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Khawaja T, Kajova M, Levonen I, Pietilä JP, Välimaa H, Paajanen J, Pakkanen SH, Patjas A, Montonen R, Miettinen S, Virtanen J, Smura T, Sironen T, Fagerlund R, Ugurlu H, Iheozor-Ejiofor R, Saksela K, Vahlberg T, Ranki A, Vierikko A, Ihalainen J, Vapalahti O, Kantele A. Double-blinded, randomised, placebo-controlled trial of convalescent plasma for COVID-19: analyses by neutralising antibodies homologous to recipients' variants. Infect Dis (Lond) 2024; 56:423-433. [PMID: 38513074 DOI: 10.1080/23744235.2024.2329957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/08/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Convalescent plasma (CP) emerged as potential treatment for COVID-19 early in the pandemic. While efficacy in hospitalised patients has been lacklustre, CP may be beneficial at the first stages of disease. Despite multiple new variants emerging, no trials have involved analyses on variant-specific antibody titres of CP. METHODS We recruited hospitalised COVID-19 patients within 10 days of symptom onset and, employing a double-blinded approach, randomised them to receive 200 ml convalescent plasma with high (HCP) or low (LCP) neutralising antibody (NAb) titre against the ancestral strain (Wuhan-like variant) or placebo in 1:1:1 ratio. Primary endpoints comprised intubation, corticosteroids for symptom aggravation, and safety assessed as serious adverse events. For a preplanned ad hoc analysis, the patients were regrouped by infused CP's NAb titers to variants infecting the recipients i.e. by titres of homologous HCP (hHCP) or LCP (hLCP). RESULTS Of the 57 patients, 18 received HCP, 19 LCP and 20 placebo, all groups smaller than planned. No significant differences were found for primary endpoints. In ad hoc analysis, hHCPrecipients needed significantly less respiratory support, and appeared to be given corticosteroids less frequently (1/14; 7.1%) than those receiving hLCP (9/23; 39.1%) or placebo (8/20; 40%), (p = 0.077). DISCUSSION Our double-blinded, placebo-controlled CP therapy trial remained underpowered and does not allow any firm conclusions for early-stage hospitalised COVID-19 patients. Interestingly, however, regrouping by homologous - recipients' variant-specific - CP titres suggested benefits for hHCP. We encourage similar re-analysis of ongoing/previous larger CP studies. TRIAL REGISTRATION ClinTrials.gov identifier: NCT0473040.
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Affiliation(s)
- T Khawaja
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - M Kajova
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - I Levonen
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J P Pietilä
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - H Välimaa
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - J Paajanen
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S H Pakkanen
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - A Patjas
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
| | - R Montonen
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - S Miettinen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - J Virtanen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - T Smura
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - T Sironen
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - R Fagerlund
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - H Ugurlu
- Department of Virology, University of Helsinki, Helsinki, Finland
| | - R Iheozor-Ejiofor
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - K Saksela
- Department of Virology, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Centre, HUSLAB, Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - A Ranki
- Department of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Vierikko
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - J Ihalainen
- Finnish Red Cross Blood Service, Helsinki, Finland
| | - O Vapalahti
- Department of Virology, University of Helsinki, Helsinki, Finland
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Centre, HUSLAB, Clinical Microbiology, Helsinki University Hospital, Helsinki, Finland
| | - A Kantele
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- FIMAR, Multidisciplinary Center of Excellence in Antimicrobial Resistance Research, University of Helsinki, Helsinki, Finland
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Berentschot JC, Martine Bek L, Heijenbrok-Kal MH, van den Berg-Emons RJG, Ribbers GM, Aerts JGJV, Hellemons ME. Acute COVID-19 treatment is not associated with health problems 2 years after hospitalization. Int J Infect Dis 2024; 142:106966. [PMID: 38367953 DOI: 10.1016/j.ijid.2024.02.009] [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: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024] Open
Abstract
OBJECTIVES Various mechanisms, such as immune dysregulation, viral reservoir, and auto-immunity, are hypothesized to underlie the pathogenesis of long-term health problems after hospitalization for COVID-19. We aimed to assess the effect of in-hospital COVID-19 treatments on prominent long-term health problems. METHODS In this prospective multicenter cohort study, we enrolled patients (age ≥18 years) who had been hospitalized for COVID-19 in the Netherlands between July 2020 and October 2021. We retrospectively collected data on in-hospital COVID-19 treatments, including steroid, anti-inflammatory, and antiviral treatments. Patients completed questionnaires on self-reported recovery, dyspnea, fatigue, cognitive failures, and health-related quality of life and performed the 6-minute walk test at the 2-year follow-up visit. RESULTS Five hundred two patients with COVID-19 were included, all were discharged from the hospital between March 2020 and June 2021. The median age at admission was 60.0 (IQR 53.0-68.0) years and 350 (69.7%) patients were male. At hospital admission, 5/405 (1.2%) of the patients had been vaccinated against SARS-CoV-2. Among all 502 patients, the majority (248 [49.4%]) received steroids only, 57 (11.4%) anti-inflammatory treatment, 78 (15.5%) antiviral treatment, and 119 (23.7%) none during hospitalization. Long-term health problems were common in all groups. We found that in-hospital treatments were not significantly associated with health problems at 2 years after hospital discharge, nor after adjusting for confounders. CONCLUSION Many patients with COVID-19 suffer from long-term health problems 2 years after hospital discharge. Acute treatment for COVID-19 is not associated with long-term health problems.
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Affiliation(s)
- Julia C Berentschot
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - L Martine Bek
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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3
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Franco JVA, Garegnani LI, Metzendorf MI, Heldt K, Mumm R, Scheidt-Nave C. Post-covid-19 conditions in adults: systematic review and meta-analysis of health outcomes in controlled studies. BMJ MEDICINE 2024; 3:e000723. [PMID: 38293681 PMCID: PMC10826558 DOI: 10.1136/bmjmed-2023-000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
Objective To assess the impact of post-covid-19 conditions among adults. Design Systematic review and meta-analysis of health outcomes in controlled studies. Data sources Two sources were searched from database inception to 20 October 2022: Cochrane covid-19 study register (comprising Cochrane Central Register of Controlled Trials, Medline, Embase, clinicalTrials.gov, World Health Organization's International Clinical Trials Registry Platform, medRxiv) and WHO's covid-19 research database. Eligibility criteria Cohort studies recruiting more than 100 participants with a control group and a follow-up of at least 12 weeks were included. Adults who were documented to have SARS-CoV-2 infection based on clinical, imaging, or laboratory criteria were included. Data extraction and synthesis Two independent reviewers extracted data. The main outcomes included quality of life, functionality in daily activities, use of resources, recovery rates (cluster of symptoms), and the incidence of new medical diagnoses. Data were pooled using a random effects model. The risk of bias was assessed with the Joanna Briggs Institute critical appraisal tool for cohort studies. Results We included 63 controlled cohort studies, encompassing more than 96 million participants. Based on five studies, we found a reduction in overall quality of life between individuals with confirmed SARS-CoV-2 infection versus controls at six to 24 months follow-up, although heterogeneity was very high (mean difference in EQ-5D scale -5.28 (95% confidence interval -7.88 to 2.68; I2=93.81%). Evidence from ten studies, which could not be pooled in a meta-analysis, indicated that an increased rate of functional impairment associated with SARS-CoV-2 infection. Use of care increased compared with controls at six to 24 months follow-up at intensive care units (risk ratio 2.00 (95% confidence interval 0.69 to 5.80), five studies, I2=91.96%) and in outpatient care (1.12 (1.01 to 1.24), seven studies, I2=99.51%). Regarding persistent symptoms, individuals with documented SARS-CoV-2 infection had an increased risk of having two or more persistent symptoms at follow-up, especially those related to neurological clusters (ie, risk ratio 1.51 (95% confidence interval 1.17 to 1.93), I2=98.91%). Evidence also showed an increased incidence of a wide variety of metabolic, cardiovascular, neurological, respiratory, haematological and other incident diagnoses. Conclusion Evidence suggests functional impairment after SARS-CoV-2 infection, in addition to a higher use of resources and a higher incidence of widely varying medical diagnoses. These results should be interpreted with caution, considering the high heterogeneity across studies and study limitations related to outcome measurement and attrition of participants. Systematic review registration Open Science Framework, osf.io/drm39.
