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Cobo-Ibáñez T, Mora Ortega G, Sánchez-Piedra C, Serralta-San Martín G, Thuissard-Vasallo IJ, Lores Gutiérrez V, Soler Rangel L, García Yubero C, Esteban-Vázquez A, López-Aspiroz E, Andreu Vázquez C, Toboso I, Martínez Alonso de Armiño BM, Olivares Alviso RA, Calderón Nieto R, Yañez C, Zakhour González MA, Sainz Sánchez T, Arroyo de la Torre S, Del Amo Del Arco N, Gómez-Cerezo JF, Ramírez Prieto T, Martínez Hernández A, Muñoz-Fernández S. Cyclosporine A in hospitalized COVID-19 pneumonia patients to prevent the development of interstitial lung disease: a pilot randomized clinical trial. Sci Rep 2024; 14:3789. [PMID: 38360855 PMCID: PMC10869838 DOI: 10.1038/s41598-024-54196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/09/2024] [Indexed: 02/17/2024] Open
Abstract
Post-COVID-19 interstitial lung disease (ILD) is a new entity that frequently causes pulmonary fibrosis and can become chronic. We performed a single-center parallel-group open-label pilot randomized clinical trial to investigate the efficacy and safety of cyclosporine A (CsA) in the development of ILD in the medium term among patients hospitalized with COVID-19 pneumonia. Patients were randomized 1:1 to receive CsA plus standard of care or standard of care alone. The primary composite outcome was the percentage of patients without ILD 3 months after diagnosis of pneumonia and not requiring invasive mechanical ventilation (IMV) (response without requiring IMV). The key secondary composite outcomes were the percentage of patients who achieve a response requiring IMV or irrespective of the need for IMV, and adverse events. A total of 33 patients received at least one dose of CsA plus standard of care (n = 17) or standard of care alone (n = 16). No differences were found between the groups in the percentage of patients who achieved a response without requiring IMV or a response requiring IMV. A higher percentage of patients achieved a response irrespective of the need for IMV in the CsA plus standard of care group although the RR was almost significant 2.833 (95% CI, 0.908-8.840; p = 0.057). No differences were found between the groups for adverse events. In hospitalized patients with COVID-19 pneumonia, we were unable to demonstrate that CsA achieved a significant effect in preventing the development of ILD. (EU Clinical Trials Register; EudraCT Number: 2020-002123-11; registration date: 08/05/2020).
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Affiliation(s)
- Tatiana Cobo-Ibáñez
- Department of Rheumatology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain.
- Fundación para la Investigación e Innovación Biomédica del Hospital Universitario Infanta Sofía y Hospital Universitario del Henares (FIIB HUIS HHEN), 28702, Madrid, Spain.
| | - Gemma Mora Ortega
- Department of Pneumology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | | | - Gonzalo Serralta-San Martín
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | - Israel J Thuissard-Vasallo
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670, Madrid, Spain
| | - Vanesa Lores Gutiérrez
- Department of Pneumology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | - Llanos Soler Rangel
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | | | - Ana Esteban-Vázquez
- Department of Rheumatology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | - Elena López-Aspiroz
- Deparment of Pharmacy, Hospital Universitario Infanta Sofía, 28702, Madrid, Spain
| | - Cristina Andreu Vázquez
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670, Madrid, Spain
| | - Inmaculada Toboso
- Deparment of Immunology, Hospital Universitario Infanta Sofía, 28702, Madrid, Spain
| | | | | | - Rocío Calderón Nieto
- Department of Emergency, Hospital Universitario Infanta Sofía, 28702, Madrid, Spain
| | - Cecilia Yañez
- Department of Emergency, Hospital Universitario Infanta Sofía, 28702, Madrid, Spain
| | | | - Tatiana Sainz Sánchez
- Department of Pneumology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | - Silvia Arroyo de la Torre
- Department of Pneumology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | | | - Jorge Francisco Gómez-Cerezo
- Department of Internal Medicine, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | - Teresa Ramírez Prieto
- Department of Pneumology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
| | | | - Santiago Muñoz-Fernández
- Department of Rheumatology, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid, 28702, Madrid, Spain
