at low levels, efforts should focus on enhancing self-efficacy to expand the vaccine coverage rate among the Chinese population. For rural residents, building awareness of the vaccine's benefits and improving their overall health status should be prioritized. In urban areas, a larger proportion of people with COVID-19 and patients with chronic illness should be vaccinated.
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Affiliation(s)
- Wenyong Dong
- Department of Hypertension, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Clifford Silver Tarimo
- Department of Science and Laboratory Technology, Dar Es Salaam Institute of Technology, Dar es Salaam, United Republic of Tanzania
| | - Theodora Ojangba
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
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Murthy SC, Gordon SM, Lowry AM, Blackstone EH. Evolution of serious and life-threatening COVID-19 pneumonia as the SARS-CoV-2 pandemic progressed: an observational study of mortality to 60 days after admission to a 15-hospital US health system. BMJ Open 2024; 14:e075028. [PMID: 38977360 PMCID: PMC11256047 DOI: 10.1136/bmjopen-2023-075028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/13/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE In order to predict at hospital admission the prognosis of patients with serious and life-threatening COVID-19 pneumonia, we sought to understand the clinical characteristics of hospitalised patients at admission as the SARS-CoV-2 pandemic progressed, document their changing response to the virus and its variants over time, and identify factors most importantly associated with mortality after hospital admission. DESIGN Observational study using a prospective hospital systemwide COVID-19 database. SETTING 15-hospital US health system. PARTICIPANTS 26 872 patients admitted with COVID-19 to our Northeast Ohio and Florida hospitals from 1 March 2020 to 1 June 2022. MAIN OUTCOME MEASURES 60-day mortality (highest risk period) after hospital admission analysed by random survival forests machine learning using demographics, medical history, and COVID-19 vaccination status, and viral variant, symptoms, and routine laboratory test results obtained at hospital admission. RESULTS Hospital mortality fell from 11% in March 2020 to 3.7% in March 2022, a 66% decrease (p<0.0001); 60-day mortality fell from 17% in May 2020 to 4.7% in May 2022, a 72% decrease (p<0.0001). Advanced age was the strongest predictor of 60-day mortality, followed by admission laboratory test results. Risk-adjusted 60-day mortality had all patients been admitted in March 2020 was 15% (CI 3.0% to 28%), and had they all been admitted in May 2022, 12% (CI 2.2% to 23%), a 20% decrease (p<0.0001). Dissociation between observed and predicted decrease in mortality was related to temporal change in admission patient profile, particularly in laboratory test results, but not vaccination status or viral variant. CONCLUSIONS Hospital mortality from COVID-19 decreased substantially as the pandemic evolved but persisted after hospital discharge, eclipsing hospital mortality by 50% or more. However, after accounting for the many, even subtle, changes across the pandemic in patients' demographics, medical history and particularly admission laboratory results, a patient admitted early in the pandemic and predicted to be at high risk would remain at high risk of mortality if admitted tomorrow.
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Affiliation(s)
- Sudish C Murthy
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ashley M Lowry
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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Trøseid M. Viral, Host Factors or Both as COVID-19 Biomarkers. Clin Infect Dis 2024; 78:1504-1505. [PMID: 38376208 DOI: 10.1093/cid/ciad779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- Marius Trøseid
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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6
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Lebold KM, Moore AR, Sanchez PA, Pacheco‐Navarro AE, O'Donnell C, Roque J, Parmer C, Pienkos S, Levitt J, Collins WJ, Rogers AJ, Wilson JG. Association between emergency department disposition and mortality in patients with COVID-19 acute respiratory distress syndrome. J Am Coll Emerg Physicians Open 2024; 5:e13192. [PMID: 38887225 PMCID: PMC11180691 DOI: 10.1002/emp2.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 06/20/2024] Open
Abstract
Objectives Patients hospitalized for COVID-19 frequently develop hypoxemia and acute respiratory distress syndrome (ARDS) after admission. In non-COVID-19 ARDS studies, admission to hospital wards with subsequent transfer to intensive care unit (ICU) is associated with worse outcomes. We hypothesized that initial admission to the ward may affect outcomes in patient with COVID-19 ARDS. Methods This was a retrospective study of consecutive adults admitted for COVID-19 ARDS between March 2020 and March 2021 at Stanford Health Care. Mortality scores at hospital admission (Coronavirus Clinical Characterization Consortium Mortality Score [4C score]) and ICU admission (Simplified Acute Physiology Score III [SAPS-III]) were calculated, as well as ROX index for patients on high flow nasal oxygen. Patients were classified by emergency department (ED) disposition (ward-first vs. ICU-direct), and 28- and 60-day mortality and highest level of respiratory support within 1 day of ICU admission were compared. A second cohort (April 2021‒July 2022, n = 129) was phenotyped to validate mortality outcome. Results A total of 157 patients were included, 48% of whom were first admitted to the ward (n = 75). Ward-first patients had more comorbidities, including lung disease. Ward-first patients had lower 4C and similar SAPS-III score, yet increased mortality at 28 days (32% vs. 17%, hazard ratio [HR] 2.0, 95% confidence interval [95% CI] 1.0‒3.7, p = 0.039) and 60 days (39% vs. 23%, HR 1.83, 95% CI 1.04‒3.22, p = 0.037) compared to ICU-direct patients. More ward-first patients escalated to mechanical ventilation on day 1 of ICU admission (36% vs. 14%, p = 0.002) despite similar ROX index. Ward-first patients who upgraded to ICU within 48 h of ED presentation had the highest mortality. Mortality findings were replicated in a sensitivity analysis. Conclusion Despite similar baseline risk scores, ward-first patients with COVID-19 ARDS had increased mortality and escalation to mechanical ventilation compared to ICU-direct patients. Ward-first patients requiring ICU upgrade within 48 h were at highest risk, highlighting a need for improved identification of this group at ED admission.
