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Li L, Zhang X, Wu Y, Xing C, Du H. Challenges of mesenchymal stem cells in the clinical treatment of COVID-19. Cell Tissue Res 2024; 396:293-312. [PMID: 38512548 DOI: 10.1007/s00441-024-03881-y] [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: 06/17/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024]
Abstract
The 2019 coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has brought an enormous public health burden to the global society. The duration of the epidemic, the number of infected people, and the widespread of the epidemic are extremely rare in modern society. In the initial stage of infection, people generally show fever, cough, and dyspnea, which can lead to pneumonia, acute respiratory syndrome, kidney failure, and even death in severe cases. The strong infectivity and pathogenicity of SARS-CoV-2 make it more urgent to find an effective treatment. Mesenchymal stem cells (MSCs) are a kind of pluripotent stem cells with the potential for self-renewal and multi-directional differentiation. They are widely used in clinical experiments because of their low immunogenicity and immunomodulatory function. Mesenchymal stem cell-derived exosomes (MSC-Exo) can play a physiological role similar to that of stem cells. Since the COVID-19 pandemic, a series of clinical trials based on MSC therapy have been carried out. The results show that MSCs are safe and can significantly improve patients' respiratory function and prognosis of COVID-19. Here, the effects of MSCs and MSC-Exo in the treatment of COVID-19 are reviewed, and the clinical challenges that may be faced in the future are clarified.
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Affiliation(s)
- Luping Li
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, No. 30 XueYuan Road, Haidian District, Beijing, 100083, China
- Daxing Research Institute, University of Science and Technology Beijing, Beijing, 100083, China
| | - Xiaoshuang Zhang
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, No. 30 XueYuan Road, Haidian District, Beijing, 100083, China
- Daxing Research Institute, University of Science and Technology Beijing, Beijing, 100083, China
| | - Yawen Wu
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, No. 30 XueYuan Road, Haidian District, Beijing, 100083, China
- Daxing Research Institute, University of Science and Technology Beijing, Beijing, 100083, China
| | - Cencan Xing
- Daxing Research Institute, University of Science and Technology Beijing, Beijing, 100083, China.
| | - Hongwu Du
- School of Chemistry and Biological Engineering, University of Science and Technology Beijing, No. 30 XueYuan Road, Haidian District, Beijing, 100083, China.
- Daxing Research Institute, University of Science and Technology Beijing, Beijing, 100083, China.
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Li J, Wang L, Zhang H, Zou T, Kang Y, He W, Xu Y, Yin W. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis. J Intensive Care 2023; 11:29. [PMID: 37408020 DOI: 10.1186/s40560-023-00674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/04/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence. METHODS We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks. RESULTS Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50). CONCLUSIONS In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273). TRIAL REGISTRATION The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Huan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Tongjuan Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital of Capital Medical University, Beijing, 100730, China
| | - Yuan Xu
- Department of Critical Care Medicine, Beijing Tsinghua Chunggung Hospital, Tsinghua University, 168 Litang Rd., Beijing, 102218, China.
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, 37 Guo Xue Xiang St., Chengdu, 610041, Sichuan, China.
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Asadi J, Rasouli MA, Ghaderi E, Roshani D, Mohsenpour B, Moradi Y, Moradi G. Effectiveness of different treatment regimens on patients with COVID-19, hospitalized in Sanandaj hospitals: a retrospective cohort study. J Pharm Policy Pract 2023; 16:4. [PMID: 36647128 PMCID: PMC9841691 DOI: 10.1186/s40545-023-00511-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Different drugs have different effects on the prognosis of patients with COVID-19. This study aimed to evaluate the effect of different drug regimens on patients with COVID-19, hospitalized in Sanandaj city. METHODS In this retrospective cohort study, 660 patients with COVID-19, hospitalized in the Tohid, Kowsar and Besat hospitals located Sanandaj (Kurdistan Province, Iran) were studied from February 2020 to February 2021 with clinical symptoms and positive test results. RESULTS The results of multivariate regression analysis showed the days of hospitalization for patients who had received the drug regimen 2 (Interferons (ReciGen/Ziphron) or Interferon Vectra (lopinavir/ritonavir)) was 1.92 times higher than those who had received the drug regimen 1 (hydroxychloroquine group or a combination of chloroquine and azithromycin) while a significant association was observed (OR = 1.92, 95% CI: 1.16-3.16, P = 0.011). Also, the hospitalization in ICU was longer in patients treated by the drug regimen 2 (Interferons (ReciGen/Ziphron) or Interferon Vectra (lopinavir/ritonavir)) (OR = 4.63, 95% CI: 1.80-11.82, P = 0.001), however, drug regimens did not show a significant effect on mortality and use of ventilator in patients (P > 0.05). CONCLUSION The study results showed the drug regimens 2 and 5 increased the days of hospitalization and hospitalization in ICU, respectively, while the other drug regimens had no significant effect on mortality and use a ventilator in the studied patients and none of the drug regimens had an effect on reducing mortality compared to other ones.