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Bingham GC, Muehling LM, Li C, Huang Y, Ma SF, Abebayehu D, Noth I, Sun J, Woodfolk JA, Barker TH, Bonham CA. High-dimensional comparison of monocytes and T cells in post-COVID and idiopathic pulmonary fibrosis. Front Immunol 2024; 14:1308594. [PMID: 38292490 PMCID: PMC10824838 DOI: 10.3389/fimmu.2023.1308594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Up to 30% of hospitalized COVID-19 patients experience persistent sequelae, including pulmonary fibrosis (PF). Methods We examined COVID-19 survivors with impaired lung function and imaging worrisome for developing PF and found within six months, symptoms, restriction and PF improved in some (Early-Resolving COVID-PF), but persisted in others (Late-Resolving COVID-PF). To evaluate immune mechanisms associated with recovery versus persistent PF, we performed single-cell RNA-sequencing and multiplex immunostaining on peripheral blood mononuclear cells from patients with Early- and Late-Resolving COVID-PF and compared them to age-matched controls without respiratory disease. Results and discussion Our analysis showed circulating monocytes were significantly reduced in Late-Resolving COVID-PF patients compared to Early-Resolving COVID-PF and non-diseased controls. Monocyte abundance correlated with pulmonary function forced vital capacity and diffusion capacity. Differential expression analysis revealed MHC-II class molecules were upregulated on the CD8 T cells of Late-Resolving COVID-PF patients but downregulated in monocytes. To determine whether these immune signatures resembled other interstitial lung diseases, we analyzed samples from Idiopathic Pulmonary Fibrosis (IPF) patients. IPF patients had a similar marked decrease in monocyte HLA-DR protein expression compared to Late-Resolving COVID-PF patients. Our findings indicate decreased circulating monocytes are associated with decreased lung function and uniquely distinguish Late-Resolving COVID-PF from Early-Resolving COVID-PF, IPF, and non-diseased controls.
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Affiliation(s)
- Grace C. Bingham
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Lyndsey M. Muehling
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Chaofan Li
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Yong Huang
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, United States
| | - Shwu-Fan Ma
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, United States
| | - Daniel Abebayehu
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, United States
| | - Jie Sun
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, Charlottesville, VA, United States
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Judith A. Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Thomas H. Barker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Catherine A. Bonham
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, United States
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Selvarajah B, Platé M, Chambers RC. Pulmonary fibrosis: Emerging diagnostic and therapeutic strategies. Mol Aspects Med 2023; 94:101227. [PMID: 38000335 DOI: 10.1016/j.mam.2023.101227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Fibrosis is the concluding pathological outcome and major cause of morbidity and mortality in a number of common chronic inflammatory, immune-mediated and metabolic diseases. The progressive deposition of a collagen-rich extracellular matrix (ECM) represents the cornerstone of the fibrotic response and culminates in organ failure and premature death. Idiopathic pulmonary fibrosis (IPF) represents the most rapidly progressive and lethal of all fibrotic diseases with a dismal median survival of 3.5 years from diagnosis. Although the approval of the antifibrotic agents, pirfenidone and nintedanib, for the treatment of IPF signalled a watershed moment for the development of anti-fibrotic therapeutics, these agents slow but do not halt disease progression or improve quality of life. There therefore remains a pressing need for the development of effective therapeutic strategies. In this article, we review emerging therapeutic strategies for IPF as well as the pre-clinical and translational approaches that will underpin a greater understanding of the key pathomechanisms involved in order to transform the way we diagnose and treat pulmonary fibrosis.
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Affiliation(s)
- Brintha Selvarajah
- Oncogenes and Tumour Metabolism Laboratory, The Francis Crick Institute, London, UK
| | - Manuela Platé
- Department of Respiratory Medicine (UCL Respiratory), Division of Medicine, University College London, UK
| | - Rachel C Chambers
- Department of Respiratory Medicine (UCL Respiratory), Division of Medicine, University College London, UK.