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Affiliation(s)
- Katie M. Lebold
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Andrew R. Moore
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Pablo A. Sanchez
- Division of Cardiovascular Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Ana E. Pacheco‐Navarro
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Christian O'Donnell
- Division of Cardiovascular Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Jonasel Roque
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Caitlin Parmer
- Divison of Hospital Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Shaun Pienkos
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Joseph Levitt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - William J. Collins
- Divison of Hospital Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Angela J. Rogers
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Jennifer G. Wilson
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
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Montejano R, Soler-Carracedo A, Borobia AM, Martin-Quiros A, Grandioso D, Cañada C, Roman A, Arribas JR. The Current Mismatch Between COVID-19 Clinical Trial Design and the Evolving Profile of Hospitalized Patients: A Retrospective Cohort Analysis. Clin Infect Dis 2024; 78:918-921. [PMID: 37882613 DOI: 10.1093/cid/ciad655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/04/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023] Open
Abstract
Evaluating 100 adult coronavirus disease 2019 (COVID-19) patients at a Madrid hospital, we identified a mismatch between current clinical trial designs and the evolving profile of hospitalized patients. Most patients were ineligible due to design constraints, suggesting a need to rethink trial criteria for a more accurate representation of the hospitalized COVID-19 cohort.
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Affiliation(s)
- Rocio Montejano
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Alfredo Soler-Carracedo
- Clinical Trial Unit, Clinical Pharmacology Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - Alberto M Borobia
- Clinical Pharmacology Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, School of Medicine, Autonomous University of Madrid, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Alejandro Martin-Quiros
- Emergency Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - David Grandioso
- Microbiology Department, La Paz University Hospital, Madrid, Spain
| | - Carlos Cañada
- Emergency Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - Alicia Roman
- Emergency Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - Jose R Arribas
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Instituto de Investigación del Hospital Universitario La Paz, School of Medicine, Autonomous University of Madrid, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
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8
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Lauring AS, Gaglani M, Ghamande S, Peltan ID, Brown SM, Ginde AA, Martinez A, Mohr NM, Gibbs KW, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Srinivasan V, Steingrub JS, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Bendall EE, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Mosier JM, Safdar B, Casey JD, Talbot HK, Rice TW, Halasa N, Chappell JD, Grijalva CG, Baughman A, Womack KN, Swan SA, Johnson CA, Lwin CT, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Severity of Respiratory Syncytial Virus vs COVID-19 and Influenza Among Hospitalized US Adults. JAMA Netw Open 2024; 7:e244954. [PMID: 38573635 PMCID: PMC11192181 DOI: 10.1001/jamanetworkopen.2024.4954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 04/05/2024] Open
Abstract
Importance On June 21, 2023, the Centers for Disease Control and Prevention recommended the first respiratory syncytial virus (RSV) vaccines for adults aged 60 years and older using shared clinical decision-making. Understanding the severity of RSV disease in adults can help guide this clinical decision-making. Objective To describe disease severity among adults hospitalized with RSV and compare it with the severity of COVID-19 and influenza disease by vaccination status. Design, Setting, and Participants In this cohort study, adults aged 18 years and older admitted to the hospital with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 US states from February 1, 2022, to May 31, 2023. Clinical data during each patient's hospitalization were collected using standardized forms. Data were analyzed from August to October 2023. Exposures RSV, SARS-CoV-2, or influenza infection. Main Outcomes and Measures Using multivariable logistic regression, severity of RSV disease was compared with COVID-19 and influenza severity, by COVID-19 and influenza vaccination status, for a range of clinical outcomes, including the composite of invasive mechanical ventilation (IMV) and in-hospital death. Results Of 7998 adults (median [IQR] age, 67 [54-78] years; 4047 [50.6%] female) included, 484 (6.1%) were hospitalized with RSV, 6422 (80.3%) were hospitalized with COVID-19, and 1092 (13.7%) were hospitalized with influenza. Among patients with RSV, 58 (12.0%) experienced IMV or death, compared with 201 of 1422 unvaccinated patients with COVID-19 (14.1%) and 458 of 5000 vaccinated patients with COVID-19 (9.2%), as well as 72 of 699 unvaccinated patients with influenza (10.3%) and 20 of 393 vaccinated patients with influenza (5.1%). In adjusted analyses, the odds of IMV or in-hospital death were not significantly different among patients hospitalized with RSV and unvaccinated patients hospitalized with COVID-19 (adjusted odds ratio [aOR], 0.82; 95% CI, 0.59-1.13; P = .22) or influenza (aOR, 1.20; 95% CI, 0.82-1.76; P = .35); however, the odds of IMV or death were significantly higher among patients hospitalized with RSV compared with vaccinated patients hospitalized with COVID-19 (aOR, 1.38; 95% CI, 1.02-1.86; P = .03) or influenza disease (aOR, 2.81; 95% CI, 1.62-4.86; P < .001). Conclusions and Relevance Among adults hospitalized in this US cohort during the 16 months before the first RSV vaccine recommendations, RSV disease was less common but similar in severity compared with COVID-19 or influenza disease among unvaccinated patients and more severe than COVID-19 or influenza disease among vaccinated patients for the most serious outcomes of IMV or death.