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Affiliation(s)
- Jalal Asadi
- grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Aziz Rasouli
- grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran ,grid.484406.a0000 0004 0417 6812Clinical Research Development Unit, Kowsar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran ,grid.484406.a0000 0004 0417 6812Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Daem Roshani
- grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran ,grid.484406.a0000 0004 0417 6812Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Behzad Mohsenpour
- grid.484406.a0000 0004 0417 6812Department of Infectious Diseases, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Moradi
- grid.484406.a0000 0004 0417 6812Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ghobad Moradi
- grid.484406.a0000 0004 0417 6812Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran ,grid.484406.a0000 0004 0417 6812Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Corral-Gudino L, Cusacovich I, Martín-González JI, Muela-Molinero A, Abadía-Otero J, González-Fuentes R, Ruíz-de-Temiño Á, Tapia-Moral E, Cuadrado-Medina F, Martín-Asenjo M, Miramontes-González P, Delgado-González JL, Ines S, Abad-Manteca L, Usategui-Martín I, Ruiz-Albi T, Miranda-Riaño S, Rodríguez-Fortúnez P, Rodríguez-Jiménez C, López-Franco E, Marcos M. Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalised adults with severe COVID-19 pneumonia: An open-label randomised trial. Eur J Clin Invest 2023; 53:e13881. [PMID: 36169086 PMCID: PMC9538428 DOI: 10.1111/eci.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/10/2022] [Accepted: 09/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The efficacy and safety of high versus medium doses of glucocorticoids for the treatment of patients with COVID-19 has shown mixed outcomes in controlled trials and observational studies. We aimed to evaluate the effectiveness of methylprednisolone 250 mg bolus versus dexamethasone 6 mg in patients with severe COVID-19. METHODS A randomised, open-label, controlled trial was conducted between February and August 2021 at four hospitals in Spain. The trial was suspended after the first interim analysis since the investigators considered that continuing the trial would be futile. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 mg once daily for up to 10 days or methylprednisolone 250 mg once daily for 3 days. RESULTS Of the 128 randomised patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group versus 4.8% in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; p = 0.98). None of the secondary outcomes (admission to the intensive care unit, non-invasive respiratory or high-flow oxygen support, additional immunosuppressive drugs, or length of stay), or prespecified sensitivity analyses were statistically significant. Hyperglycaemia was more frequent in the methylprednisolone group at 27.0 versus 8.1% (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; p = 0.007). CONCLUSIONS Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.
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Affiliation(s)
- Luis Corral-Gudino
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Ivan Cusacovich
- Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain.,Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Jose Ignacio Martín-González
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Alberto Muela-Molinero
- Internal Medicine Department, Hospital Universitario de León, Gerencia Regional de Salud de Castilla y Leon (SACYL), León, Spain
| | - Jésica Abadía-Otero
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Roberto González-Fuentes
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Ángela Ruíz-de-Temiño
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Elena Tapia-Moral
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Francisca Cuadrado-Medina
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Miguel Martín-Asenjo
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Pablo Miramontes-González
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Jose Luis Delgado-González
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Sandra Ines
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - Laura Abad-Manteca
- Internal Medicine Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain.,Department of Medicine, Dermatology and Toxicology. School of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Iciar Usategui-Martín
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Tomás Ruiz-Albi
- Pneumology Department, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Sara Miranda-Riaño
- Internal Medicine Department, Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y Leon (SACYL), Valladolid, Spain
| | - Patricia Rodríguez-Fortúnez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Consuelo Rodríguez-Jiménez
- Clinical Trials Unit, Pharmacology Department, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Esperanza López-Franco
- UICEC, Complejo Asistencial Universitario de Salamanca - Instituto de Investigación Biomédica de Salamanca (IBSAL), Plataforma SCReN, Salamanca, Spain
| | - Miguel Marcos
- Internal Medicine Department, Hospital Universitario de Salamanca-IBSAL, Gerencia Regional de Salud de Castilla y Leon (SACYL), Salamanca, Spain.,School of Medicine, Universidad de Salamanca, Salamanca, Spain.,UICEC, Complejo Asistencial Universitario de Salamanca - Instituto de Investigación Biomédica de Salamanca (IBSAL), Plataforma SCReN, Salamanca, Spain