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Wolff D, Drewitz KP, Ulrich A, Siegels D, Deckert S, Sprenger AA, Kuper PR, Schmitt J, Munblit D, Apfelbacher C. Allergic diseases as risk factors for Long-COVID symptoms: Systematic review of prospective cohort studies. Clin Exp Allergy 2023; 53:1162-1176. [PMID: 37936547 DOI: 10.1111/cea.14391] [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: 06/16/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The role of allergy as a risk factor for Long-COVID (LC) is unclear and has not been thoroughly examined yet. We aimed to systematically review and appraise the epidemiological evidence on allergic diseases as risk factors for LC. DESIGN This is an initial systematic review. Two reviewers independently performed the study selection and data extraction using Covidence. Risk of bias (RoB) and certainty of evidence (GRADE) were assessed. Random effects meta-analyses were used to pool unadjusted ORs within homogeneous data subsets. DATA SOURCES We retrieved articles published between January 1st, 2020 and January 19th, 2023 from MEDLINE via PubMed, Scopus, the WHO-COVID-19 database and the LOVE platform (Epistemonikos Foundation). In addition, citations and reference lists were searched. ELIGIBILITY CRITERIA We included prospective cohort studies recruiting individuals of all ages with confirmed SARS-CoV-2 infection that were followed up for at least 12 months for LC symptoms where information on pre-existing allergic diseases was available. We excluded all study designs that were not prospective cohort studies and all publication types that were not original articles. RESULTS We identified 13 studies (9967 participants, range 39-1950 per study), all assessed as high RoB, due to population selection and methods used to ascertain the exposures and the outcome. Four studies did not provide sufficient data to calculate Odds Ratios. The evidence supported a possible relationship between LC and allergy, but was very uncertain. For example, pre-existing asthma measured in hospital-based populations (6 studies, 4019 participants) may be associated with increased risk of LC (Odds Ratio 1.94, 95% CI 1.08, 3.50) and findings were similar for pre-existing rhinitis (3 studies, 1141 participants; Odds Ratio 1.96, 95% CI 1.61, 2.39), both very low certainty evidence. CONCLUSIONS Pre-existing asthma or rhinitis may increase the risk of LC.
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Affiliation(s)
- Doreen Wolff
- Institute of Social Medicine and Health Systems Research, University of Magdeburg, Magdeburg, Germany
| | - Karl Philipp Drewitz
- Institute of Social Medicine and Health Systems Research, University of Magdeburg, Magdeburg, Germany
| | - Angela Ulrich
- Institute of Social Medicine and Health Systems Research, University of Magdeburg, Magdeburg, Germany
| | - Doreen Siegels
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Stefanie Deckert
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Antonia Anabella Sprenger
- Institute of Social Medicine and Health Systems Research, University of Magdeburg, Magdeburg, Germany
| | - Paula Ricarda Kuper
- Institute of Social Medicine and Health Systems Research, University of Magdeburg, Magdeburg, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Daniel Munblit
- Care for Long Term Conditions Division, King's College London, London, UK
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, University of Magdeburg, Magdeburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore City, Singapore
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Mosavat A, Mirhosseini A, Shariati A, Mohareri M, Valizadeh N, Mohammadi FS, Shamsian SAA, Jafari Rad M, Rezaee SA. SARS-CoV-2 infection and increasing autoimmune disorders among ICU-hospitalized COVID-19 patients. Int J Rheum Dis 2023; 26:2151-2156. [PMID: 37578135 DOI: 10.1111/1756-185x.14875] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/24/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION In acute conditions, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes multi-organ damage due to the induction of inappropriate immune responses, particularly lung tissue fibrosis. To evaluate the consequence of the deterioration of the immune system, autoimmune markers were assessed. METHODS In a case-control study, 108 patients with coronavirus disease 2019 (COVID-19) were admitted to the intensive care unit (ICU), and 158 outpatients with mild clinical symptoms, with SARS-CoV-2 reverse transcription quantitative polymerase chain reaction (RT-qPCR) positive tests, were included for comparison. The demographic and hematologic variables and presence of the main autoantibodies in sera of 40 eligible ICU-hospitalized COVID-19 patients and 40 COVID-19 outpatients were assessed. Out of 108 COVID-19 ICU-hospitalized patients, 40 were selected as the control group (40/158) who had no underlying diseases before hospitalization, according to their self-declaration and clinical records at the time of admission. RESULTS The results demonstrated that the main complete blood count indices, such as red blood cells and platelets, decreased dramatically in ICU-hospitalized patients. Furthermore, the autoantibody profiles were positive in 45% and 15% of ICU-admitted patients for antinuclear antibodies and antineutrophilic cytoplasmic autoantibodies, respectively. In ICU patients, anti-PM/Scl 100 or AMA-M2 was 33%. Anti SS-A, anti-SS-B, anti-Ro-52, and anti-Jo-1 in 11.5% for each one were reactive. Other autoantibodies of the ICU group were as follows: CENP (5.6%), Rib-protein (5.6%), and nucleosome (5.6%). However, only two individuals in the control group had positive results for SS-A and SS-B (5%). CONCLUSION Induction of such particular autoantibodies by the virus can justify the multi-organ involvement and severity of the disease in ICU patients, which may also cause other organ involvement in the long term.
