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Duarte-Herrera ID, López-Martínez C, Rodríguez-García R, Parra D, Martín-Vicente P, Exojo-Ramirez SM, Miravete-Lagunes K, Iglesias L, González-Iglesias M, Fernández-Rodríguez M, Carretero-Ledesma M, López-Alonso I, Gómez J, Coto E, Fernández RG, García BP, Fernández J, Amado-Rodríguez L, Albaiceta GM. Identification of host endotypes using peripheral blood transcriptomics in a prospective cohort of patients with endocarditis. Int J Infect Dis 2024; 148:107235. [PMID: 39245315 DOI: 10.1016/j.ijid.2024.107235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 08/30/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024] Open
Abstract
OBJECTIVES Host responses to infection are a major determinant of outcome. However, the existence of different response profiles in patients with endocarditis has not been addressed. Our objective was to apply transcriptomics to identify endotypes in patients with infective endocarditis. METHODS A total of 32 patients with infective endocarditis were studied. Clinical data and blood samples were collected at diagnosis and RNA sequenced. Gene expression was used to identify two clusters (endocarditis endotype 1 [EE1] and endocarditis endotype 2 [EE2]). RNA sequencing was repeated after surgery. Transcriptionally active cell populations were identified by deconvolution. Differences between endotypes in clinical data, survival, gene expression, and molecular pathways involved were assessed. The identified endotypes were recapitulated in a cohort of COVID-19 patients. RESULTS A total of 18 and 14 patients were assigned to EE1 and EE2, respectively, with no differences in clinical data. Patients assigned to EE2 showed an enrichment in genes related to T-cell maturation and a decrease in the activation of the signal transducer and activator of transcription protein family pathway, with higher counts of active T cells and lower counts of neutrophils. A total of 14 patients (nine in EE1 and five in EE2) were submitted to surgery. Surgery in EE2 patients shifted gene expression toward a EE1-like profile. In-hospital mortality was higher in EE1 (56% vs 14%, P = 0.027), with an adjusted hazard ratio of 12.987 (95% confidence interval 3.356-50). Translation of these endotypes to COVID-19 and non-COVID-19 septic patients yielded similar results in cell populations and outcome. CONCLUSIONS Gene expression reveals two endotypes in patients with acute endocarditis, with different underlying pathogenetic mechanisms, responses to surgery, and outcomes.
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Affiliation(s)
- Israel David Duarte-Herrera
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Cecilia López-Martínez
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Raquel Rodríguez-García
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Diego Parra
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Paula Martín-Vicente
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Sara M Exojo-Ramirez
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Lisardo Iglesias
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Marta Carretero-Ledesma
- Unidad de Enfermedades Infecciosas, Microbiología y Parasitología. Hospital Universitario Virgen del Rocío. Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Inés López-Alonso
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Departamento de Morfología y Biología Celular, Universidad de Oviedo, Oviedo, Spain
| | - Juan Gómez
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Servicio de Genética, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Eliecer Coto
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Servicio de Genética, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | | | - Belén Prieto García
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Servicio de Bioquímica Clínica, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Javier Fernández
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Laura Amado-Rodríguez
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
| | - Guillermo M Albaiceta
- Centro de Investigación Biomédica en Red (CIBER)-Enfermedades Respiratorias, Madrid, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain; Instituto de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain; Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitario Central de Asturias, Oviedo, Spain; Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain
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Negri S, Mazzuca E, Lococo F, Mondoni M, Covino M, Kuzmych K, Agati S, Amata M, Arcoleo G, Gabbrielli L, Pancani R, Tedeschi E, Baiamonte P, Sassu A, Patrucco F, Foci V, Marchetti G, Vernuccio F, Zanardi E, Gaccione AT, Sorino C. Pneumomediastinum in COVID-19: Risk factors and outcomes from a multicentre case-control study. Respir Med 2024; 230:107684. [PMID: 38823564 DOI: 10.1016/j.rmed.2024.107684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND An increased incidence of pneumomediastinum has been observed among patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. The study aimed to identify risk factors for COVID-19-associated pneumomediastinum and investigate the impact of pneumomediastinum on clinical outcomes. METHODS In this multicentre retrospective case-control study, we included consecutive patients with COVID-19 pneumonia and pneumomediastinum hospitalized from March 2020 to July 2020 at ten centres; then, we identified a similarly sized control group of consecutive patients hospitalized with COVID-19 pneumonia and respiratory failure who did not develop pneumomediastinum during the same period. Clinical, laboratory, and radiological characteristics, as well as respiratory support and outcomes, were collected and compared between the two groups. Risk factors of pneumomediastinum were assessed by multivariable logistic analysis. RESULTS Overall 139 patients with pneumomediastinum and 153 without pneumomediastinum were analysed. Lung involvement ≥75 %, consolidations, body mass index (BMI) < 22 kg/m2, C-reactive protein (CRP) > 150 mg/L, D-dimer >3000 ng/mL FEUs, and smoking exposure >20 pack-year were all independently correlated with the occurrence of pneumomediastinum. Patients with pneumomediastinum had a longer hospital stay (mean ± SD 31.2 ± 20.2 days vs 19.6 ± 14.2, p < 0.001), higher intubation rate (73/139, 52.5 % vs 27/153, 17.6 %, p < 0.001), and in-hospital mortality (68/139, 48.9 % vs 36/153, 23.5 %, p < 0.001) compared to controls. CONCLUSIONS Extensive lung parenchyma involvement, consolidations, low BMI, high inflammatory markers, and tobacco exposure are associated with a greater risk of pneumomediastinum in COVID-19 pneumonia. This complication significantly worsens the outcomes.