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Said KB, Alsolami A, Alreshidi FS, Fathuddin A, Alshammari F, Alrashid F, Aljadani A, Aboras R, Alreshidi F, Alghozwi MH, Alshammari SF, Alharbi NF. Profiles of Independent-Comorbidity Groups in Senior COVID-19 Patients Reveal Low Fatality Associated with Standard Care and Low-Dose Hydroxychloroquine over Antivirals. J Multidiscip Healthc 2023; 16:1215-1229. [PMID: 37153358 PMCID: PMC10162097 DOI: 10.2147/jmdh.s403700] [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: 01/26/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction The lack of feasible therapies and comorbidities aggravate the COVID-19 case-fatality rate (CFR). However, reports examining CFR associations with diabetes, concomitant cardiovascular diseases, chronic kidney disease, and chronic liver disease (CLD) are limited. More studies assessing hydroxychloroquine (Hcq) and antivirals are needed. Purpose To examine associations of COVID-19 CFR in comorbid patient groups each with single comorbidities and after treatment with Hcq, favipiravir, and dexamethasone (Dex), either alone or in combination versus standard care. Methods Using statistical analysis, we descriptively determined these associations among 750 COVID-19 patient groups during the last quarter of 2021. Results A diabetes comorbidity (40%, n=299) showed twice the fatality (CFR 14%) of the others (CFR 7%; P=0.001). Hypertension (Htn) was the second-commonest comorbidity (29.5%, n=221), with similar CFR to diabetes (15% and 7% for Htn and non-Htn, respectively), but with higher significance (P=0.0006167). Although only 4% (n=30) heart failure (HF) was reported, the CFR (40%) was much higher than in those without it (8%). A similar rate (4%) for chronic kidney disease was reported, with CFRs of 33% and 9% among those with and without it, respectively (P=0.00048). Ischemic heart disease was 11% (n=74), followed by chronic liver disease (0.4%) and history of smoking (1%); however, these were not significant due to the sample sizes. Treatment indicated standard care and Hcq alone or in combination were superior (CFR of 4% and 0.5%, respectively) compared to favipiravir (25%) or Dex (38.5%) independently or in combination (35.4%). Furthermore, Hcq performed well (CFR 9%) when combined with Dex (9%; P=4.28-26). Conclusion The dominance of diabetes and other comorbidities with significant association with CFR implied existence of a common virulence mechanism. The superiority of low-dose Hcq and standard care over antivirals warrants further studies.
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Affiliation(s)
- Kamaleldin B Said
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
- Genomics, Bioinformatics and Systems Biology, Carleton University, Ottawa, ON K1S 5B6, Canada
- Correspondence: Kamaleldin B Said, Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia, Tel +966500771459, Email
| | - Ahmed Alsolami
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Fayez Saud Alreshidi
- Deparmtent of Family, Community Medicine, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Anas Fathuddin
- Department of Plastic Surgery, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Fawwaz Alshammari
- Department of Dermatology, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Fauwaz Alrashid
- Department of Surgery, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Ahmed Aljadani
- Department of Internal Medicine, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Rana Aboras
- Deparmtent of Family, Community Medicine, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Fatmah Alreshidi
- Deparmtent of Family, Community Medicine, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Mohammed H Alghozwi
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Suliman F Alshammari
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
| | - Nawaf F Alharbi
- Department of Pathology and Microbiology, College of Medicine, University of Ha’il, Ha’il, 55476, Saudi Arabia
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Wang X, Wen D, He Q, Yang J, You C, Tao C, Ma L. Effect of corticosteroids in patients with COVID-19: a Bayesian network meta-analysis. Int J Infect Dis 2022; 125:84-92. [PMID: 36272700 PMCID: PMC9581790 DOI: 10.1016/j.ijid.2022.10.021] [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: 04/12/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We sought to perform a network meta-analysis to compare the safety and efficacy of the systemic administration of corticosteroids for the treatment of COVID-19. METHODS A Bayesian network meta-analysis was performed to combine the direct and indirect evidence. The surface under the cumulative ranking curve was obtained to estimate the ranking probability of the treatment agents for each outcome. The efficacy outcome was 28-day all-cause mortality. The safety outcome was serious adverse events. RESULTS A total of 16 trials with 2992 patients comparing four treatments (dexamethasone, hydrocortisone, methylprednisolone, and placebo) were identified. Direct analysis showed that corticosteroids were associated with a reduced risk of 28-day mortality compared with usual care (risk ratio [RR] 0.83; 95% confidence interval [CrI] 0.70-0.99). Network analysis showed that the pooled RR was 0.63 (95% CrI 0.39-0.93) for all-cause mortality at 28 days comparing methylprednisolone with usual care or placebo (surface under the cumulative ranking curve: 91%). Our analysis demonstrated that patients who received a low dose of corticosteroids (RR 0.80; 95% CrI 0.70-0.91) and a long course of treatment (RR 0.81; 95% CrI 0.71-0.91) had higher survival rates than patients in the placebo group. CONCLUSION Administration of corticosteroids was associated with a reduced all-cause mortality at 28 days compared with placebo or usual care. Our analysis also confirmed the mortality benefit associated with low-dose and long-term treatment with corticosteroids.