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Affiliation(s)
- Arman Mosavat
- Blood Borne Infections Research Center, Academic Center for Education, Culture and Research (ACECR), Mashhad, Razavi Khorasan, Iran
| | - Ali Mirhosseini
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Shariati
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Mohareri
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Valizadeh
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sadat Mohammadi
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Akbar Shamsian
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mozhdeh Jafari Rad
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Abdolrahim Rezaee
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, Mashhad University of Medical Sciences, Mashhad, Iran
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Saunders LC, Collier GJ, Chan HF, Hughes PJC, Smith LJ, Watson JGR, Meiring JE, Gabriel Z, Newman T, Plowright M, Wade P, Eaden JA, Thomas S, Strickland S, Gustafsson L, Bray J, Marshall H, Capener DA, Armstrong L, Rodgers J, Brook M, Biancardi AM, Rao MR, Norquay G, Rodgers O, Munro R, Ball JE, Stewart NJ, Lawrie A, Jenkins RG, Grist JT, Gleeson F, Schulte RF, Johnson KM, Wilson FJ, Cahn A, Swift AJ, Rajaram S, Mills GH, Watson L, Collini PJ, Lawson R, Thompson AAR, Wild JM. Longitudinal Lung Function Assessment of Patients Hospitalized With COVID-19 Using 1H and 129Xe Lung MRI. Chest 2023; 164:700-716. [PMID: 36965765 PMCID: PMC10036146 DOI: 10.1016/j.chest.2023.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Microvascular abnormalities and impaired gas transfer have been observed in patients with COVID-19. The progression of pulmonary changes in these patients remains unclear. RESEARCH QUESTION Do patients hospitalized with COVID-19 without evidence of architectural distortion on structural imaging exhibit longitudinal improvements in lung function measured by using 1H and 129Xe MRI between 6 and 52 weeks following hospitalization? STUDY DESIGN AND METHODS Patients who were hospitalized with COVID-19 pneumonia underwent a pulmonary 1H and 129Xe MRI protocol at 6, 12, 25, and 51 weeks following hospital admission in a prospective cohort study between November 2020 and February 2022. The imaging protocol was as follows: 1H ultra-short echo time, contrast-enhanced lung perfusion, 129Xe ventilation, 129Xe diffusion-weighted, and 129Xe spectroscopic imaging of gas exchange. RESULTS Nine patients were recruited (age 57 ± 14 [median ± interquartile range] years; six of nine patients were male). Patients underwent MRI at 6 (n = 9), 12 (n = 9), 25 (n = 6), and 51 (n = 8) weeks following hospital admission. Patients with signs of interstitial lung damage were excluded. At 6 weeks, patients exhibited impaired 129Xe gas transfer (RBC to membrane fraction), but lung microstructure was not increased (apparent diffusion coefficient and mean acinar airway dimensions). Minor ventilation abnormalities present in four patients were largely resolved in the 6- to 25-week period. At 12 weeks, all patients with lung perfusion data (n = 6) showed an increase in both pulmonary blood volume and flow compared with 6 weeks, although this was not statistically significant. At 12 weeks, significant improvements in 129Xe gas transfer were observed compared with 6-week examinations; however, 129Xe gas transfer remained abnormally low at weeks 12, 25, and 51. INTERPRETATION 129Xe gas transfer was impaired up to 1 year following hospitalization in patients who were hospitalized with COVID-19 pneumonia, without evidence of architectural distortion on structural imaging, whereas lung ventilation was normal at 52 weeks.
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Affiliation(s)
- Laura C Saunders
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Guilhem J Collier
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Ho-Fung Chan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Paul J C Hughes
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Laurie J Smith
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - J G R Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James E Meiring
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Zoë Gabriel
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Thomas Newman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Megan Plowright
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James A Eaden
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Siby Thomas
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | | | - Lotta Gustafsson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Jody Bray
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Helen Marshall
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - David A Capener
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Leanne Armstrong
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Jennifer Rodgers
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Martin Brook
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Alberto M Biancardi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Madhwesha R Rao
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Graham Norquay
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Oliver Rodgers
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Ryan Munro
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - James E Ball
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Neil J Stewart
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, England
| | - James T Grist
- Department of Radiology, Oxford University Hospitals, Oxford, England; Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, England; Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, England
| | - Fergus Gleeson
- Department of Oncology, University of Oxford, Oxford, England; Department of Radiology, Oxford University Hospitals, Oxford, England
| | | | - Kevin M Johnson
- Department of Medical Physics, University of Madison, Madison, WI, USA
| | | | | | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Smitha Rajaram
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Gary H Mills
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Lisa Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Paul J Collini
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England.