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Affiliation(s)
- Stefano Negri
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy
| | - Emilia Mazzuca
- Pulmonology, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Marcello Covino
- Emergency Department - Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Khrystyna Kuzmych
- Department of Thoracic Surgery, Fondazione Policlinico Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy; Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Sergio Agati
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy
| | - Marta Amata
- Pulmonology, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Ersilia Tedeschi
- Pulmonology, Ente Ecclesiastico Ospedale "F. Miulli" Acquaviva delle Fonti-Bari, Italy
| | | | - Alessandro Sassu
- Pulmonology and Semintensive Respiratory Unit, Ospedale Santissima Trinità, Cagliari, Italy
| | - Filippo Patrucco
- Pulmonology, Dipartimento Medico, AOU Maggiore della Carità di Novara, Italy
| | - Valentina Foci
- Pulmonology, Ospedali Riuniti di Livorno, Azienda Usl Toscana Nord-Ovest, Italy
| | | | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
| | - Erika Zanardi
- Pulmonology, Ospedale di Cittadella, AULSS6-Euganea, Padova, Italy
| | | | - Claudio Sorino
- Department of Pulmonology, Sant'Anna Hospital of Como, Italy; Faculty of Medicine and Surgery, University of Insubria, Varese, Italy.
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Murawska Baptista A, Sinclair De Frías J, Singh T, Vasudhar A, Guzzino J, Khalili W, Tekin A, Bansal V, Kashyap R, Joyce WJ, Lewis PA, Sanghavi D, Gavrancic T, Moreno Franco P. Pneumothorax, pneumomediastinum, and subcutaneous emphysema in hospitalized COVID-19 patients: incidence, clinical characteristics, and outcomes. Expert Rev Respir Med 2023; 17:727-733. [PMID: 37675598 DOI: 10.1080/17476348.2023.2254689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Limited data is available on the incidence and outcomes of pneumothorax (PTX), pneumomediastinum (PNM), and subcutaneous emphysema (SCE) in COVID-19 patients. This study aimed to investigate the characteristics of these complications in hospitalized COVID-19 patients. RESEARCH DESIGN AND METHODS A retrospective study was conducted, involving adult COVID-19 patients admitted to Mayo Clinic Florida from 03/2020-06/2022. Patients were divided into two groups based on the presence or absence of PTX/PNM/SCE. RESULTS 1926 hospitalized patients with COVID-19 were included, of which 518 were admitted to the ICU. The incidence of PTX/PNM/SCE was 6.3%. Patients with these complications were more likely to be male, Asian, and unvaccinated. Conversely, they were less likely to have chronic obstructive pulmonary disease. Patients who developed PTX/PNM/SCE after 72 hours of admission were more likely to receive high-dose corticosteroids and for an extended duration. The affected group had an adjusted odds ratio for in-hospital mortality of 13.32 (95%CI, 8.19-21.59) and ICU admission of 9.14 (95%CI, 5.3-12.78) compared to the unaffected group. CONCLUSION Although the occurrence of PTX/PNM/SCE in hospitalized COVID-19 patients was rare, it was associated with worse outcomes. Corticosteroids may contribute to the pathogenesis of these complications; however, further studies are needed to investigate this relationship in more detail.