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Affiliation(s)
- Juan Victor Ariel Franco
- Institute of General Practice, Medical Faculty, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | | | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Katharina Heldt
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Rebekka Mumm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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4
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Pagen DME, Van Herck M, van Bilsen CJA, Brinkhues S, Konings K, den Heijer CDJ, Spruit MA, Hoebe CJPA, Dukers-Muijrers NHTM. High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study. Front Med (Lausanne) 2023; 10:1292446. [PMID: 38162880 PMCID: PMC10757844 DOI: 10.3389/fmed.2023.1292446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Abstract
Background Exercise-based treatments can worsen/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM and OI are not routinely assessed by clinicians. We estimated PEM and OI proportions in PL-PCC, as well as in people not living with PCC (PnL-PCC) and negatives (i.e., never reported a SARS-CoV-2 positive test), and identified associated factors. Methods Participants from the Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study were included. PEM and OI were assessed using validated questionnaires. PCC was defined as feeling unrecovered after SARS-CoV-2 infection. Multivariable regression analyses to study PEM and OI were stratified for sex. Results Data from 3,783 participants were analyzed. In PL-PCC, the proportion of PEM was 48.1% and 41.2%, and the proportion of OI was 29.3% and 27.9% in women and men, respectively. Proportions were higher in PL-PCC than negatives, for PEM in women OR=4.38 [95%CI:3.01-6.38]; in men OR = 4.78 [95%CI:3.13-7.29]; for OI in women 3.06 [95%CI:1.97-4.76]; in men 2.71 [95%CI:1.75-4.21]. Associated factors were age ≤ 60 years, ≥1 comorbidities, and living alone. Conclusion High proportions of PEM and OI are observed in PL-PCC. Standard screening for PEM and OI is recommended in PL-PCC to promote appropriate therapies.
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Affiliation(s)
- Demi M. E. Pagen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Maarten Van Herck
- Department of Research and Education, Ciro, Horn, Netherlands
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
- Faculty of Rehabilitation Sciences, The Rehabilitation Research Center (REVAL), BIOMED–Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Céline J. A. van Bilsen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Stephanie Brinkhues
- Department of Knowledge and Innovation, South Limburg Public Health Service, Heerlen, Netherlands
| | - Kevin Konings
- Department of Process and Information Management, Communication and Automation, South Limburg Public Health Service, Heerlen, Netherlands
| | - Casper D. J. den Heijer
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Martijn A. Spruit
- Department of Research and Education, Ciro, Horn, Netherlands
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Gorst SL, Seylanova N, Dodd SR, Harman NL, O'Hara M, Terwee CB, Williamson PR, Needham DM, Munblit D, Nicholson TR. Core outcome measurement instruments for use in clinical and research settings for adults with post-COVID-19 condition: an international Delphi consensus study. THE LANCET. RESPIRATORY MEDICINE 2023; 11:1101-1114. [PMID: 37926103 DOI: 10.1016/s2213-2600(23)00370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/04/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
Post-COVID-19 condition (also known as long COVID) is a new, complex, and poorly understood disorder. A core outcome set (COS) for post-COVID-19 condition in adults has been developed and agreement is now required on the most appropriate measurement instruments for these core outcomes. We conducted an international consensus study involving multidisciplinary experts and people with lived experience of long COVID. The study comprised a literature review to identify measurement instruments for the core outcomes, a three-round online modified Delphi process, and an online consensus meeting to generate a core outcome measurement set (COMS). 594 individuals from 58 countries participated. The number of potential instruments for the 12 core outcomes was reduced from 319 to 19. Consensus was reached for inclusion of the modified Medical Research Council Dyspnoea Scale for respiratory outcomes. Measures for two relevant outcomes from a previously published COS for acute COVID-19 were also included: time until death, for survival, and the Recovery Scale for COVID-19, for recovery. Instruments were suggested for consideration for the remaining nine core outcomes: fatigue or exhaustion, pain, post-exertion symptoms, work or occupational and study changes, and cardiovascular, nervous system, cognitive, mental health, and physical outcomes; however, consensus was not achieved for instruments for these outcomes. The recommended COMS and instruments for consideration provide a foundation for the evaluation of post-COVID-19 condition in adults, which should help to optimise clinical care and accelerate research worldwide. Further assessment of this COMS is warranted as new data emerge on existing and novel measurement instruments.
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Affiliation(s)
- Sarah L Gorst
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Susanna R Dodd
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Nicola L Harman
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Caroline B Terwee
- Methodology Program, Amsterdam Public Health Research Institute, and Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Research Group, Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Kasten MJ, Lahr BD, Parisapogu A, Yetmar ZA, O'Horo JC, Orenstein R, Moreno Franco P, Razonable RR, Vergidis P, Shah AS, Enzler MJ, Inwards DJ, Bauer PR. COVID-19 outcome is not affected by anti-CD20 or high-titer convalescent plasma in immunosuppressed patients. Sci Rep 2023; 13:21249. [PMID: 38040756 PMCID: PMC10692159 DOI: 10.1038/s41598-023-48145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
The role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) convalescent plasma in the treatment of Coronavirus Disease 2019 (COVID-19) in immunosuppressed individuals remains controversial. We describe the course of COVID-19 in patients who had received anti-CD20 therapy within the 3 years prior to infection. We compared outcomes between those treated with and those not treated with high titer SARS-CoV2 convalescent plasma. We identified 144 adults treated at Mayo clinic sites who had received anti-CD20 therapies within a median of 5.9 months prior to the COVID-19 index date. About one-third (34.7%) were hospitalized within 14 days and nearly half (47.9%) within 90 days. COVID-19 directed therapy included anti-spike monoclonal antibodies (n = 30, 20.8%), and, among those hospitalized within 14 days (n = 50), remdesivir (n = 45, 90.0%), glucocorticoids (n = 36, 72.0%) and convalescent plasma (n = 24, 48.0%). The duration from receipt of last dose of anti-CD20 therapy did not correlate with outcomes. The overall 90-day mortality rate was 14.7%. Administration of convalescent plasma within 14 days of the COVID-19 diagnosis was not significantly associated with any study outcome. Further study of COVID-19 in CD20-depleted individuals is needed focusing on the early administration of new and potentially combination antiviral agents, associated or not with vaccine-boosted convalescent plasma.
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Affiliation(s)
- Mary J Kasten
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Zachary A Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Department of Infectious Disease, Integrated Hospital-Care Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John C O'Horo
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Raymund R Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Paschalis Vergidis
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aditya S Shah
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Mark J Enzler
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - David J Inwards
- Division of Hematology, Emeritus Staff Center, Mayo Clinic, Rochester, MN, USA
| | - Philippe R Bauer
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA.
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7
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Shaver N, Katz M, Darko Asamoah G, Linkins LA, Abdelkader W, Beck A, Bennett A, Hughes SE, Smith M, Begin M, Coyle D, Piggott T, Kagina BM, Welch V, Colijn C, Earn DJD, El Emam K, Heffernan J, O'Brien SF, Wilson K, Collins E, Navarro T, Beyene J, Boutron I, Bowdish D, Cooper C, Costa A, Curran J, Griffith L, Hsu A, Grimshaw J, Langlois MA, Li X, Pham-Huy A, Raina P, Rubini M, Thabane L, Wang H, Xu L, Brouwers M, Horsley T, Lavis J, Iorio A, Little J. Protocol for a living evidence synthesis on variants of concern and COVID-19 vaccine effectiveness. Vaccine 2023; 41:6411-6418. [PMID: 37718186 DOI: 10.1016/j.vaccine.2023.09.012] [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: 02/08/2023] [Revised: 07/17/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND It is evident that COVID-19 will remain a public health concern in the coming years, largely driven by variants of concern (VOC). It is critical to continuously monitor vaccine effectiveness as new variants emerge and new vaccines and/or boosters are developed. Systematic surveillance of the scientific evidence base is necessary to inform public health action and identify key uncertainties. Evidence syntheses may also be used to populate models to fill in research gaps and help to prepare for future public health crises. This protocol outlines the rationale and methods for a living evidence synthesis of the effectiveness of COVID-19 vaccines in reducing the morbidity and mortality associated with, and transmission of, VOC of SARS-CoV-2. METHODS Living evidence syntheses of vaccine effectiveness will be carried out over one year for (1) a range of potential outcomes in the index individual associated with VOC (pathogenesis); and (2) transmission of VOC. The literature search will be conducted up to May 2023. Observational and database-linkage primary studies will be included, as well as RCTs. Information sources include electronic databases (MEDLINE; Embase; Cochrane, L*OVE; the CNKI and Wangfang platforms), pre-print servers (medRxiv, BiorXiv), and online repositories of grey literature. Title and abstract and full-text screening will be performed by two reviewers using a liberal accelerated method. Data extraction and risk of bias assessment will be completed by one reviewer with verification of the assessment by a second reviewer. Results from included studies will be pooled via random effects meta-analysis when appropriate, or otherwise summarized narratively. DISCUSSION Evidence generated from our living evidence synthesis will be used to inform policy making, modelling, and prioritization of future research on the effectiveness of COVID-19 vaccines against VOC.
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Affiliation(s)
- Nicole Shaver
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Melanie Katz
- Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Gideon Darko Asamoah
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Lori-Ann Linkins
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | | | - Andrew Beck
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Alexandria Bennett
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Sarah E Hughes
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.
| | - Maureen Smith
- The Cochrane Consumer Network, Ottawa, Ontario, Canada.
| | - Mpho Begin
- Cassidy e-Care Solutions Inc, Winnipeg, Manitoba, Canada.
| | - Doug Coyle
- Faculty of Medicine, University of Ottawa, Ontario, Canada.