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Affiliation(s)
- Diya Surie
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katharine A. Yuengling
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer DeCuir
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam S. Lauring
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Manjusha Gaglani
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Shekhar Ghamande
- Baylor Scott & White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
- Baylor College of Medicine, Temple, Texas
| | - Ithan D. Peltan
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Samuel M. Brown
- Department of Medicine, Intermountain Medical Center, Murray, Utah and University of Utah, Salt Lake City
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | - Amanda Martinez
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora
| | | | - Kevin W. Gibbs
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David N. Hager
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harith Ali
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew E. Prekker
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Michelle N. Gong
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Amira Mohamed
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Nicholas J. Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | | | - Jay S. Steingrub
- Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
| | - Aleda M. Leis
- School of Public Health, University of Michigan, Ann Arbor
| | - Akram Khan
- Department of Medicine, Oregon Health and Sciences University, Portland
| | | | | | - Abhijit Duggal
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Emily E. Bendall
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor
| | - Jennifer G. Wilson
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Nida Qadir
- Department of Medicine, University of California, Los Angeles
| | - Steven Y. Chang
- Department of Medicine, University of California, Los Angeles
| | | | - Jennie H. Kwon
- Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | | | - Nathan I. Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cristie Columbus
- Baylor Scott &White Health, Dallas, Texas
- Texas A&M University College of Medicine, Dallas
| | - Ivana A. Vaughn
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Mayur Ramesh
- Division of Infectious Diseases, Henry Ford Health, Detroit, Michigan
| | | | - Basmah Safdar
- Yale University School of Medicine, New Haven, Connecticut
| | - Jonathan D. Casey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - H. Keipp Talbot
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W. Rice
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natasha Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carlos G. Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrienne Baughman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelsey N. Womack
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sydney A. Swan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cassandra A. Johnson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cara T. Lwin
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nathaniel M. Lewis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith L. McMorrow
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Wesley H. Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Raja A, Khan O, Sagar RS, Kumar R, Bhimani PD, Bhimani RK, Danial M, Raja S, Deepak F, Shafique MA, Mustafa MS. Insights into Covid-19 mortality: A comprehensive study of cardiovascular sensitivity, gender, race, and geography trends in the United States (2020-2023). Curr Probl Cardiol 2024; 49:102435. [PMID: 38301913 DOI: 10.1016/j.cpcardiol.2024.102435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
This investigation meticulously explores the evolving landscape of Covid-19-related mortality in the United States from 2020 to 2023. Leveraging the comprehensive CDC WONDER database, the study conducts a detailed analysis of age-adjusted mortality rates (AAMRs), considering various demographic and regional parameters. The identified pattern illustrates an initial surge in AAMRs from 2020 to 2021, followed by a subsequent decline until 2023. Notably, there is a discernible reduction in AAMRs for both the elderly (85 years and older) and infants (below one year). Within specific demographic segments, heightened AAMRs are observed among NH American Indian or Alaska Native individuals, men, and residents in particular states and regions. Emphasizing the significant impact of Covid-19 on cardiovascular health, the study underscores increased mortality rates associated with the cardiovascular and respiratory systems. AAMR rates were standardized per 100,000 population, providing a comparative metric. Noteworthy states with elevated AAMRs include Mississippi, Oklahoma, Kentucky, New Mexico, and Alabama, with the Southern region exhibiting the highest AAMR. The research sheds light on demographic and regional disparities in Covid-19-related mortality, calling for intensified efforts in prevention and treatment strategies. These findings, offering nuanced insights, serve as a guide for strategic public health initiatives to mitigate the multifaceted repercussions of the pandemic, especially among vulnerable populations.