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Affiliation(s)
- Xing Wang
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Dingke Wen
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qiang He
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Jingguo Yang
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Chao You
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China,Corresponding authors at: West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, PR China
| | - Chuanyuan Tao
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China,Corresponding authors at: West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, PR China
| | - Lu Ma
- West China Hospital, Sichuan University, Chengdu, Sichuan, PR China,West China Brain Research Centre, Sichuan University, Chengdu, Sichuan, PR China,Corresponding authors at: West China Hospital, Sichuan University, No.37, St. Guoxuexiang, Chengdu, Sichuan 610041, PR China
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Old drugs, new tricks: leveraging known compounds to disrupt coronavirus-induced cytokine storm. NPJ Syst Biol Appl 2022; 8:38. [PMID: 36216820 PMCID: PMC9549818 DOI: 10.1038/s41540-022-00250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/27/2022] [Indexed: 11/11/2022] Open
Abstract
A major complication in COVID-19 infection consists in the onset of acute respiratory distress fueled by a dysregulation of the host immune network that leads to a run-away cytokine storm. Here, we present an in silico approach that captures the host immune system’s complex regulatory dynamics, allowing us to identify and rank candidate drugs and drug pairs that engage with minimal subsets of immune mediators such that their downstream interactions effectively disrupt the signaling cascades driving cytokine storm. Drug–target regulatory interactions are extracted from peer-reviewed literature using automated text-mining for over 5000 compounds associated with COVID-induced cytokine storm and elements of the underlying biology. The targets and mode of action of each compound, as well as combinations of compounds, were scored against their functional alignment with sets of competing model-predicted optimal intervention strategies, as well as the availability of like-acting compounds and known off-target effects. Top-ranking individual compounds identified included a number of known immune suppressors such as calcineurin and mTOR inhibitors as well as compounds less frequently associated for their immune-modulatory effects, including antimicrobials, statins, and cholinergic agonists. Pairwise combinations of drugs targeting distinct biological pathways tended to perform significantly better than single drugs with dexamethasone emerging as a frequent high-ranking companion. While these predicted drug combinations aim to disrupt COVID-induced acute respiratory distress syndrome, the approach itself can be applied more broadly to other diseases and may provide a standard tool for drug discovery initiatives in evaluating alternative targets and repurposing approved drugs.
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Aouissi HA, Kechebar MSA, Ababsa M, Roufayel R, Neji B, Petrisor AI, Hamimes A, Epelboin L, Ohmagari N. The Importance of Behavioral and Native Factors on COVID-19 Infection and Severity: Insights from a Preliminary Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10071341. [PMID: 35885867 PMCID: PMC9323463 DOI: 10.3390/healthcare10071341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on a global scale. Understanding the innate and lifestyle-related factors influencing the rate and severity of COVID-19 is important for making evidence-based recommendations. This cross-sectional study aims at establishing a potential relationship between human characteristics and vulnerability/resistance to SARS-CoV-2. We hypothesize that the impact of the virus is not the same due to cultural and ethnic differences. A cross-sectional study was performed using an online questionnaire. The methodology included the development of a multi-language survey, expert evaluation, and data analysis. Data were collected using a 13-item pre-tested questionnaire based on a literature review between 9 December 2020 and 21 July 2021. Data were statistically analyzed using logistic regression. For a total of 1125 respondents, 332 (29.5%) were COVID-19 positive; among them, 130 (11.5%) required home-based treatment, and 14 (1.2%) intensive care. The significant and most influential factors on infection included age, physical activity, and health status (p < 0.05), i.e., better physical activity and better health status significantly reduced the possibility of infection, while older age significantly increased it. The severity of infection was negatively associated with the acceptance (adherence and respect) of preventive measures and positively associated with tobacco (p < 0.05), i.e., smoking regularly significantly increases the severity of COVID-19 infection. This suggests the importance of behavioral factors compared to innate ones. Apparently, individual behavior is mainly responsible for the spread of the virus. Therefore, adopting a healthy lifestyle and scrupulously observing preventive measures, including vaccination, would greatly limit the probability of infection and prevent the development of severe COVID-19.
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Affiliation(s)
- Hani Amir Aouissi
- Scientific and Technical Research Center on Arid Regions (CRSTRA), Biskra 07000, Algeria; (M.S.A.K.); (M.A.)
- Laboratoire de Recherche et d’Etude en Aménagement et Urbanisme (LREAU), Université des Sciences et de la Technologie (USTHB), Algiers 16000, Algeria
- Environmental Research Center (CRE), Badji-Mokhtar Annaba University, Annaba 23000, Algeria
- Correspondence: (H.A.A.); (R.R.); Tel.: +21-3662387144 (H.A.A.)
| | - Mohamed Seif Allah Kechebar
- Scientific and Technical Research Center on Arid Regions (CRSTRA), Biskra 07000, Algeria; (M.S.A.K.); (M.A.)
| | - Mostefa Ababsa
- Scientific and Technical Research Center on Arid Regions (CRSTRA), Biskra 07000, Algeria; (M.S.A.K.); (M.A.)