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Affiliation(s)
| | | | - Trisha Singh
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ananya Vasudhar
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jacob Guzzino
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Waheed Khalili
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Aysun Tekin
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vikas Bansal
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rahul Kashyap
- Department of Anesthesiology and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - William J Joyce
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Patricia A Lewis
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Tatjana Gavrancic
- Department of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Hattori M, Ohshimo S, Shime N. Is Pneumomediastinum Really an Independent Prognostic Factor for COVID-19 Pneumonia? Crit Care Med 2023; 51:e136-e137. [PMID: 37199560 DOI: 10.1097/ccm.0000000000005858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Miyuki Hattori
- All authors: Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Muley M, Finamore P, Pedone C, Margiotta DPE, Gilardi E, Sambuco F, De Vincentis A, Vespasiani-Gentilucci U, Travaglino F, Incalzi RA. The authors reply. Crit Care Med 2023; 51:e138-e139. [PMID: 37199561 DOI: 10.1097/ccm.0000000000005882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Moises Muley
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Panaiotis Finamore
- Geriatrics Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Claudio Pedone
- Geriatrics Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | | | - Emanuele Gilardi
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Federica Sambuco
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | - Antonio De Vincentis
- Internal Medicine Unit, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
| | | | - Francesco Travaglino
- Emergency Medicine Department, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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Vetrugno L, Deana C, Castaldo N, Fantin A, Belletti A, Sozio E, De Martino M, Isola M, Palumbo D, Longhini F, Cammarota G, Spadaro S, Maggiore SM, Bassi F, Tascini C, Patruno V. Barotrauma during Noninvasive Respiratory Support in COVID-19 Pneumonia Outside ICU: The Ancillary COVIMIX-2 Study. J Clin Med 2023; 12:jcm12113675. [PMID: 37297869 DOI: 10.3390/jcm12113675] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Noninvasive respiratory support (NIRS) has been extensively used during the COVID-19 surge for patients with acute respiratory failure. However, little data are available about barotrauma during NIRS in patients treated outside the intensive care unit (ICU) setting. METHODS COVIMIX-2 was an ancillary analysis of the previous COVIMIX study, a large multicenter observational work investigating the frequencies of barotrauma (i.e., pneumothorax and pneumomediastinum) in adult patients with COVID-19 interstitial pneumonia. Only patients treated with NIRS outside the ICU were considered. Baseline characteristics, clinical and radiological disease severity, type of ventilatory support used, blood tests and mortality were recorded. RESULTS In all, 179 patients were included, 60 of them with barotrauma. They were older and had lower BMI than controls (p < 0.001 and p = 0.045, respectively). Cases had higher respiratory rates and lower PaO2/FiO2 (p = 0.009 and p < 0.001). The frequency of barotrauma was 0.3% [0.1-1.3%], with older age being a risk factor for barotrauma (OR 1.06, p = 0.015). Alveolar-arterial gradient (A-a) DO2 was protective against barotrauma (OR 0.92 [0.87-0.99], p = 0.026). Barotrauma required active treatment, with drainage, in only a minority of cases. The type of NIRS was not explicitly related to the development of barotrauma. Still, an escalation of respiratory support from conventional oxygen therapy, high flow nasal cannula to noninvasive respiratory mask was predictive for in-hospital death (OR 15.51, p = 0.001). CONCLUSIONS COVIMIX-2 showed a low frequency for barotrauma, around 0.3%. The type of NIRS used seems not to increase this risk. Patients with barotrauma were older, with more severe systemic disease, and showed increased mortality.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Nadia Castaldo
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Alberto Fantin
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuela Sozio
- Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
| | - Maria De Martino
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Miriam Isola
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater, Domini, Magna Graecia University, 88100 Catanzaro, Italy
| | - Gianmaria Cammarota
- Anesthesiology and Intensive Care, Department of Translational medicine, Faculty of Medicine and Surgery, University of Ferrara, 44121 Ferrara, Italy
| | - Savino Spadaro
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, 66100 Chieti, Italy
- Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti Pescara, 66100 Chieti, Italy
| | - Flavio Bassi
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Venezia Giulia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Carlo Tascini
- Infectious Disease Unit, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Unit, Department of Cardio-Thoracic Surgery, Health Integrated Agency of Friuli Venezia Giulia, 33100 Udine, Italy
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