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Peterborough Public Health, Peterborough, Ontario, Canada; Department of Family Medicine, Queens University, Kingston, Ontario, Canada.
| | - Benjamin M Kagina
- Vaccines for Africa Initiative; NITAGs Support Hub (NISH), Faculty of Health Sciences, School of Public Health, University of Cape Town, South Africa.
| | - Vivian Welch
- Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada.
| | - Caroline Colijn
- Department of mathematics, Faculty of Science, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - David J D Earn
- Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada.
| | | | - Jane Heffernan
- Centre for Disease Modelling, Department of Mathematics & Statistics, Faculty of Science, York University, Toronto, Ontario, Canada.
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA.
| | - Erin Collins
- Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | | | - Joseph Beyene
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Isabelle Boutron
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and Statistics (CRESS), F75004 Paris, France.
| | - Dawn Bowdish
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Curtis Cooper
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Andrew Costa
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Lauren Griffith
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Amy Hsu
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | | | - Xiaoguang Li
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Anne Pham-Huy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Parminder Raina
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Michele Rubini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.
| | - Hui Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Lan Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
| | - Melissa Brouwers
- Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada.
| | - John Lavis
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada.
| | - Alfonso Iorio
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Julian Little
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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8
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Pagen DME, van Bilsen CJA, Brinkhues S, Van Herck M, Konings K, den Heijer CDJ, ter Waarbeek HLG, Spruit MA, Hoebe CJPA, Dukers-Muijrers NHTM. Prevalence of Long-term Symptoms Varies When Using Different Post-COVID-19 Definitions in Positively and Negatively Tested Adults: The PRIME Post-COVID Study. Open Forum Infect Dis 2023; 10:ofad471. [PMID: 37885796 PMCID: PMC10599319 DOI: 10.1093/ofid/ofad471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Background Long-term symptoms after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (ie, post-coronavirus disease 2019 [COVID-19] condition or long COVID) constitute a substantial public health problem. Yet, the prevalence remains currently unclear as different case definitions are used, and negatively tested controls are lacking. We aimed to estimate post-COVID-19 condition prevalence using 6 definitions. Methods The Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study is a population-based sample of COVID-19-tested adults. In 2021, 61 655 adults were invited to complete an online questionnaire, including 44 symptoms plus a severity score (0-10) per symptom. Prevalence was calculated in both positively and negatively tested adults, stratified by time since their COVID-19 test (3-5, 6-11, or ≥12 months ago). Results In positive individuals (n = 7405, 75.6%), the prevalence of long-term symptoms was between 26.9% and 64.1% using the 6 definitions, while in negative individuals (n = 2392, 24.4%), the prevalence varied between 11.4% and 32.5%. The prevalence of long-term symptoms potentially attributable to COVID-19 ranged from 17.9% to 26.3%. Conclusions There is a (substantial) variation in prevalence estimates when using different post-COVID-19 condition definitions, as is current practice; there is limited overlap between definitions, indicating that the essential post-COVID-19 condition criteria are still unclear. Including negatives is important to determine long-term symptoms attributable to COVID-19. Trial registration ClinicalTrials.gov Identifier: NCT05128695.
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Affiliation(s)
- Demi M E Pagen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands
- Department of Social Medicine, Maastricht University, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Céline J A van Bilsen
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands
- Department of Social Medicine, Maastricht University, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Stephanie Brinkhues
- Department of Knowledge & Innovation, South Limburg Public Health Service, Heerlen, the Netherlands
| | - Maarten Van Herck
- Department of Research and Education, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University Medical Centre+, Maastricht, the Netherlands
- REVAL—Rehabilitation Research Center, BIOMED—Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kevin Konings
- Department of Process & Information Management, Communication & Automation, South Limburg Public Health Service, Heerlen, the Netherlands
| | - Casper D J den Heijer
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands
- Department of Social Medicine, Maastricht University, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Henriëtte L G ter Waarbeek
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, the Netherlands
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine, and Life Sciences, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands
- Department of Social Medicine, Maastricht University, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases, and Environmental Health, Living Lab Public Health, South Limburg Public Health Service, Heerlen, the Netherlands
- Department of Health Promotion, Faculty of Health, Medicine, and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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9
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Martin CM, Slessarev M, Campbell E, Basmaji J, Ball I, Fraser DD, Leligdowicz A, Mele T, Priestap F, Tschirhart BJ, Bentall T, Lu X, Feng Q. Annexin A5 in Patients With Severe COVID-19 Disease: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Feasibility Trial. Crit Care Explor 2023; 5:e0986. [PMID: 37811130 PMCID: PMC10558223 DOI: 10.1097/cce.0000000000000986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES To evaluate the study design and feasibility of drug administration and safety in a randomized clinical trial of recombinant human annexin A5 (SY-005), a constitutively expressed protein with anti-inflammatory, antiapoptotic, and anticoagulant properties, in patients with severe coronavirus disease 2019 (COVID-19). DESIGN Double-blind, randomized clinical trial. SETTING Two ICUs at an academic medical center. PATIENTS/SUBJECTS Adults admitted to the ICU with a confirmed diagnosis of COVID-19 and requiring ventilatory or vasopressor support. INTERVENTIONS SY-005, a recombinant human annexin A5, at 50 or 100 µg/kg IV every 12 hours for 7 days. MEASUREMENTS AND MAIN RESULTS We enrolled 18 of the 55 eligible patients (33%) between April 21, 2021, and February 3, 2022. We administered 82% (196/238) of the anticipated doses of study medication and 86% (169/196) were given within 1 hour of the scheduled time. There were no drug-related serious adverse events. We captured 100% of the data that would be required for measuring clinical outcomes in a phase 2 or 3 trial. LIMITATIONS The small sample size was a result of decreasing admissions of patients with COVID-19, which triggered a stopping rule for the trial. CONCLUSIONS Although enrollment was low, administration of SY-005 to critically ill patients with COVID-19 every 12 hours for up to 7 days was feasible and safe. Further clinical trials of annexin A5 for the treatment of COVID-19 are warranted. Given reduction of severe COVID-19 disease, future studies should explore the safety and effectiveness of SY-005 use in non-COVID-related sepsis.
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Affiliation(s)
- Claudio M Martin
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Marat Slessarev
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Eileen Campbell
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - John Basmaji
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Ian Ball
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Aleksandra Leligdowicz
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Tina Mele
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Fran Priestap
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Brent J Tschirhart
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
| | - Tracey Bentall
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Xiangru Lu
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Qingping Feng
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Department of Physiology and Pharmacology, Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
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10
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Brus IM, Spronk I, Haagsma JA, de Groot A, Tieleman P, Biere-Rafi S, Polinder S. The prolonged impact of COVID-19 on symptoms, health-related quality of life, fatigue and mental well-being: a cross-sectional study. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1144707. [PMID: 38455946 PMCID: PMC10911032 DOI: 10.3389/fepid.2023.1144707] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/01/2023] [Indexed: 03/09/2024]
Abstract
Background A subset of patients experience persisting symptoms after an acute COVID-19 infection, referred to as "post COVID-19 condition". This cross-sectional study aimed to compare symptoms, health-related quality of life (HRQoL), fatigue, mental well-being, and determinants of diminished HRQoL, between patients with post COVID-19 condition categorized by time since acute infection. Methods We performed an online survey and analyzed responses of 10,194 adult respondents with a confirmed or suspected COVID-19 infection, who experienced persisting symptoms ≥3 months after the initial infection. The most debilitating symptoms and health outcomes were studied separately for respondents 3-6, 7-9, 10-12, 13-18, 19-24, and >24 months after acute infection. Results At each time period, fatigue, sensory-processing problems, and concentration problems were the most debilitating symptoms reported by respondents, although the proportion of respondents who reported these symptoms differed significantly between time periods. Respondents 3-6 months post-acute infection had the lowest HRQoL (median EQ-5D utility score: 0.59), the highest fatigue level (median score: 110.0) and the highest proportion with a likely depressive disorder (32.4%), whereas respondents 13-18 months post-infection had the highest HRQoL (0.65), the lowest fatigue level (106.0), and the second lowest proportion with a likely depressive disorder (25.0%) (p = 0.000-0.007). Compared to those 13-18 and 19-24 months post-infection, respondents >24 months post-infection had a slightly lower HRQoL (0.60), lower fatigue level (108.0), and lower proportion with a likely depressive disorder (29.2%), although only the differences in HRQoL were statistically significant (p = 0.001-0.010). Younger age, female gender, lower level of education, not having paid work before COVID-19, comorbidity, and not being vaccinated, seemed to be associated with lower HRQoL. Conclusion Regardless of time since infection, respondents considered fatigue, sensory processing problems and concentration problems the most debilitating symptoms. They experienced a low HRQoL and severe fatigue, even more than two years after acute COVID-19 infection. Respondents 3-6 months post-infection had the worst health outcomes, whereas respondents 13-18 months post-infection had the best outcomes, indicating that, at least for a subgroup of patients, health status may improve over time.