| | - Rabih Roufayel
- College of Engineering and Technology, American University of the Middle East, Kuwait;
- Correspondence: (H.A.A.); (R.R.); Tel.: +21-3662387144 (H.A.A.)
| | - Bilel Neji
- College of Engineering and Technology, American University of the Middle East, Kuwait;
| | - Alexandru-Ionut Petrisor
- Doctoral School of Urban Planning, Ion Mincu University of Architecture and Urbanism, 010014 Bucharest, Romania;
- National Institute for Research and Development in Tourism, 50741 Bucharest, Romania
- National Institute for Research and Development in Constructions, Urbanism and Sustainable Spatial Development URBAN-INCERC, 021652 Bucharest, Romania
| | - Ahmed Hamimes
- Faculty of Medicine, University Salah Boubnider of Constantine 3, Constantine 25000, Algeria;
| | - Loïc Epelboin
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, 97306 Cayenne, France;
- Centre d’Investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne Andrée Rosemon, 97306 Cayenne, France
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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9
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Su S, Chen R, Zhang S, Shu H, Luo J. Immune system changes in those with hypertension when infected with SARS-CoV-2. Cell Immunol 2022; 378:104562. [PMID: 35901625 PMCID: PMC9183242 DOI: 10.1016/j.cellimm.2022.104562] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has become an evolving global health crisis. With an increasing incidence of primary hypertension, there is greater awareness of the relationship between primary hypertension and the immune system [including CD4+, CD8+ T cells, interleukin-17 (IL-17)/T regulatory cells (Treg) balance, macrophages, natural killer (NK) cells, neutrophils, B cells, and cytokines]. Hypertension is associated with an increased risk of various infections, post-infection complications, and increased mortality from severe infections. Despite ongoing reports on the epidemiological and clinical features of COVID-19, no articles have systematically addressed the role of primary hypertension in COVID-19 or how COVID-19 affects hypertension or specific treatment in these high-risk groups. Here, we synthesize recent advances in understanding the relationship between primary hypertension and COVID-19 and its underlying mechanisms and provide specific treatment guidelines for these high-risk groups.
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10
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Meduri GU, Shih MC, Bridges L, Martin TJ, El-Solh A, Seam N, Davis-Karim A, Umberger R, Anzueto A, Sriram P, Lan C, Restrepo MI, Guardiola JJ, Buck T, Johnson DP, Suffredini A, Bell WA, Lin J, Zhao L, Uyeda L, Nielsen L, Huang GD. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med 2022; 48:1009-1023. [PMID: 35723686 PMCID: PMC9208259 DOI: 10.1007/s00134-022-06684-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
Purpose Severe community-acquired pneumonia (CAP) requiring intensive care unit admission is associated with significant acute and long-term morbidity and mortality. We hypothesized that downregulation of systemic and pulmonary inflammation with prolonged low-dose methylprednisolone treatment would accelerate pneumonia resolution and improve clinical outcomes. Methods This double-blind, randomized, placebo-controlled clinical trial recruited adult patients within 72–96 h of hospital presentation. Patients were randomized in 1:1 ratio; an intravenous 40 mg loading bolus was followed by 40 mg/day through day 7 and progressive tapering during the 20-day treatment course. Randomization was stratified by site and need for mechanical ventilation (MV) at the time of randomization. Outcomes included a primary endpoint of 60-day all-cause mortality and secondary endpoints of morbidity and mortality up to 1 year of follow-up. Results Between January 2012 and April 2016, 586 patients from 42 Veterans Affairs Medical Centers were randomized, short of the 1420 target sample size because of low recruitment. 584 patients were included in the analysis. There was no significant difference in 60-day mortality between the methylprednisolone and placebo arms (16% vs. 18%; adjusted odds ratio 0.90, 95% CI 0.57–1.40). There were no significant differences in secondary outcomes or complications. Conclusions In patients with severe CAP, prolonged low-dose methylprednisolone treatment did not significantly reduce 60-day mortality. Treatment was not associated with increased complications. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06684-3.
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Affiliation(s)
- G Umberto Meduri
- Pulmonary, Critical Care and Sleep Medicine Services, Memphis VA Medical Center, Memphis, USA. .,University of Tennessee Health Science Center, Memphis, USA.