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Affiliation(s)
- Adarsh Raja
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Owais Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Rohet Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | | | | | - Muhammad Danial
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sandesh Raja
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Fnu Deepak
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
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10
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Zinna G, Pipitò L, Colomba C, Scichilone N, Licata A, Barbagallo M, Russo A, Almasio PL, Coppola N, Cascio A. COVID-19: The Development and Validation of a New Mortality Risk Score. J Clin Med 2024; 13:1832. [PMID: 38610597 PMCID: PMC11012743 DOI: 10.3390/jcm13071832] [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: 02/07/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic has found the whole world unprepared for its correct management. Italy was the first European country to experience the spread of the SARS-CoV-2 virus at the end of February 2020. As a result of hospital overcrowding, the quality of care delivered was not always optimal. A substantial number of patients admitted to non-ICU units could have been treated at home. It would have been extremely useful to have a score that, based on personal and clinical characteristics and simple blood tests, could have predicted with sufficient reliability the probability that a patient had or did not have a disease that could have led to their death. This study aims to develop a scoring system to identify which patients with COVID-19 are at high mortality risk upon hospital admission, to expedite and enhance clinical decision making. Methods: A retrospective analysis was performed to develop a multivariable prognostic prediction model. Results: Derivation and external validation cohorts were obtained from two Italian University Hospital databases, including 388 (10.31% deceased) and 1357 (7.68% deceased) patients with confirmed COVID-19, respectively. A multivariable logistic model was used to select seven variables associated with in-hospital death (age, baseline oxygen saturation, hemoglobin value, white blood cell count, percentage of neutrophils, platelet count, and creatinine value). Calibration and discrimination were satisfactory with a cumulative AUC for prediction mortality of 0.924 (95% CI: 0.893-0.944) in derivation cohorts and 0.808 (95% CI: 0.886-0.828) in external validation cohorts. The risk score obtained was compared with the ISARIC 4C Mortality Score, and with all the other most important scores considered so far, to evaluate the risk of death of patients with COVID-19. It performed better than all the above scores to evaluate the predictability of dying. Its sensitivity, specificity, and AUC were higher than the other COVID-19 scoring systems when the latter were calculated for the 388 patients in our derivation cohort. Conclusions: In conclusion, the CZ-COVID-19 Score may help all physicians by identifying those COVID-19 patients who require more attention to provide better therapeutic regimens or, on the contrary, by identifying those patients for whom hospitalization is not necessary and who could therefore be sent home without overcrowding healthcare facilities. We developed and validated a new risk score based on seven variables for upon-hospital admission of COVID-19 patients. It is very simple to calculate and performs better than all the other similar scores to evaluate the predictability of dying.
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Affiliation(s)
- Giuseppe Zinna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
- Department of Surgery, Dentistry, Paediatrics, and Gynaecology, Division of Cardiac Surgery, University of Verona Medical School, 37129 Verona, Italy
| | - Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
- Pediatric Infectious Disease Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy
| | - Nicola Scichilone
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Anna Licata
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Antonio Russo
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80131 Naples, Italy; (A.R.); (N.C.)
| | - Piero Luigi Almasio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
| | - Nicola Coppola
- Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Via Luciano Armanni 5, 80131 Naples, Italy; (A.R.); (N.C.)
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy; (G.Z.); (L.P.); (C.C.); (N.S.); (A.L.); (M.B.); (P.L.A.)
- Infectious and Tropical Disease Unit, AOU Policlinico “P. Giaccone”, Via del Vespro 129, 90127 Palermo, Italy
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11
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Bhavani SV, Robichaux C, Verhoef PA, Churpek MM, Coopersmith CM. Using Trajectories of Bedside Vital Signs to Identify COVID-19 Subphenotypes. Chest 2024; 165:529-539. [PMID: 37748574 PMCID: PMC10925543 DOI: 10.1016/j.chest.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/23/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Trajectories of bedside vital signs have been used to identify sepsis subphenotypes with distinct outcomes and treatment responses. The objective of this study was to validate the vitals trajectory model in a multicenter cohort of patients hospitalized with COVID-19 and to evaluate the clinical characteristics and outcomes of the resulting subphenotypes. RESEARCH QUESTION Can the trajectory of routine bedside vital signs identify COVID-19 subphenotypes with distinct clinical characteristics and outcomes? STUDY DESIGN AND METHODS The study included adult patients admitted with COVID-19 to four academic hospitals in the Emory Healthcare system between March 1, 2020, and May 31, 2022. Using a validated group-based trajectory model, we classified patients into previously defined vital sign trajectories using oral temperature, heart rate, respiratory rate, and systolic and diastolic BP measured in the first 8 h of hospitalization. Clinical characteristics, biomarkers, and outcomes were compared between subphenotypes. Heterogeneity of treatment effect to tocilizumab was evaluated. RESULTS The 7,065 patients with hospitalized COVID-19 were classified into four subphenotypes: group A (n = 1,429, 20%)-high temperature, heart rate, respiratory rate, and hypotensive; group B (1,454, 21%)-high temperature, heart rate, respiratory rate, and hypertensive; group C (2,996, 42%)-low temperature, heart rate, respiratory rate, and normotensive; and group D (1,186, 17%)-low temperature, heart rate, respiratory rate, and hypotensive. Groups A and D had higher ORs of mechanical ventilation, vasopressors, and 30-day inpatient mortality (P < .001). On comparing patients receiving tocilizumab (n = 55) with those who met criteria for tocilizumab but were admitted before its use (n = 461), there was significant heterogeneity of treatment effect across subphenotypes in the association of tocilizumab with 30-day mortality (P = .001). INTERPRETATION By using bedside vital signs available in even low-resource settings, we found novel subphenotypes associated with distinct manifestations of COVID-19, which could lead to preemptive and targeted treatments.