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Affiliation(s)
- Iris M. Brus
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Inge Spronk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | | | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
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11
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Ballouz T, Menges D, Anagnostopoulos A, Domenghino A, Aschmann HE, Frei A, Fehr JS, Puhan MA. Recovery and symptom trajectories up to two years after SARS-CoV-2 infection: population based, longitudinal cohort study. BMJ 2023; 381:e074425. [PMID: 37257891 DOI: 10.1136/bmj-2022-074425] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate longer term symptoms and health outcomes associated with post-covid-19 condition within a cohort of individuals with a SARS-CoV-2 infection. DESIGN Population based, longitudinal cohort. SETTING General population of canton of Zurich, Switzerland. PARTICIPANTS 1106 adults with a confirmed SARS-CoV-2 infection who were not vaccinated before infection and 628 adults who did not have an infection. MAIN OUTCOME MEASURES Trajectories of self-reported health status and covid-19 related symptoms between months six, 12, 18, and 24 after infection and excess risk of symptoms at six months after infection compared with individuals who had no infection. RESULTS 22.9% (95% confidence interval 20.4% to 25.6%) of individuals infected with SARS-CoV-2 did not fully recover by six months. The proportion of individuals who had an infection who reported not having recovered decreased to 18.5% (16.2% to 21.1%) at 12 months and 17.2% (14.0% to 20.8%) at 24 months after infection. When assessing changes in self-reported health status, most participants had continued recovery (68.4% (63.8% to 72.6%)) or had an overall improvement (13.5% (10.6% to 17.2%)) over time. Yet, 5.2% (3.5% to 7.7%) had a worsening in health status and 4.4% (2.9% to 6.7%) had alternating periods of recovery and health impairment. The point prevalence and severity of covid-19 related symptoms also decreased over time, with 18.1% (14.8% to 21.9%) reporting symptoms at 24 months. 8.9% (6.5% to 11.2%) of participants reported symptoms at all four follow-up time points, while in 12.5% (9.8% to 15.9%) symptoms were alternatingly absent and present. Symptom prevalence was higher among individuals who were infected compared with those who were not at six months (adjusted risk difference 17.0% (11.5% to 22.4%)). Excess risk (adjusted risk difference) for individual symptoms among those infected ranged from 2% to 10%, with the highest excess risks observed for altered taste or smell (9.8% (7.7% to 11.8%)), post-exertional malaise (9.4% (6.1% to 12.7%)), fatigue (5.4% (1.2% to 9.5%)), dyspnoea (7.8% (5.2% to 10.4%)), and reduced concentration (8.3% (6.0% to 10.7%)) and memory (5.7% (3.5% to 7.9%)). CONCLUSIONS Up to 18% of individuals who were not vaccinated before infection had post-covid-19 condition up to two years after infection, with evidence of excess symptom risk compared with controls. Effective interventions are needed to reduce the burden of post-covid-19 condition. Use of multiple outcome measures and consideration of the expected rates of recovery and heterogeneity in symptom trajectories are important in the design and interpretation of clinical trials. REGISTRATIONS ISRCTN18181860, .
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Affiliation(s)
- Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alexia Anagnostopoulos
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anja Domenghino
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hélène E Aschmann
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Nikbin R, Beydokhti TB, Moghaddam KB, Rohandeh Z. Comparison of the effect of Continuous Positive Airway Pressure (CPAP) and Bi-Level Positive Airway Pressure (BiPAP) on hemodynamic parameters in Covid-19 patients: A clinical trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:178. [PMID: 37404940 PMCID: PMC10317288 DOI: 10.4103/jehp.jehp_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/21/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The most prevalent clinical sign for COVID-19 patients are respiratory diseases such that the criteria for clinical screening and care of the patients in most countries, including Iran, are based on the three primary symptoms, i.e., fever, cough, shortness of breath, or difficulty breathing. The purpose of the current study was to compare the effect of continuous positive airway pressure and bi-level positive airway pressure on hemodynamic parameters in COVID-19 patients. MATERIALS AND METHODS It was a clinical trial conducted on 46 COVID-19 patients admitted to Imam Hassan Hospital in Bojnourd in 2022. This study included patients selected through convenient sampling and then through Permuted block randomization, who were assigned to continuous positive airway pressure (CPAP), and Bi-Level Positive Airway Pressure (BiPAP) groups. Patients were compared in terms of the severity of their COVID-19 disease in both groups and were divided equally in each disease severity. After determining their type of respiratory aid use, the patient's hemodynamic status (systolic blood pressure, diastolic blood pressure, pulse, arterial oxygen saturation, and temperature) was examined beforehand, immediately after 1 hour, 6 hours, and then daily up to 3 days of CPAP/BiPAP at a specific time. Data collection tools were demographic data questionnaires and information on patients' diseases. A checklist was also used to record the main variables of the research. The collected data were put into SPSS software version 19. To analyze the data, the Kolmogorov-Smirnov normality test was used to evaluate the normality of quantitative variables. As a result, it was found that the data had a normal distribution. Repeated measures of ANOVA and independent t-tests were employed to compare quantitative variables in the two groups at different times. In this study, a significance level of 0.05 was considered. RESULTS There was a significant difference in terms of systolic blood pressure, diastolic blood pressure, respiration rate, pulse rate, oxygen saturation, and temperature in the two groups of patients at 1 day, 2 days, and 3 days after use (P < 0.05). CONCLUSION The results displayed better performance of CPAP than BiPAP in the parameters of systolic blood pressure, diastolic blood pressure, respiration rate, pulse rate, oxygen saturation, and temperature in COVID-19 patients. Therefore, in necessary cases, it is recommended to use a CPAP mask.
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Affiliation(s)
- Razieh Nikbin
- School of Nursing, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Tahereh Baloochi Beydokhti
- Department of Medical Emergencies, School of Nursing, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Kokab Basiri Moghaddam
- School of Nursing, Department of Operating Room Technology, Nursing Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Zohreh Rohandeh
- Department of Anesthesiology and ICU, The Head of the Hospital, Bentolhoda Hospital, ICU Department, North Khorasan Medical University, Iran
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13
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Wahlgren C, Forsberg G, Divanoglou A, Östholm Balkhed Å, Niward K, Berg S, Levi R. Two-year follow-up of patients with post-COVID-19 condition in Sweden: a prospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 28:100595. [PMID: 36855599 PMCID: PMC9951394 DOI: 10.1016/j.lanepe.2023.100595] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 05/04/2023]
Abstract
Background Few studies have reported the long-term health effects of COVID-19. The regional population-based Linköping COVID-19 study (LinCoS) included all patients hospitalised due to COVID-19 during the first pandemic wave. Four months post-discharge, over 40% (185/433) experienced persisting symptoms and activity/participation limitations, indicating post-COVID-19 condition (PCC). The present follow-up study aimed to determine the long-term recovery among these patients 24 months post-admission. Methods This prospective cohort study included all patients from LinCoS with PCC at four months post-discharge. We repeated the same structured interview at a 24-month follow-up to identify persisting symptoms and their impact on daily life. Intercurrent health issues were identified by reviewing medical records. Findings Of 185 patients with PCC at 4 months post-discharge, 181 were alive at the 24-month assessment and 165 agreed to participate. Of those, 21% (35/165) had been readmitted to hospital for various causes in the interim period. The majority of patients (139/165, 84%) reported persisting problems affecting everyday life at 24 months. Significant improvements were seen in the prevalence and magnitude of some symptoms/limitations compared with four months post-discharge. Cognitive, sensorimotor, and fatigue symptoms were the most common persisting symptoms at 24 months. No clear difference was evident between individuals treated in the intensive care unit (ICU) and non-ICU-treated individuals. Approximately half of those who were on sick leave related to PCC at four months after infection were on sick leave at 24 months. Interpretation This is one of the first studies to report 2-year outcomes in patients with PCC following COVID-19 hospitalisation. Despite some improvements over time, we found a high prevalence of persisting symptoms and a need for long-term follow-up and rehabilitation post COVID-19 infection. Funding The study was funded by Region Östergötland.
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Affiliation(s)
- Carl Wahlgren
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gustaf Forsberg
- Department of Cardiothoracic and Vascular Surgery and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anestis Divanoglou
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Åse Östholm Balkhed
- Department of Infectious Diseases and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katarina Niward
- Department of Infectious Diseases and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sören Berg
- Department of Cardiothoracic and Vascular Surgery and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Richard Levi
- Department of Rehabilitation Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Measures for the Core Outcome Set for Research Evaluating Interventions to Prevent and/or Treat Delirium in Critically Ill Adults: An International Consensus Study (Del-COrS). Crit Care Explor 2023; 5:e0884. [PMID: 37025304 PMCID: PMC10072315 DOI: 10.1097/cce.0000000000000884] [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: 04/07/2023] Open
Abstract
To gain consensus on measurement methods for outcomes (delirium occurrence, severity, time to resolution, mortality, health-related quality of life [HrQoL], emotional distress including anxiety, depression, acute stress, and post-traumatic stress disorder, and cognition) of our Core Outcome Set (COS) for trials of interventions to prevent and/or treat delirium in critically ill adults.