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, Palo Alto, USA.,Department of Biomedical Data Sciences, Stanford University, Stanford, USA
| | - Lisa Bridges
- Pulmonary, Critical Care and Sleep Medicine Services, Memphis VA Medical Center, Memphis, USA.,University of Tennessee Health Science Center, Memphis, USA
| | - Thomas J Martin
- Salem VA Health Care System, Salem, USA.,Virginia Tech Carilion School of Medicine, Roanoke, USA.,Edward Via Virginia College of Osteopathic Medicine, Blacksburg, USA
| | - Ali El-Solh
- VA Western New York Health Care System, Buffalo, USA.,University at Buffalo, Buffalo, USA
| | - Nitin Seam
- National Institutes of Health Clinical Center, Bethesda, USA
| | - Anne Davis-Karim
- VA Cooperative Studies Program Pharmacy Coordinating Center, Albuquerque, USA
| | - Reba Umberger
- University of Tennessee Health Science Center, Memphis, USA
| | - Antonio Anzueto
- South Texas Veterans Health San Antonio, San Antonio, USA.,University of Texas Health Science Center, Houston, USA
| | | | - Charlie Lan
- Michael E Debakey VA Medical Center, Houston, USA
| | - Marcos I Restrepo
- South Texas Veterans Health San Antonio, San Antonio, USA.,University of Texas Health Science Center, Houston, USA
| | - Juan J Guardiola
- Robley Rex VA Medical Center, Louisville, USA.,University of Louisville, Louisville, USA
| | - Teresa Buck
- Bay Pines VA Healthcare Center, Bay Pines, USA
| | | | | | | | - Julia Lin
- VA Cooperative Studies Program Coordinating Center, Palo Alto, USA
| | - Lan Zhao
- VA Cooperative Studies Program Coordinating Center, Palo Alto, USA
| | - Lauren Uyeda
- VA Cooperative Studies Program Coordinating Center, Palo Alto, USA
| | - Lori Nielsen
- VA Cooperative Studies Program Coordinating Center, Palo Alto, USA
| | - Grant D Huang
- Office of Research and Development, Department of Veterans Affairs, Baltimore, USA
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11
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Comparison of high-dose, short-term steroid and low-dose long-term steroid use in ARDS caused by COVID-19: Retrospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1058849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Caiazzo E, Rezig AOM, Bruzzese D, Ialenti A, Cicala C, Cleland JGF, Guzik TJ, Maffia P, Pellicori P. Systemic administration of glucocorticoids, cardiovascular complications and mortality in patients hospitalised with COVID-19, SARS, MERS or influenza: A systematic review and meta-analysis of randomised trials. Pharmacol Res 2022; 176:106053. [PMID: 34979235 PMCID: PMC8719379 DOI: 10.1016/j.phrs.2021.106053] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Administration of glucocorticoids might reduce mortality in patients with severe COVID-19 but have adverse cardiometabolic effects. OBJECTIVES to investigate the effect of systemic administration of glucocorticoids on cardiovascular complications and all-cause mortality in patients hospitalised with respiratory viral infections, including COVID-19, SARS, MERS and influenza. METHODS We identified randomised trials published prior to July 28th, 2021. The Mantel-Haenszel random effects method and the Hartung and Knapp adjustment were used to obtain pooled estimates of treatment effect with 95% confidence intervals. RESULTS No randomised trials of glucocorticoids for SARS, MERS or influenza reported relevant outcomes. We included eleven COVID-19 randomised trials (8109 patients). Overall, compared to placebo or standard care, glucocorticoids were not associated with a reduction of in-hospital mortality (p = 0.09). In a pre-specified sub-analysis, in-hospital mortality was reduced by 19% when follow-up was restricted to 14 days from randomisation (5/11 trials, 1329 patients, p = 0.02). With longer follow-up (9/11 trials, 7874 patients), administration of glucocorticoids was associated with a trend to benefit for those requiring mechanical ventilation (RR 0.86; 95% CI 0.57-1.27) but possible harm for those not receiving oxygen at randomisation (RR 1.27; 95% CI 1.00 - 1.61), an effect that was significantly different amongst subgroups (p = 0.0359). Glucocorticoids reduced the risk of worsening renal function by 37% (4/11 trials); reported rate of other cardiovascular complications was low. CONCLUSIONS Administration of systemic glucocorticoids to patients hospitalised with COVID-19 does not lower mortality overall but may reduce it in those requiring respiratory support and increase it in those who do not.
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Affiliation(s)
- Elisabetta Caiazzo
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Asma O M Rezig
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Dario Bruzzese
- Department of Public health, University of Naples Federico II, Naples, Italy
| | - Armando Ialenti
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carla Cicala
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - John G F Cleland
- Robertson Centre for Biostatistics, and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, UK; National Heart & Lung Institute, Imperial College London, UK
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Internal and Agricultural Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK; Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy; Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.
| | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, and Glasgow Clinical Trials Unit, Institute of Health and Wellbeing, University of Glasgow, UK.
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13
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Belhassen-García M, Sánchez-Puente A, Dorado-Díaz PI, López-Bernús A, Sampedro-Gómez J, Azibeiro-Melchor R, Marcano-Millán E, Rodríguez-Alonso B, Sánchez-Barrado ME, Hernández-García I, Madruga I, Hernández-Pérez G, Carbonell C, García-Aparicio J, Burgos L, López-Sánchez E, Reina C, Ramón AM, Cestero-Ramírez L, Boumhir F, Encinas-Sánchez D, Sánchez-Ledesma M, Herráez J, Araoz P, Sánchez-Crespo MJ, Rodríguez-Rodríguez S, Rodríguez-Gude AE, Sánchez-Hernández MV, Borrás R, Sagredo-Meneses V, Sánchez PL, Marcos M, Martín-Oterino JÁ. Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone. J Clin Med 2021; 11:jcm11010198. [PMID: 35011938 PMCID: PMC8746130 DOI: 10.3390/jcm11010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. METHODS A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400-600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. RESULTS An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. CONCLUSIONS MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.