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Singh SJ, Baldwin MM, Daynes E, Evans RA, Greening NJ, Jenkins RG, Lone NI, McAuley H, Mehta P, Newman J, Novotny P, Smith DJF, Stanel S, Toshner M, Brightling CE. Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation. THE LANCET. RESPIRATORY MEDICINE 2023; 11:709-725. [PMID: 37216955 PMCID: PMC10198676 DOI: 10.1016/s2213-2600(23)00159-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies.
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Affiliation(s)
- Sally J Singh
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK.
| | - Molly M Baldwin
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Enya Daynes
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Rachael A Evans
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Neil J Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - R Gisli Jenkins
- Imperial College London National Heart and Lung Institute, London, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hamish McAuley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, UK
| | - Joseph Newman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petr Novotny
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | | | - Stefan Stanel
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Mark Toshner
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Christopher E Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
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Parotto M, Gyöngyösi M, Howe K, Myatra SN, Ranzani O, Shankar-Hari M, Herridge MS. Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations. THE LANCET. RESPIRATORY MEDICINE 2023:S2213-2600(23)00239-4. [PMID: 37475125 DOI: 10.1016/s2213-2600(23)00239-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023]
Abstract
Individuals with SARS-CoV-2 infection can develop symptoms that persist well beyond the acute phase of COVID-19 or emerge after the acute phase, lasting for weeks or months after the initial acute illness. The post-acute sequelae of COVID-19, which include physical, cognitive, and mental health impairments, are known collectively as long COVID or post-COVID-19 condition. The substantial burden of this multisystem condition is felt at individual, health-care system, and socioeconomic levels, on an unprecedented scale. Survivors of COVID-19-related critical illness are at risk of the well known sequelae of acute respiratory distress syndrome, sepsis, and chronic critical illness, and these multidimensional morbidities might be difficult to differentiate from the specific effects of SARS-CoV-2 and COVID-19. We provide an overview of the manifestations of post-COVID-19 condition after critical illness in adults. We explore the effects on various organ systems, describe potential pathophysiological mechanisms, and consider the challenges of providing clinical care and support for survivors of critical illness with multisystem manifestations. Research is needed to reduce the incidence of post-acute sequelae of COVID-19-related critical illness and to optimise therapeutic and rehabilitative care and support for patients.
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Affiliation(s)
- Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada; Department of Anesthesia and Pain Medicine, Toronto General Hospital, Toronto, ON, Canada.
| | - Mariann Gyöngyösi
- Division of Cardiology, 2nd Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Kathryn Howe
- Division of Vascular Surgery, University Health Network, Toronto, ON, Canada
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Manu Shankar-Hari
- The Queen's Medical Research Institute, Edinburgh BioQuarter, Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Margaret S Herridge
- Department of Medicine, University of Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, ON, Canada; Department of Medicine, University Health Network, Toronto, ON, Canada
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9
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Meiler S, Poschenrieder F, Mohr A, Strotzer Q, Scharf G, Rennert J, Stroszczynski C, Pfeifer M, Hamer O. CT findings in "Post-Covid": residua from acute pneumonia or "Post-Covid-ILD"? SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2023; 40:e2023024. [PMID: 37382073 PMCID: PMC10494745 DOI: 10.36141/svdld.v40i2.13983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
The aim of this study was to evaluate if CT findings in patients with pulmonary Post Covid syndrome represent residua after acute pneumonia or if SARS-CoV 2 induces a true ILD. Consecutive patients with status post acute Covid-19 pneumonia and persisting pulmonary symptoms were enrolled. Inclusion criteria were availability of at least one chest CT performed in the acute phase and at least one chest CT performed at least 80 days after symptom onset. In both acute and chronic phase CTs 14 CT features as well as distribution and extent of opacifications were independently determined by two chest radiologists. Evolution of every single CT lesion over time was registered intraindividually for every patient. Moreover, lung abnormalities were automatically segmented using a pre-trained nnU-Net model and volume as well as density of parenchymal lesions were plotted over the entire course of disease including all available CTs. 29 patients (median age 59 years, IQR 8, 22 men) were enrolled. Follow-up period was 80-242 days (mean 134). 152/157 (97 %) lesions in the chronic phase CTs represented residua of lung pathology in the acute phase. Subjective and objective evaluation of serial CTs showed that CT abnormalities were stable in location and continuously decreasing in extent and density. The results of our study support the hypothesis that CT abnormalities in the chronic phase after Covid-19 pneumonia represent residua in terms of prolonged healing of acute infection. We did not find any evidence for a Post Covid ILD.