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Affiliation(s)
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Philip A Verhoef
- Department of Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, HI; Hawaii Permanente Medical Group, Honolulu, HI
| | | | - Craig M Coopersmith
- Emory Critical Care Center, Atlanta, GA; Department of Surgery, Emory University, Atlanta, GA
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12
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Sočan M, Mrzel M, Prosenc K, Korva M, Avšič-Županc T, Poljak M, Lunar MM, Zupanič T. Comparing COVID-19 severity in patients hospitalized for community-associated Delta, BA.1 and BA.4/5 variant infection. Front Public Health 2024; 12:1294261. [PMID: 38450129 PMCID: PMC10915065 DOI: 10.3389/fpubh.2024.1294261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Background Despite decreasing COVID-19 disease severity during the Omicron waves, a proportion of patients still require hospitalization and intensive care. Objective To compare demographic characteristics, comorbidities, vaccination status, and previous infections in patients hospitalized for community-associated COVID-19 (CAC) in predominantly Delta, Omicron BA.1 and BA.4/5 SARS-CoV-2 waves. Methods Data were extracted from three national databases-the National COVID-19 Database, National Vaccination Registry and National Registry of Hospitalizations. Results Among the hospitalized CAC patients analyzed in this study, 5,512 were infected with Delta, 1,120 with Omicron BA.1, and 1,143 with the Omicron BA.4/5 variant. The age and sex structure changed from Delta to BA.4/5, with the proportion of women (9.5% increase), children and adolescents (10.4% increase), and octa- and nonagenarians increasing significantly (24.5% increase). Significantly more patients had comorbidities (measured by the Charlson Comorbidity Index), 30.3% in Delta and 43% in BA.4/5 period. The need for non-invasive ventilatory support (NiVS), ICU admission, mechanical ventilation (MV), and in-hospital mortality (IHM) decreased from Delta to Omicron BA.4/5 period for 12.6, 13.5, 11.5, and 6.3%, respectively. Multivariate analysis revealed significantly lower odds for ICU admission (OR 0.68, CI 0.54-0.84, p < 0.001) and IHM (OR 0.74, CI 0.58-0.93, p = 0.011) during the Delta period in patients who had been fully vaccinated or boosted with a COVID-19 vaccine within the previous 6 months. In the BA.1 variant period, patients who had less than 6 months elapsed between the last vaccine dose and SARS-CoV-2 positivity had lower odds for MV (OR 0.38, CI 0.18-0.72, p = 0.005) and IHM (OR 0.56, CI 0.37- 0.83, p = 0.005), but not for NIVS or ICU admission. Conclusion The likelihood of developing severe CAC in hospitalized patients was higher in those with the Delta and Omicron BA.1 variant compared to BA.4/5.
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Affiliation(s)
- Maja Sočan
- National Institute of Public Health, Ljubljana, Slovenia
| | - Maja Mrzel
- National Institute of Public Health, Ljubljana, Slovenia
| | - Katarina Prosenc
- National Institute of Health, Environment and Food, Ljubljana, Slovenia
| | - Miša Korva
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Avšič-Županc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja M. Lunar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tina Zupanič
- National Institute of Public Health, Ljubljana, Slovenia
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13
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Berenguer J, Calvo-Alcántara MJ, Alvaro-Meca A, Estévez JC, Basanta M, Ruiz S, Matáix ÁL, Bienzóbas C, Cosano L, Silva AP, Salas P, Gullón P, Franco M, Arribas JR, Molero JM, Hernán MA. Three Years of the Coronavirus Disease 2019 Pandemic in a European Region: A Population-Based Longitudinal Assessment in Madrid Between 2020 and 2022. Open Forum Infect Dis 2024; 11:ofad635. [PMID: 38173846 PMCID: PMC10763997 DOI: 10.1093/ofid/ofad635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Background Our objective was to assess the health impact of coronavirus disease 2019 (COVID-19) during 2020-2022 in the Madrid region. Methods We included all individuals registered in the Madrid Health System Registry as of 31 December 2019, and followed them until 31 December 2022. Using a unique personal identifier, we linked the databases of primary care, hospitals, pharmacies, certified laboratories performing diagnostic tests, vaccines, and mortality. Results Of 6 833 423 individuals, 21.4% had a confirmed COVID-19 diagnosis, and 1.5% had a COVID-19 hospitalization (primary diagnosis). Thirty-day mortality was 1.6% for confirmed COVID-19 (from 11.4% in first semester 2020 to 0.4% in first semester 2022). Thirty-day mortality was 10.8% for COVID-19 hospitalizations (from 14.0% in first semester 2020 to 6.0% in second semester 2022). There were 24 073 deaths within 30 days of a confirmed COVID-19 diagnosis. Advanced age, male sex, higher socioeconomic deprivation, and comorbidities were associated with higher mortality. Conclusions By linking administrative and clinical databases, we characterized the burden of the COVID-19 pandemic in Madrid over 3 years. Our analysis proposes a high-level framework for comparisons of the burden of COVID-19 across areas worldwide.