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Affiliation(s)
- Moncef Belhassen-García
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain; (M.B.-G.); (A.L.-B.); (G.H.-P.); (C.C.)
- Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), University of Salamanca, 37007 Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Antonio Sánchez-Puente
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (A.S.-P.); (P.-I.D.-D.); (J.S.-G.); (P.-L.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28013 Madrid, Spain
| | - Pedro-Ignacio Dorado-Díaz
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (A.S.-P.); (P.-I.D.-D.); (J.S.-G.); (P.-L.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28013 Madrid, Spain
| | - Amparo López-Bernús
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain; (M.B.-G.); (A.L.-B.); (G.H.-P.); (C.C.)
- Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), University of Salamanca, 37007 Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Jesús Sampedro-Gómez
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (A.S.-P.); (P.-I.D.-D.); (J.S.-G.); (P.-L.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28013 Madrid, Spain
| | - Raúl Azibeiro-Melchor
- Department of Hematology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain;
| | - Edgard Marcano-Millán
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (E.M.-M.); (L.C.-R.); (V.S.-M.)
| | - Beatriz Rodríguez-Alonso
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - María-Elisa Sánchez-Barrado
- Department of Anesthesiology and Reanimation, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (M.-E.S.-B.); (M.-V.S.-H.)
| | - Ignacio Hernández-García
- Department of Preventive Medicine and Public Health, Lozano Blesa University Clinical Hospital of Zaragoza, 50009 Zaragoza, Spain;
| | - Ignacio Madruga
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Guillermo Hernández-Pérez
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain; (M.B.-G.); (A.L.-B.); (G.H.-P.); (C.C.)
- Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), University of Salamanca, 37007 Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Cristina Carbonell
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Salamanca-IBSAL, 37007 Salamanca, Spain; (M.B.-G.); (A.L.-B.); (G.H.-P.); (C.C.)
- Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), University of Salamanca, 37007 Salamanca, Spain
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Judit García-Aparicio
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Laura Burgos
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Eugenia López-Sánchez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Carlos Reina
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Ana-María Ramón
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Laura Cestero-Ramírez
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (E.M.-M.); (L.C.-R.); (V.S.-M.)
| | - Fátima Boumhir
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Daniel Encinas-Sánchez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - María Sánchez-Ledesma
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Jacinto Herráez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Patricia Araoz
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - María-José Sánchez-Crespo
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Sandra Rodríguez-Rodríguez
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Ana-Elisa Rodríguez-Gude
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
| | - Miguel-Vicente Sánchez-Hernández
- Department of Anesthesiology and Reanimation, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (M.-E.S.-B.); (M.-V.S.-H.)
| | - Rafael Borrás
- Department of Emergency Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain;
| | - Víctor Sagredo-Meneses
- Department of Intensive Care Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (E.M.-M.); (L.C.-R.); (V.S.-M.)
| | - Pedro-Luis Sánchez
- Department of Cardiology, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (A.S.-P.); (P.-I.D.-D.); (J.S.-G.); (P.-L.S.)
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28013 Madrid, Spain
| | - Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
- Correspondence: ; Tel.: +34-923-291100 (ext. 55437); Fax: +34-923-294739
| | - José-Ángel Martín-Oterino
- Department of Internal Medicine, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007 Salamanca, Spain; (B.R.-A.); (I.M.); (J.G.-A.); (L.B.); (E.L.-S.); (C.R.); (A.-M.R.); (F.B.); (D.E.-S.); (M.S.-L.); (J.H.); (P.A.); (M.-J.S.-C.); (S.R.-R.); (A.-E.R.-G.); (J.-Á.M.-O.)