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McAuley HJ, Evans RA, Bolton CE, Brightling CE, Chalmers JD, Docherty AB, Elneima O, Greenhaff PL, Gupta A, Harris VC, Harrison EM, Ho LP, Horsley A, Houchen-Wolloff L, Jolley CJ, Leavy OC, Lone NI, Man WDC, Marks M, Parekh D, Poinasamy K, Quint JK, Raman B, Richardson M, Saunders RM, Sereno M, Shikotra A, Singapuri A, Singh SJ, Steiner M, Tan AL, Wain LV, Welch C, Whitney J, Witham MD, Lord J, Greening NJ. Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study. EClinicalMedicine 2023; 57:101896. [PMID: 36936404 PMCID: PMC10005893 DOI: 10.1016/j.eclinm.2023.101896] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
Background The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty. Methods This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group-robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)-at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107. Findings Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered. Interpretation Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required. Funding UK Research and Innovation and National Institute for Health Research.
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Affiliation(s)
- Hamish J.C. McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachael A. Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Charlotte E. Bolton
- University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Christopher E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - James D. Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Annemarie B. Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Ayushman Gupta
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Victoria C. Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ewen M. Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
| | - Caroline J. Jolley
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Olivia C. Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nazir I. Lone
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - William D-C Man
- Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Faculty of Life Sciences and Medicine, King's College London, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College London Hospital, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | - Dhruv Parekh
- University of Birmingham, Birmingham, UK
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Betty Raman
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M. Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Sally J. Singh
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Michael Steiner
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ai Lyn Tan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Louise V. Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Julie Whitney
- The School of Life Course & Population Sciences, King's College London, UK
| | - Miles D. Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Janet Lord
- University of Birmingham, Birmingham, UK
| | - Neil J. Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
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16
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Kho ME, Connolly B. From Strict Bedrest to Early Mobilization. Crit Care Clin 2023; 39:479-502. [DOI: 10.1016/j.ccc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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17
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Núñez-Seisdedos MN, Valcárcel-Linares D, Gómez-González MT, Lázaro-Navas I, López-González L, Pecos-Martín D, Rodríguez-Costa I. Inspiratory muscle strength and function in mechanically ventilated COVID-19 survivors 3 and 6 months after intensive care unit discharge. ERJ Open Res 2023; 9:00329-2022. [PMID: 36659933 PMCID: PMC9571163 DOI: 10.1183/23120541.00329-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Background Knowledge regarding the long-term impact of invasive mechanical ventilation on the inspiratory muscles and functional outcomes in COVID-19 survivors is limited. Methods In this single-centre prospective cohort study, we evaluated invasively ventilated patients with COVID-19 pneumonia 3 and 6 months post-intensive care unit (ICU) discharge. Outcomes included: maximal inspiratory pressure (MIP), ultrasound parameters for diaphragm function, 6-min walk distance (6MWD), dyspnoea and quality of life. We evaluated associations between MIP and duration of mechanical ventilation with follow-up outcomes. Results 50 COVID-19 survivors discharged from ICU between 15 October 2020 and 1 April 2021 were enrolled. Overall, survivors showed a recovery trajectory over time. However, impaired MIP remained in 24 (48%) and 12 (24%) at 3 and 6 months, respectively. Diaphragm dysfunction was not observed. At 3 months, 23 (46%) had impaired functional capacity versus 10 (20%) at 6 months. Dyspnoea persisted in 44 (88%) patients at 3 months and 38 (76%) at 6 months. Quality of life was slightly decreased at 3 months with further improvements at 6 months. MIP was correlated to 6MWD, 6MWD % predicted, dyspnoea across follow-up, and quality of life at 3 months. The duration of invasive ventilation was correlated with 6MWD and 6MWD % predicted. Conclusion In invasively ventilated COVID-19 survivors, inspiratory muscle strength impairments persisted 6 months after ICU discharge, while maintaining normal diaphragm function. Decreased functional capacity, dyspnoea and slightly reduced health status were observed. Early screening of survivors is of utmost importance to identify those with impairments and at risk of delayed or incomplete recovery.
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Affiliation(s)
- Maria Natividad Núñez-Seisdedos
- Physiotherapy Department, Ramón y Cajal University Hospital, Madrid, Spain,Corresponding author: Maria Natividad Núñez-Seisdedos ()
| | | | | | - Irene Lázaro-Navas
- Physiotherapy Department, Ramón y Cajal University Hospital, Madrid, Spain
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18
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Moskowitz A, Shotwell MS, Gibbs KW, Harkins M, Rosenberg Y, Troendle J, Merck LH, Files DC, de Wit M, Hudock K, Thompson BT, Gong MN, Ginde AA, Douin DJ, Brown SM, Rubin E, Joly MM, Wang L, Lindsell CJ, Bernard GR, Semler MW, Collins SP, Self WH. Oxygen-Free Days as an Outcome Measure in Clinical Trials of Therapies for COVID-19 and Other Causes of New-Onset Hypoxemia. Chest 2022; 162:804-814. [PMID: 35504307 PMCID: PMC9055785 DOI: 10.1016/j.chest.2022.04.145] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 11/21/2022] Open
Abstract
Mortality historically has been the primary outcome of choice for acute and critical care clinical trials. However, undue reliance on mortality can limit the scope of trials that can be performed. Large sample sizes are usually needed for trials powered for a mortality outcome, and focusing solely on mortality fails to recognize the importance that reducing morbidity can have on patients' lives. The COVID-19 pandemic has highlighted the need for rapid, efficient trials to rigorously evaluate new therapies for hospitalized patients with acute lung injury. Oxygen-free days (OFDs) is a novel outcome for clinical trials that is a composite of mortality and duration of new supplemental oxygen use. It is designed to characterize recovery from acute lung injury in populations with a high prevalence of new hypoxemia and supplemental oxygen use. In these populations, OFDs captures two patient-centered consequences of acute lung injury: mortality and hypoxemic lung dysfunction. Power to detect differences in OFDs typically is greater than that for other clinical trial outcomes, such as mortality and ventilator-free days. OFDs is the primary outcome for the Fourth Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV-4) Host Tissue platform, which evaluates novel therapies targeting the host response to COVID-19 among adults hospitalized with COVID-19 and new hypoxemia. This article outlines the rationale for use of OFDs as an outcome for clinical trials, proposes a standardized method for defining and analyzing OFDs, and provides a framework for sample size calculations using the OFD outcome.
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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
| | - Kevin W Gibbs
- Department of Medicine, Wake Forest University, Winston-Salem, NC
| | - Michelle Harkins
- Department of Medicine, University of New Mexico, Albuquerque, NM
| | | | | | - Lisa H Merck
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA
| | - D Clark Files
- Department of Medicine, Wake Forest University, Winston-Salem, NC
| | - Marjolein de Wit
- Department of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Kristin Hudock
- Department of Medicine, University of Cincinnati, Cincinnati, OH
| | | | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, The Bronx, NY
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO
| | - Samuel M Brown
- Department of Medicine, Intermountain Medical Center, Murray, UT; Office of Research, Intermountain Medical Center, Murray, UT
| | | | - Meghan Morrison Joly
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Gordon R Bernard
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew W Semler
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Sean P Collins
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN
| | - Wesley H Self
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN.
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19
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Griffith DM, Walsh TS. Outcomes from COVID-19 Clinical Trials in Hospitalized Patients: Seeking the Truth That Matters. Am J Respir Crit Care Med 2022; 206:659-660. [PMID: 35608532 PMCID: PMC9799102 DOI: 10.1164/rccm.202205-0907ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- David M Griffith
- Usher Institute University of Edinburgh Edinburgh, United Kingdom
| | - Timothy S Walsh
- Usher Institute University of Edinburgh Edinburgh, United Kingdom
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20
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Patient-centered outcomes at hospital discharge in mechanically ventilated COVID-19 patients in Kobe, Japan: A single-center retrospective cohort study. Respir Investig 2022; 60:694-703. [PMID: 35872085 PMCID: PMC9271455 DOI: 10.1016/j.resinv.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Apart from saving the lives of coronavirus disease (COVID-19) patients on mechanical ventilation (MV), recovery from the sequelae of prolonged MV (PMV) is an emerging issue.c METHODS: We conducted a retrospective study among consecutive adult COVID-19 patients admitted to an intensive care unit (ICU) in Kobe, Japan, between March 3, 2020, and January 31, 2021, and received invasive MV. Clinical outcomes included in-hospital mortality and recovery from COVID-19 in survivors regarding organ dysfunction, respiratory symptoms, and functional status at discharge. We compared survivors' outcomes with MV durations of >14 days and ≤14 days. RESULTS We included 85 patients with a median age of 69 years (interquartile range, 64-75 years); 76 (89%) patients had at least 1 comorbidity, 72 (85%) were non-frail, and 79 (93%) were functionally independent before COVID-19 infection. Eighteen patients (21%) died during hospitalization. At discharge, 59/67 survivors (88%) no longer required respiratory support, 50 (75%) complained of dyspnea, and 40 (60%) were functionally independent. Of the survivors, 23 patients receiving MV for >14 days had a worse recovery from COVID-19 at discharge compared with those on MV for ≤14 days, as observed using the Barthel index (median: 35 [5-65] vs. 100 [85-100]), ICU mobility scale (8 [5-9] vs. 10 [10-10]), and functional oral intake scale (3 [1-7] vs. 7 [7-7]) (P < 0.0001). CONCLUSION Although four-fifths of the patients survived and >50% of survivors demonstrated clinically important recovery in organ function and functional status during hospitalization, PMV was related to poor recovery from COVID-19 at discharge.