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Affiliation(s)
- Juan Berenguer
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | | | - Alejandro Alvaro-Meca
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, Spain
| | - José C Estévez
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Miguel Basanta
- Dirección General de Sistemas de Información y Equipamientos Sanitarios, Madrid, Spain
| | - Sergio Ruiz
- Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Ángel L Matáix
- Subdirección General de Farmacia y Productos Sanitarios, Madrid, Spain
| | - César Bienzóbas
- Dirección General de Inspección y Ordenación Sanitaria, Madrid, Spain
| | - Lourdes Cosano
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Aura P Silva
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Salas
- Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pedro Gullón
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - Manuel Franco
- Departamento de Cirugía, Ciencias Médicas y Sociales, Grupo de Investigación en Epidemiología y Salud Pública, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
| | - José R Arribas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases, Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Miguel A Hernán
- CAUSALab, Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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14
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Prasad A, Rashmi KG, Sahoo J, Kamalanathan S, Wyawahare M, Anusuya R, Naik D. Male Hypogonadism After Recovery from Acute COVID-19 Infection: A Prospective Observational Study. Exp Clin Endocrinol Diabetes 2024; 132:23-32. [PMID: 38049105 DOI: 10.1055/a-2201-8816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 can affect the hypothalamic-pituitary-gonadal axis (HPG) due to the expression of the angiotensin-converting enzyme 2 receptor. OBJECTIVES To assess the prevalence of hypogonadism and Sertoli cell dysfunction in coronavirus disease 2019 (COVID-19) male survivors. METHOD Male subjects recovered from acute COVID-19 infection were prospectively observed. The primary outcomes included the proportion of hypogonadism, defined biochemically as serum testosterone<230 ng/dL or CFT of<6.4 ng/mL if the total testosterone is between 230-320 ng/m. Sertoli cell dysfunction was defined as inhibin-B level<54.5 pg/mL. Subjects with hypogonadism were followed up at 12 months to assess the recovery of the HPG axis. RESULTS Eighty-three subjects aged≥18 years were evaluated at a median of 120 (±35) days post-recovery. Their mean age was 49.50±12.73 years, and the mean BMI was 26.84±5.62 kg/m2. Low testosterone was detected in 21 (24.71%) and low inhibin-B was detected in 14 (19.71%) out of 71 subjects at 3 months. Subjects with low testosterone were younger, with a mean age of 43.29±12.03 years (P-0.08) and higher BMI (P-0.012). The severity of COVID-19 infection, duration of hospitalization, and other factors were not significantly associated with low testosterone. At 12 months, 18 out of 21 subjects came for follow-up, of which 9 (50%) showed persistently low testosterone, suggestive of hypogonadism. CONCLUSION Following COVID-19 infection, testosterone levels recovered over time; however, a significant proportion of subjects had low levels at 12-month follow-up. These findings have long-term implications for the management of COVID-19 subjects.
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Affiliation(s)
- Aravind Prasad
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - K G Rashmi
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Mukta Wyawahare
- Department of Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R Anusuya
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kojima N, Taylor CA, Tenforde MW, Ujamaa D, O’Halloran A, Patel K, Chai SJ, Daily Kirley P, Alden NB, Kawasaki B, Meek J, Yousey-Hindes K, Anderson EJ, Openo KP, Reeg L, Tellez Nunez V, Lynfield R, Como-Sabetti K, Ropp SL, Shaw YP, Spina NL, Barney G, Bushey S, Popham K, Moran NE, Shiltz E, Sutton M, Abdullah N, Talbot HK, Schaffner W, Chatelain R, Price A, Garg S, Havers FP, Bozio CH. Clinical Outcomes of US Adults Hospitalized for COVID-19 and Influenza in the Respiratory Virus Hospitalization Surveillance Network, October 2021-September 2022. Open Forum Infect Dis 2024; 11:ofad702. [PMID: 38269052 PMCID: PMC10807992 DOI: 10.1093/ofid/ofad702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Severe outcomes were common among adults hospitalized for COVID-19 or influenza, while the percentage of COVID-19 hospitalizations involving critical care decreased from October 2021 to September 2022. During the Omicron BA.5 period, intensive care unit admission frequency was similar for COVID-19 and influenza, although patients with COVID-19 had a higher frequency of in-hospital death.