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14
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Crothers K, DeFaccio R, Tate J, Alba PR, Goetz MB, Jones B, King JT, Marconi V, Ohl ME, Rentsch CT, Rodriguez-Barradas MC, Shahrir S, Justice AC, Akgün KM. Dexamethasone in hospitalised coronavirus-19 patients not on intensive respiratory support. Eur Respir J 2021; 60:13993003.02532-2021. [PMID: 34824060 PMCID: PMC8841623 DOI: 10.1183/13993003.02532-2021] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022]
Abstract
Background Dexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS. Methods We included patients admitted to US Veterans Affairs hospitals between 7 June 2020 and 31 May 2021 within 14 days after a positive test for severe acute respiratory syndrome coronavirus 2. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weighting (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality. Results Of 19 973 total patients (95% men, median age 71 years, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514 out of 9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472 out of 5954 (75%) patients on low-flow nasal cannula (NC) only received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio (HR) 1.76, 95% CI 1.47–2.12); there was no association with mortality among patients on NC only (HR 1.08, 95% CI 0.86–1.36). Conclusions In patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC only in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS. Although commonly used, dexamethasone within 48 h of admission was associated with increased 90-day mortality in patients hospitalised with COVID-19 not on oxygen and with no mortality benefit in patients on low-flow nasal cannulahttps://bit.ly/3l2aqjb
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Affiliation(s)
- Kristina Crothers
- Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA .,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rian DeFaccio
- Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
| | - Janet Tate
- VA Connecticut Health Care System and Yale University School of Medicine, New Haven, CT, USA
| | - Patrick R Alba
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Barbara Jones
- VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph T King
- VA Connecticut Health Care System and Yale University School of Medicine, New Haven, CT, USA
| | - Vincent Marconi
- Atlanta VA Medical Center, and Emory University, Atlanta, GA, USA
| | - Michael E Ohl
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Christopher T Rentsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London , UK
| | | | - Shahida Shahrir
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Amy C Justice
- VA Connecticut Health Care System and Yale University School of Medicine, New Haven, CT, USA.,Yale School of Public Health, New Haven, CT, USA
| | - Kathleen M Akgün
- VA Connecticut Health Care System and Yale University School of Medicine, New Haven, CT, USA
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15
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Li J, Liao X, Zhou Y, Wang L, Yang H, Zhang W, Zhang Z, Kang Y. Association between glucocorticoids treatment and viral clearance delay in patients with COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2021; 21:1063. [PMID: 34649502 PMCID: PMC8514812 DOI: 10.1186/s12879-021-06548-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. METHODS In this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids. RESULTS 38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I2 = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I2 = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I2 = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I2 = 45%; MD 3.98, 95% CI 3.07 to 4.88, I2 = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I2 = 59%; MD 1.46, 95% CI -0.79 to 3.70, I2 = 82%). CONCLUSIONS Glucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids.
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Affiliation(s)
- Jianbo Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Yue Zhou
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Luping Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Hang Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Wei Zhang
- Molecular Medicine Research Center, State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China.
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, 37 Guo Xue Xiang St, Chengdu, 610041, Sichuan, China.
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16
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Darlington DN. What's New in Shock, August 2021? Shock 2021; 56:155-157. [PMID: 34172610 DOI: 10.1097/shk.0000000000001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel N Darlington
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
- Department of Surgery, University of Texas Health, San Antonio, Texas
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17
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Hou X, Tian L, Zhou L, Jia X, Kong L, Xue Y, Hao H, Meng X, Zhang F, Dong X. Intravenous immunoglobulin-based adjuvant therapy for severe COVID-19: a single-center retrospective cohort study. Virol J 2021; 18:101. [PMID: 34020680 PMCID: PMC8139546 DOI: 10.1186/s12985-021-01575-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) is a major challenge facing the world. Certain guidelines issued by National Health Commission of the People's Repubilic of China recommend intravenous immunoglobulin (IVIG) for adjuvant treatment of COVID-19. However, there is a lack of clinical evidence to support the use of IVIG. Methods This single-center retrospective cohort study included all adult patients with laboratory-confirmed severe COVID-19 in the Respiratory and Critical Care Unit of Dabie Mountain Regional Medical Center, China. Patient information, including demographic data, laboratory indicators, the use of glucocorticoids and IVIG, hospital mortality, the application of mechanical ventilation, and the length of hospital stay was collected. The primary outcome was the composite end point, including death and the use of mechanical ventilation. The secondary outcome was the length of hospital stay. Results Of the 285 patients with confirmed COVID-19, 113 severely ill patients were included in this study. Compared to the non-IVIG group, more patients in the IVIG group reached the composite end point [12 (25.5%) vs 5 (7.6%), P = 0.008] and had longer hospital stay periods [23.0 (19.0–31.0) vs 16.0 (13.8–22.0), P < 0.001]. After adjusting for confounding factors, differences in primary outcomes between the two groups were not statistically significant (P = 0.167), however, patients in the IVIG group had longer hospital stay periods (P = 0.041). Conclusion Adjuvant therapy with IVIG did not improve in-hospital mortality rates or the need for mechanical ventilation in severe COVID-19 patients. Our study does not support the use of immunoglobulin in patients with severe COVID-19 patients.
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Affiliation(s)
- Xiao Hou
- Pelvic Floor Disease Center, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, Shandong, People's Republic of China
| | - Li Tian
- Department of Lung Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Lei Zhou
- Department of Pulmonary Critical Care Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Xinhua Jia
- Department of Lung Disease, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Li Kong
- Department of Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Yitao Xue
- Department of Cardiovascular Diseases, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Hao Hao
- Department of Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China.
| | - Xianqing Meng
- Department of Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Feihu Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
| | - Xiaobin Dong
- Department of Critical Care Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People's Republic of China
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