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21
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Munblit D, Nicholson T, Akrami A, Apfelbacher C, Chen J, De Groote W, Diaz JV, Gorst SL, Harman N, Kokorina A, Olliaro P, Parr C, Preller J, Schiess N, Schmitt J, Seylanova N, Simpson F, Tong A, Needham DM, Williamson PR. A core outcome set for post-COVID-19 condition in adults for use in clinical practice and research: an international Delphi consensus study. THE LANCET. RESPIRATORY MEDICINE 2022; 10:715-724. [PMID: 35714658 PMCID: PMC9197249 DOI: 10.1016/s2213-2600(22)00169-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/26/2022]
Abstract
Health consequences that persist beyond the acute infection phase of COVID-19, termed post-COVID-19 condition (also commonly known as long COVID), vary widely and represent a growing global health challenge. Research on post-COVID-19 condition is expanding but, at present, no agreement exists on the health outcomes that should be measured in people living with the condition. To address this gap, we conducted an international consensus study, which included a comprehensive literature review and classification of outcomes for post-COVID-19 condition that informed a two-round online modified Delphi process followed by an online consensus meeting to finalise the core outcome set (COS). 1535 participants from 71 countries were involved, with 1148 individuals participating in both Delphi rounds. Eleven outcomes achieved consensus for inclusion in the final COS: fatigue; pain; post-exertion symptoms; work or occupational and study changes; survival; and functioning, symptoms, and conditions for each of cardiovascular, respiratory, nervous system, cognitive, mental health, and physical outcomes. Recovery was included a priori because it was a relevant outcome that was part of a previously published COS on COVID-19. The next step in this COS development exercise will be to establish the instruments that are most appropriate to measure these core outcomes. This international consensus-based COS should provide a framework for standardised assessment of adults with post-COVID-19 condition, aimed at facilitating clinical care and research worldwide.
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Affiliation(s)
- Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK; Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
| | - Timothy Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Athena Akrami
- Sainsbury Wellcome Centre, UCL, London, UK; Patient-Led Research Collaborative, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Jessica Chen
- Faculty of Medicine, Imperial College London, London, UK
| | - Wouter De Groote
- Department of Noncommunicable Diseases, Rehabilitation Programme, World Health Organization, Geneva, Switzerland
| | - Janet V Diaz
- Clinical Management Team, World Health Organization, Geneva, Switzerland
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Nicola Harman
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Alisa Kokorina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Piero Olliaro
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Callum Parr
- Faculty of Medicine, Imperial College London, London, UK
| | - Jacobus Preller
- Health Care Readiness Unit, Health Emergencies Unit, World Health Organization, Geneva, Switzerland
| | - Nicoline Schiess
- Brain Health Unit, World Health Organization, Geneva, Switzerland
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Research Group, Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paula R Williamson
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
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22
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Ramaswamy P, Gong JJ, Saleh SN, McDonald SA, Blumberg S, Medford RJ, Liu X. Developing a COVID-19 WHO Clinical Progression Scale inpatient database from electronic health record data. J Am Med Inform Assoc 2022; 29:1279-1285. [PMID: 35289912 PMCID: PMC9196693 DOI: 10.1093/jamia/ocac041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE There is a need for a systematic method to implement the World Health Organization's Clinical Progression Scale (WHO-CPS), an ordinal clinical severity score for coronavirus disease 2019 patients, to electronic health record (EHR) data. We discuss our process of developing guiding principles mapping EHR data to WHO-CPS scores across multiple institutions. MATERIALS AND METHODS Using WHO-CPS as a guideline, we developed the technical blueprint to map EHR data to ordinal clinical severity scores. We applied our approach to data from 2 medical centers. RESULTS Our method was able to classify clinical severity for 100% of patient days for 2756 patient encounters across 2 institutions. DISCUSSION Implementing new clinical scales can be challenging; strong understanding of health system data architecture was integral to meet the clinical intentions of the WHO-CPS. CONCLUSION We describe a detailed blueprint for how to apply the WHO-CPS scale to patient data from the EHR.
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Affiliation(s)
- Priya Ramaswamy
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.,Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, USA
| | - Jen J Gong
- Center of Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Sameh N Saleh
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Section of Hospital Medicine, Division of General Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Department of Biomedical & Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Samuel A McDonald
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Emergency Medicine, University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.,Centers of Disease Control's Modeling infectious Diseases (MInD) Healthcare Program, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Richard J Medford
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Clinical Informatics Center, Dallas, Texas, USA
| | - Xinran Liu
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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23
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Jhuti D, Rawat A, Guo CM, Wilson LA, Mills EJ, Forrest JI. Interferon Treatments for SARS-CoV-2: Challenges and Opportunities. Infect Dis Ther 2022; 11:953-972. [PMID: 35445964 PMCID: PMC9022612 DOI: 10.1007/s40121-022-00633-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022] Open
Abstract
Interferon (IFN) therapies are used to treat a variety of infections and diseases and could be used to treat SARS-CoV-2. However, optimal use and timing of IFN therapy to treat SARS-CoV-2 is not well documented. We aimed to synthesize available evidence to understand whether interferon therapy should be recommended for treatment compared to a placebo or standard of care in adult patients. We reviewed literature comparing outcomes of randomized control trials that used IFN therapy for adults diagnosed with SARS-CoV-2 between 2019 and 2021. Data were extracted from 11 of 669 screened studies. Evidence of IFN effectiveness was mixed. Five studies reported that IFN was a better therapy than the control, four found no or minimal difference between IFN and the control, and two concluded that IFN led to worse patient outcomes than the control. Evidence was difficult to compare because of high variability in outcome measures, intervention types and administration, subtypes of IFNs used and timing of interventions. We recommend standardized indicators and reporting for IFN therapy for SARS-CoV-2 to improve evidence synthesis and generation. While IFN therapy has the potential to be a viable treatment for SARS-CoV-2, especially when combined with antivirals and early administration, the lack of comparable of study outcomes prevents evidence synthesis and uptake.
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Affiliation(s)
| | - Angeli Rawat
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Lindsay A Wilson
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.,Platform Life Sciences, Vancouver, Canada
| | - Edward J Mills
- McMaster University, Hamilton, Canada.,Platform Life Sciences, Vancouver, Canada
| | - Jamie I Forrest
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada. .,Platform Life Sciences, Vancouver, Canada.
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24
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Munblit D, Nicholson TR, Needham DM, Seylanova N, Parr C, Chen J, Kokorina A, Sigfrid L, Buonsenso D, Bhatnagar S, Thiruvengadam R, Parker AM, Preller J, Avdeev S, Klok FA, Tong A, Diaz JV, Groote WD, Schiess N, Akrami A, Simpson F, Olliaro P, Apfelbacher C, Rosa RG, Chevinsky JR, Saydah S, Schmitt J, Guekht A, Gorst SL, Genuneit J, Reyes LF, Asmanov A, O'Hara ME, Scott JT, Michelen M, Stavropoulou C, Warner JO, Herridge M, Williamson PR. Studying the post-COVID-19 condition: research challenges, strategies, and importance of Core Outcome Set development. BMC Med 2022; 20:50. [PMID: 35114994 PMCID: PMC8813480 DOI: 10.1186/s12916-021-02222-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A substantial portion of people with COVID-19 subsequently experience lasting symptoms including fatigue, shortness of breath, and neurological complaints such as cognitive dysfunction many months after acute infection. Emerging evidence suggests that this condition, commonly referred to as long COVID but also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or post-COVID-19 condition, could become a significant global health burden. MAIN TEXT While the number of studies investigating the post-COVID-19 condition is increasing, there is no agreement on how this new disease should be defined and diagnosed in clinical practice and what relevant outcomes to measure. There is an urgent need to optimise and standardise outcome measures for this important patient group both for clinical services and for research and to allow comparing and pooling of data. CONCLUSIONS A Core Outcome Set for post-COVID-19 condition should be developed in the shortest time frame possible, for improvement in data quality, harmonisation, and comparability between different geographical locations. We call for a global initiative, involving all relevant partners, including, but not limited to, healthcare professionals, researchers, methodologists, patients, and caregivers. We urge coordinated actions aiming to develop a Core Outcome Set (COS) for post-COVID-19 condition in both the adult and paediatric populations.