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Affiliation(s)
- Noah Kojima
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A Taylor
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dawud Ujamaa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alissa O’Halloran
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Evan J Anderson
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Kyle P Openo
- School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Libby Reeg
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Val Tellez Nunez
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Susan L Ropp
- New Mexico Department of Health, Albuquerque, New Mexico, USA
| | - Yomei P Shaw
- New Mexico Department of Health, Albuquerque, New Mexico, USA
| | - Nancy L Spina
- New York State Department of Health, Albany, New York, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Sophrena Bushey
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | | | - Eli Shiltz
- Ohio Department of Health, Columbus, Ohio, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Nasreen Abdullah
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ryan Chatelain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Andrea Price
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Fiona P Havers
- Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Catherine H Bozio
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Harte JV, Coleman-Vaughan C, Crowley MP, Mykytiv V. It's in the blood: a review of the hematological system in SARS-CoV-2-associated COVID-19. Crit Rev Clin Lab Sci 2023; 60:595-624. [PMID: 37439130 DOI: 10.1080/10408363.2023.2232010] [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: 04/10/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global healthcare crisis. While SARS-CoV-2-associated COVID-19 affects primarily the respiratory system, patients with COVID-19 frequently develop extrapulmonary manifestations. Notably, changes in the hematological system, including lymphocytopenia, neutrophilia and significant abnormalities of hemostatic markers, were observed early in the pandemic. Hematological manifestations have since been recognized as important parameters in the pathophysiology of SARS-CoV-2 and in the management of patients with COVID-19. In this narrative review, we summarize the state-of-the-art regarding the hematological and hemostatic abnormalities observed in patients with SARS-CoV-2-associated COVID-19, as well as the current understanding of the hematological system in the pathophysiology of acute and chronic SARS-CoV-2-associated COVID-19.
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Affiliation(s)
- James V Harte
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- School of Biochemistry & Cell Biology, University College Cork, Cork, Ireland
| | | | - Maeve P Crowley
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
- Irish Network for Venous Thromboembolism Research (INViTE), Ireland
| | - Vitaliy Mykytiv
- Department of Haematology, Cork University Hospital, Wilton, Cork, Ireland
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17
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Allan-Blitz LT, Klausner JD. SARS-CoV-2 Case-Definitions Must Include Clinical Criteria: Reply to Kojima et al. Clin Infect Dis 2023; 77:1613-1614. [PMID: 37417204 DOI: 10.1093/cid/ciad413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/05/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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18
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Moskowitz A, Shotwell MS, Collins SP, Self WH. Response. Chest 2023; 164:e158-e159. [PMID: 37945202 DOI: 10.1016/j.chest.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, The Bronx, NY
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Sean P Collins
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Wesley H Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN.
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19
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Surie D, Yuengling KA, DeCuir J, Zhu Y, Gaglani M, Ginde AA, Talbot HK, Casey JD, Mohr NM, Ghamande S, Gibbs KW, Files DC, Hager DN, Ali H, Prekker ME, Gong MN, Mohamed A, Johnson NJ, Steingrub JS, Peltan ID, Brown SM, Leis AM, Khan A, Hough CL, Bender WS, Duggal A, Wilson JG, Qadir N, Chang SY, Mallow C, Kwon JH, Exline MC, Lauring AS, Shapiro NI, Columbus C, Vaughn IA, Ramesh M, Safdar B, Halasa N, Chappell JD, Grijalva CG, Baughman A, Rice TW, Womack KN, Han JH, Swan SA, Mukherjee I, Lewis NM, Ellington S, McMorrow ML, Martin ET, Self WH. Disease Severity of Respiratory Syncytial Virus Compared with COVID-19 and Influenza Among Hospitalized Adults Aged ≥60 Years - IVY Network, 20 U.S. States, February 2022-May 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:1083-1088. [PMID: 37796753 PMCID: PMC10564326 DOI: 10.15585/mmwr.mm7240a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