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Affiliation(s)
- Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. .,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK. .,Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nina Seylanova
- Sechenov Biomedical Science and Technology Park, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Callum Parr
- Faculty of Medicine, Imperial College London, London, UK
| | - Jessica Chen
- Faculty of Medicine, Imperial College London, London, UK
| | - Alisa Kokorina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Shinjini Bhatnagar
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Delhi, National Capital Region, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Delhi, National Capital Region, India
| | - Ann M Parker
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sergey Avdeev
- Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Janet V Diaz
- NCD Department, Rehabilitation Programme, WHO, Geneva, Switzerland
| | - Wouter De Groote
- NCD Department, Rehabilitation Programme, WHO, Geneva, Switzerland
| | | | - Athena Akrami
- Sainsbury Wellcome Centre, UCL, London, UK.,Patient-Led Research Collaborative, Washington, DC, USA
| | | | - Piero Olliaro
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Regis Goulart Rosa
- Critical Care Department, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
| | - Jennifer R Chevinsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon Saydah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Respiratory Viruses Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Jon Genuneit
- Paediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Luis Felipe Reyes
- Universidad de La Sabana, Chía, Colombia.,Clínica Universidad de La Sabana, Chía, Colombia
| | - Alan Asmanov
- The Research and Clinical Institute for Pediatrics named after Academician Yuri Veltischev of the Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Janet T Scott
- MRC-University of Glasgow, Centre for Virus Research, Glasgow, UK
| | - Melina Michelen
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,School of Health Sciences, City, University of London, London, UK
| | | | - John O Warner
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Margaret Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Paula R Williamson
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
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25
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Gardiner E, Baumgart A, Tong A, Elliott JH, Azevedo LC, Bersten A, Cervantes L, Chew DP, Cho Y, Crowe S, Douglas IS, Evangelidis N, Flemyng E, Horby P, Howell M, Lee J, Lorca E, Lynch D, Marshall JC, Gonzalez AM, McKenzie A, Manera K, Mehta S, Mer M, Morris AC, Nseir S, Povoa P, Reid M, Sakr Y, Shen N, Smyth AR, Snelling T, Strippoli GFM, Teixeira-Pinto A, Torres A, Viecelli AK, Webb S, Williamson PR, Woc-Colburn L, Zhang J, Craig JC. Perspectives of patients, family members, health professionals and the public on the impact of COVID-19 on mental health. J Ment Health 2022; 31:524-533. [PMID: 34983279 DOI: 10.1080/09638237.2021.2022637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The coronavirus (COVID-19) pandemic has seen a global surge in anxiety, depression, post-traumatic stress disorder (PTSD), and stress. AIMS This study aimed to describe the perspectives of patients with COVID-19, their family, health professionals, and the general public on the impact of COVID-19 on mental health. METHODS A secondary thematic analysis was conducted using data from the COVID-19 COS project. We extracted data on the perceived causes and impact of COVID-19 on mental health from an international survey and seven online consensus workshops. RESULTS We identified four themes (with subthemes in parenthesis): anxiety amidst uncertainty (always on high alert, ebb and flow of recovery); anguish of a threatened future (intense frustration of a changed normality, facing loss of livelihood, trauma of ventilation, a troubling prognosis, confronting death); bearing responsibility for transmission (fear of spreading COVID-19 in public; overwhelming guilt of infecting a loved one); and suffering in isolation (severe solitude of quarantine, sick and alone, separation exacerbating grief). CONCLUSION We found that the unpredictability of COVID-19, the fear of long-term health consequences, burden of guilt, and suffering in isolation profoundly impacted mental health. Clinical and public health interventions are needed to manage the psychological consequences arising from this pandemic.
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Affiliation(s)
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Julian H Elliott
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Andrew Bersten
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Lilia Cervantes
- Department of Medicine, Denver Health, Denver, United States
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | | | - Ivor S Douglas
- Department of Medicine, Pulmonary Sciences and Critical Care, School of Medicine Denver, Denver Health and University of Colorado Anschutz, United States
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Ella Flemyng
- Editorial and Methods Department, Cochrane, London, UK
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Eduardo Lorca
- Department of Internal Medicine, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | - John C Marshall
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Andrea Matus Gonzalez
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | | | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Mervyn Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Saad Nseir
- Critical Care Centre, CHU Lille, and Lille University, Lille, France
| | - Pedro Povoa
- Nova Medical School, CHRC, Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Denmark
| | - Mark Reid
- Department of Medicine, Denver Health, Denver, United States
| | - Yasser Sakr
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - Ning Shen
- Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China
| | - Alan R Smyth
- Evidence Based Child Health Group, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tom Snelling
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Antoni Torres
- Department of Pulmonology, Respiratory Intitute, Hospital Clinic of Barcelona, University of Barcelona (UB), CIBERES, IDIBAPS, Barcelona, Spain
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Steve Webb
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Laila Woc-Colburn
- Department of Infectious Diseases, Emory University Hospital, Atlanta, Georgia, USA
| | - Junhua Zhang
- Evidence-based Medicine center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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26
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Hoffman M, Holland AE. Clinimetrics: Core Outcome Set for trials with Coronavirus disease 2019 (COVID-19-COS). J Physiother 2022; 68:74. [PMID: 34274292 PMCID: PMC8278377 DOI: 10.1016/j.jphys.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, Alfred Health, Melbourne, Australia; Institute for Breathing and Sleep, Melbourne, Australia
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27
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Katoto PDMC, Aboubacar I, Oumarou B, Adehossi E, Anya BPM, Mounkaila A, Moustapha A, Ishagh EK, Diawara GA, Nsiari-Muzeyi BJ, Didier T, Wiysonge CS. Clinical features and predictors of mortality among hospitalized patients with COVID-19 in Niger. Confl Health 2021; 15:89. [PMID: 34906189 PMCID: PMC8669419 DOI: 10.1186/s13031-021-00426-w] [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: 03/23/2021] [Accepted: 11/30/2021] [Indexed: 08/29/2023] Open
Abstract
Introduction COVID-19 has spread across the African continent, including Niger. Yet very little is known about the phenotype of people who tested positive for COVID-19. In this humanitarian crises region, we aimed at characterizing variation in clinical features among hospitalized patients with COVID-19-like syndrome and to determine predictors associated with COVID-19 mortality among those with confirmed COVID-19. Methods The study was a retrospective nationwide cohort of hospitalized patients isolated for COVID-19 infection, using the health data of the National Health Information System from 19 March 2020 (onset of the pandemic) to 17 November 2020. All hospitalized patients with COVID-19-like syndrome at admission were included. A Cox-proportional regression model was built to identify predictors of in-hospital death among patients with confirmed COVID-19. Results Sixty-five percent (472/729) of patients hospitalized with COVID-19 like syndrome tested positive for SARS-CoV-2 among which, 70 (15%) died. Among the patients with confirmed COVID-19 infection, age was significantly associated with increased odds of reporting cough (adjusted odds ratio [aOR] 1.02; 95% confidence interval [CI] 1.01–1.03) and fever/chills (aOR 1.02; 95% CI 1.02–1.04). Comorbidity was associated with increased odds of presenting with cough (aOR 1.59; 95% CI 1.03–2.45) and shortness of breath (aOR 2.03; 95% CI 1.27–3.26) at admission. In addition, comorbidity (adjusted hazards ratio [aHR] 2.04; 95% CI 2.38–6.35), shortness of breath at baseline (aHR 2.04; 95% CI 2.38–6.35) and being 60 years or older (aHR 5.34; 95% CI 3.25–8.75) increased the risk of COVID-19 mortality two to five folds. Conclusion Comorbidity, shortness of breath on admission, and being aged 60 years or older are associated with a higher risk of death among patients hospitalized with COVID-19 in a humanitarian crisis setting. While robust prospective data are needed to guide evidence, our data might aid intensive care resource allocation in Niger.
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Affiliation(s)
- Patrick D M C Katoto
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.,Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.,Centre for Tropical Medicine and Global Health, Faculty of Medicine, Catholic University of Bukavu, Bugabo 02, Bukavu, Democratic Republic of Congo
| | - Issoufou Aboubacar
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI, 1204, Niamey, Niger
| | - Batouré Oumarou
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI, 1204, Niamey, Niger
| | - Eric Adehossi
- Department of Internal Medicine, Niamey General Reference Hospital, BP 12674, Niamey, Niger
| | | | - Aida Mounkaila
- Directorate of Statistics, Ministry of Public Health, Niamey, Niger
| | - Adamou Moustapha
- Direction of Surveillance and Response to Epidemics, Ministry of Public Health, Niamey, Niger
| | - El Khalef Ishagh
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI, 1204, Niamey, Niger
| | | | - Biey Joseph Nsiari-Muzeyi
- Sub-Regional Office for West Africa, World Health Organization, Independence Street, Gate 0058, Ouagadougou, Burkina Faso
| | - Tambwe Didier
- Country Office, World Health Organization, Quartier Plateau, Avenue Mohamed VI, 1204, Niamey, Niger
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7501, South Africa. .,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa. .,School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa.