On June 21, 2023, CDC's Advisory Committee on Immunization Practices recommended respiratory syncytial virus (RSV) vaccination for adults aged ≥60 years, offered to individual adults using shared clinical decision-making. Informed use of these vaccines requires an understanding of RSV disease severity. To characterize RSV-associated severity, 5,784 adults aged ≥60 years hospitalized with acute respiratory illness and laboratory-confirmed RSV, SARS-CoV-2, or influenza infection were prospectively enrolled from 25 hospitals in 20 U.S. states during February 1, 2022-May 31, 2023. Multivariable logistic regression was used to compare RSV disease severity with COVID-19 and influenza severity on the basis of the following outcomes: 1) standard flow (<30 L/minute) oxygen therapy, 2) high-flow nasal cannula (HFNC) or noninvasive ventilation (NIV), 3) intensive care unit (ICU) admission, and 4) invasive mechanical ventilation (IMV) or death. Overall, 304 (5.3%) enrolled adults were hospitalized with RSV, 4,734 (81.8%) with COVID-19 and 746 (12.9%) with influenza. Patients hospitalized with RSV were more likely to receive standard flow oxygen, HFNC or NIV, and ICU admission than were those hospitalized with COVID-19 or influenza. Patients hospitalized with RSV were more likely to receive IMV or die compared with patients hospitalized with influenza (adjusted odds ratio = 2.08; 95% CI = 1.33-3.26). Among hospitalized older adults, RSV was less common, but was associated with more severe disease than COVID-19 or influenza. High disease severity in older adults hospitalized with RSV is important to consider in shared clinical decision-making regarding RSV vaccination.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - IVY Network
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC; Vanderbilt University Medical Center, Nashville, Tennessee; Baylor Scott & White Health, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Baylor, Scott & White Health, Dallas, Texas; University of Colorado School of Medicine, Aurora, Colorado; University of Iowa, Iowa City, Iowa; Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; Johns Hopkins Hospital, Baltimore, Maryland; Hennepin County Medical Center, Minneapolis, Minnesota; Montefiore Healthcare Center, Albert Einstein College of Medicine, New York, New York; University of Washington School of Medicine, Seattle, Washington; Baystate Medical Center, Springfield, Massachusetts; Intermountain Medical Center and University of Utah, Salt Lake City, Utah; University of Michigan School of Public Health, Ann Arbor, Michigan; Oregon Health & Science University Hospital, Portland, Oregon; Emory University School of Medicine, Atlanta, Georgia; Cleveland Clinic, Cleveland, Ohio; Stanford University School of Medicine, Stanford, California; Ronald Reagan-UCLA Medical Center, Los Angeles, California; University of Miami, Miami, Florida; Washington University, St. Louis, Missouri; The Ohio State University Wexner Medical Center, Columbus, Ohio; University of Michigan School of Medicine, Ann Arbor, Michigan; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Henry Ford Health, Detroit, Michigan; Yale University School of Medicine, New Haven, Connecticut; Influenza Division, National Center for Immunization and Respiratory Diseases, CDC
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20
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Kambe R, Sato M, Uehara D, Iizuka Y, Kakizaki S. Prolonged SARS-CoV-2 infection during obinutuzumab and bendamustine treatment for follicular lymphoma: A case report. Clin Case Rep 2023; 11:e7861. [PMID: 37649899 PMCID: PMC10462774 DOI: 10.1002/ccr3.7861] [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: 07/17/2023] [Revised: 08/14/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023] Open
Abstract
Key Clinical Message SARS-CoV-2 infection has been associated with a prolonged course and a poor prognosis in patients who receive anti-CD20 antibodies. However, there are no established treatments for such patients. Serial changes in the SARS-CoV-2 antigen titer during the clinical course and treatment strategies for immunosuppressed patients are discussed. Abstract We report a case of prolonged SARS-CoV-2 infection during obinutuzumab and bendamustine treatment for follicular lymphoma. Four years previously, the patient had been diagnosed with follicular lymphoma (Stage IIIA, Grade 2). She received several chemotherapy regimens, including rituximab and radiation therapy. Although these therapies achieved complete response temporally, they did not continue and recurred at 8 months before. Obinutuzumab and bendamustine therapy was selected, and she received five courses of obinutuzumab and bendamustine. She also received a SARS-CoV-2 mRNA vaccine two times. Although she did not have any symptoms, a routine check-up just before the 6th course of obinutuzumab and bendamustine revealed SARS-CoV-2 infection. Because she was immunosuppressed and was considered to be at high risk for the exacerbation of her disease, molnupiravir was immediately administered, and her SARS-CoV-2 antigen decreased. However, it was not completely cleared and flared-up at 6 weeks, with symptoms of COVID-19 appearing. Despite intensive treatment for SARS-CoV-2 infection, including remdesivir, baricitinib, tocilizumab and intravenous immunoglobulin, her SARS-CoV-2 antigen titer never became negative, and she finally died of respiratory failure caused by prolonged SARS-CoV-2 infection. Serial changes in the SARS-CoV-2 antigen titer during the clinical course and treatment strategies for immunosuppressed patients are discussed.
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Affiliation(s)
- Ryosuke Kambe
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Masamichi Sato
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Daisuke Uehara
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Yutaka Iizuka
- Department of General Internal MedicineNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
| | - Satoru Kakizaki
- Department of Clinical ResearchNational Hospital Organization Takasaki General Medical CenterTakasakiGunmaJapan
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