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28
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Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC, Daines L, Baillie JK, Brown JS, Chalder T, De Soyza A, Diar Bakerly N, Easom N, Geddes JR, Greening NJ, Hart N, Heaney LG, Heller S, Howard L, Hurst JR, Jacob J, Jenkins RG, Jolley C, Kerr S, Kon OM, Lewis K, Lord JM, McCann GP, Neubauer S, Openshaw PJM, Parekh D, Pfeffer P, Rahman NM, Raman B, Richardson M, Rowland M, Semple MG, Shah AM, Singh SJ, Sheikh A, Thomas D, Toshner M, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Wain LV, Brightling CE. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. THE LANCET. RESPIRATORY MEDICINE 2021; 9:1275-1287. [PMID: 34627560 PMCID: PMC8497028 DOI: 10.1016/s2213-2600(21)00383-0] [Citation(s) in RCA: 323] [Impact Index Per Article: 107.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9-6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. INTERPRETATION We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. FUNDING UK Research and Innovation and National Institute for Health Research.
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Affiliation(s)
- Rachael A Evans
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish McAuley
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Aarti Shikotra
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Olivia C Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Jeremy S Brown
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony De Soyza
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Teaching Hospitals Trust, Newcastle upon Tyne, UK
| | - Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - Nicholas Easom
- Infection Research Group, Hull University Teaching Hospitals, Hull, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Neil J Greening
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Nick Hart
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Belfast Health & Social Care Trust, Belfast, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Luke Howard
- Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK; Lungs for Living Research Centre, University College London, London, UK
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Caroline Jolley
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Steven Kerr
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Onn M Kon
- Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Keir Lewis
- Hywel Dda University Health Board, Wales, UK; University of Swansea, Swansea, UK; Respiratory Innovation Wales, Llanelli, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Stefan Neubauer
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Dhruv Parekh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paul Pfeffer
- Barts Health NHS Trust, London, UK; Queen Mary University of London, London, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew Richardson
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew Rowland
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK; Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre and King's College Hospital NHS Foundation Trust, London, UK
| | - Sally J Singh
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Thomas
- Immunology and Inflammation, Imperial College London, London, UK
| | - Mark Toshner
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK; NIHR Cambridge Clinical Research Facility, Cambridge, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK
| | | | - Louise V Wain
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK
| | - Christopher E Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
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Bek LM, Berentschot JC, Hellemons ME, Huijts SM, Aerts JGJV, van Bommel J, van Genderen ME, Gommers DAMPJ, Ribbers GM, Heijenbrok-Kal MH, van den Berg-Emons RJG. CO-FLOW: COvid-19 Follow-up care paths and Long-term Outcomes Within the Dutch health care system: study protocol of a multicenter prospective cohort study following patients 2 years after hospital discharge. BMC Health Serv Res 2021; 21:847. [PMID: 34419032 PMCID: PMC8379596 DOI: 10.1186/s12913-021-06813-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND First studies indicate that up to 6 months after hospital discharge, coronavirus disease 2019 (COVID-19) causes severe physical, cognitive, and psychological impairments, which may affect participation and health-related quality of life (HRQoL). After hospitalization for COVID-19, a number of patients are referred to medical rehabilitation centers or skilled nursing facilities for further treatment, while others go home with or without aftercare. The aftercare paths include 1] community-based rehabilitation; 2] in- and outpatient medical rehabilitation; 3] inpatient rehabilitation in skilled nursing facilities; and 4] sheltered care (inpatient). These aftercare paths and the trajectories of recovery after COVID-19 urgently need long-term in-depth evaluation to optimize and personalize treatment. CO-FLOW aims, by following the outcomes and aftercare paths of all COVID-19 patients after hospital discharge, to systematically study over a 2-year period: 1] trajectories of physical, cognitive, and psychological recovery; 2] patient flows, healthcare utilization, patient satisfaction with aftercare, and barriers/facilitators regarding aftercare as experienced by healthcare professionals; 3] effects of physical, cognitive, and psychological outcomes on participation and HRQoL; and 4] predictors for long-term recovery, health care utilization, and patient satisfaction with aftercare. METHODS CO-FLOW is a multicenter prospective cohort study in the mid-west of the Netherlands with a 2-year follow-up period. Measurements comprise non-invasive clinical tests and patient reported outcome measures from a combined rehabilitation, pulmonary, and intensive care perspective. Measurements are performed at 3, 6, 12, and 24 months after hospital discharge and, if applicable, at rehabilitation discharge. CO-FLOW aims to include at least 500 patients who survived hospitalization for COVID-19, aged ≥18 years. DISCUSSION CO-FLOW will provide in-depth knowledge on the long-term sequelae of COVID-19 and the quality of current aftercare paths for patients who survived hospitalization. This knowledge is a prerequisite to facilitate the right care in the right place for COVID-19 and comparable future infectious diseases. TRIAL REGISTRATION The Netherlands Trial Register (NTR), https://www.trialregister.nl . Registered: 12-06-2020, CO-FLOW trialregister no. NL8710.
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Affiliation(s)
- L Martine Bek
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Julia C Berentschot
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Susanne M Huijts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michel E van Genderen
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik A M P J Gommers
- Department of Adult Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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30
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Chung EY, Palmer SC, Natale P, Krishnan A, Cooper TE, Saglimbene VM, Ruospo M, Au E, Jayanti S, Liang A, Deng DJJ, Chui J, Higgins GY, Tong A, Wong G, Teixeira-Pinto A, Hodson EM, Craig JC, Strippoli GF. Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis. Am J Kidney Dis 2021; 78:804-815. [PMID: 34364906 PMCID: PMC8339603 DOI: 10.1053/j.ajkd.2021.07.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/29/2021] [Indexed: 01/08/2023]
Abstract
Rationale & Objective Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD. Study Design Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021. Setting & Study Populations People with CKD with or without COVID-19. Selection Criteria for Studies Cohort and case-control studies. Data Extraction Incidences of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue. Analytical Approach Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than in those with CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) or in kidney or pancreas/kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1,000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher than in people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants). Limitations Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19, and potential confounders were not adjusted for in most studies. Conclusions The incidence of COVID-19 may be higher in people receiving maintenance dialysis than in those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas/kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19.
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Affiliation(s)
- Edmund Ym Chung
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Patrizia Natale
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Anoushka Krishnan
- Department of Nephrology, Sir Charles Gairdner Hospital, Nedlands, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tess E Cooper
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Valeria M Saglimbene
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Marinella Ruospo
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Eric Au
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Sumedh Jayanti
- Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Amy Liang
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Juanita Chui
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Gail Y Higgins
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Germaine Wong
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | | | - Elisabeth M Hodson
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni Fm Strippoli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Parotto M, Myatra SN, Munblit D, Elhazmi A, Ranzani OT, Herridge MS. Recovery after prolonged ICU treatment in patients with COVID-19. THE LANCET RESPIRATORY MEDICINE 2021; 9:812-814. [PMID: 34273267 PMCID: PMC8280055 DOI: 10.1016/s2213-2600(21)00318-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Matteo Parotto
- Department of Anesthesia, University of Toronto, Toronto, ON M5G2M1, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5G2M1, Canada.
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Alyaa Elhazmi
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON M5G2M1, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
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Return to Work After Coronavirus Disease 2019 Acute Respiratory Distress Syndrome and Intensive Care Admission: Prospective, Case Series at 6 Months From Hospital Discharge. Crit Care Med 2021; 49:e1157-e1162. [PMID: 34048368 PMCID: PMC8507591 DOI: 10.1097/ccm.0000000000005096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Joblessness is common in survivors from critical care. Our aim was to describe rates of return to work versus unemployment following coronavirus disease 2019 acute respiratory distress syndrome requiring intensive care admission.
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Ebinger JE, Driver M, Ji H, Claggett B, Wu M, Luong E, Sun N, Botting P, Kim EH, Hoang A, Nguyen TT, Diaz J, Park E, Davis T, Hussain S, Cheng S, Figueiredo JC. Temporal variations in the severity of COVID-19 illness by race and ethnicity. BMJ Nutr Prev Health 2021; 4:166-173. [PMID: 34308124 PMCID: PMC7985979 DOI: 10.1136/bmjnph-2021-000253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Early reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time. Methods We conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death. Results A total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic. Conclusion In our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.
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Affiliation(s)
- Joseph E Ebinger
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Matthew Driver
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hongwei Ji
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Min Wu
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Eric Luong
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nancy Sun
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Patrick Botting
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Elizabeth H Kim
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Amy Hoang
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor Trung Nguyen
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jacqueline Diaz
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Eunice Park
- Advanced Data Analytics, Enterprise Information Systems, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tod Davis
- Advanced Data Analytics, Enterprise Information Systems, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shehnaz Hussain
- Department of Public Health Sciences and Comprehensive Cancer Center, University of California, Davis, Davis, California, USA
| | - Susan Cheng
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jane C Figueiredo
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, California, USA
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