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10
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Shchepikhin EI, Shmelev EI, Ergeshov AE, Zaytseva AS, Shergina EA, Adamovskaya E. Possibilities of non-invasive diagnosis of fibrotic phenotype of interstitial lung diseases. TERAPEVT ARKH 2023; 95:230-235. [PMID: 37167144 DOI: 10.26442/00403660.2023.03.202073] [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: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Progressive pulmonary fibrosis is a major problem in respiratory medicine. Currently, there are no reliable biomarkers for early diagnosis of progressive pulmonary fibrosis, which leads to delayed diagnosis. AIM To determine the role of serum biomarkers CA-19-9 and CA-125 and the possibilities of capillaroscopy of the nail fold in the diagnosis of progressive pulmonary fibrosis. MATERIALS AND METHODS The study included 43 patients with interstitial changes in the lungs. Based on the presence/absence of signs of progression over the previous 12 months, patients were divided into 2 groups. All patients underwent forced spirometry, body plethysmography, diffusion test, CT, lung ultrasound, capillaroscopy of the nail fold, study of serum concentrations of CA-19-9 and CA-125. RESULTS In the group of patients with a progressive fibrotic phenotype of Interstitial lung diseases, a greater severity of capillaroscopic changes and a higher level of CA-19-9 were revealed. Correlation of these parameters with changes according to CT scan data (Warrick test) and lung ultrasound was shown. CONCLUSION The data obtained demonstrate the possibilities of non-invasive diagnosis of progressive fibrosing interstitial lung diseases and require further research and prospective follow-up to assess the diagnostic and prognostic role of the studied biomarkers, as well as to determine their place in clinical practice.
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11
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Santa Cruz A, Mendes-Frias A, Azarias-da-Silva M, André S, Oliveira AI, Pires O, Mendes M, Oliveira B, Braga M, Lopes JR, Domingues R, Costa R, Silva LN, Matos AR, Ângela C, Costa P, Carvalho A, Capela C, Pedrosa J, Castro AG, Estaquier J, Silvestre R. Post-acute sequelae of COVID-19 is characterized by diminished peripheral CD8 +β7 integrin + T cells and anti-SARS-CoV-2 IgA response. Nat Commun 2023; 14:1772. [PMID: 36997530 PMCID: PMC10061413 DOI: 10.1038/s41467-023-37368-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
Several millions of individuals are estimated to develop post-acute sequelae SARS-CoV-2 condition (PASC) that persists for months after infection. Here we evaluate the immune response in convalescent individuals with PASC compared to convalescent asymptomatic and uninfected participants, six months following their COVID-19 diagnosis. Both convalescent asymptomatic and PASC cases are characterised by higher CD8+ T cell percentages, however, the proportion of blood CD8+ T cells expressing the mucosal homing receptor β7 is low in PASC patients. CD8 T cells show increased expression of PD-1, perforin and granzyme B in PASC, and the plasma levels of type I and type III (mucosal) interferons are elevated. The humoral response is characterized by higher levels of IgA against the N and S viral proteins, particularly in those individuals who had severe acute disease. Our results also show that consistently elevated levels of IL-6, IL-8/CXCL8 and IP-10/CXCL10 during acute disease increase the risk to develop PASC. In summary, our study indicates that PASC is defined by persisting immunological dysfunction as late as six months following SARS-CoV-2 infection, including alterations in mucosal immune parameters, redistribution of mucosal CD8+β7Integrin+ T cells and IgA, indicative of potential viral persistence and mucosal involvement in the etiopathology of PASC.
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Affiliation(s)
- André Santa Cruz
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal.
- Clinical Academic Center-Braga, Braga, Portugal.
| | - Ana Mendes-Frias
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | - Sónia André
- INSERM-U1124, Université Paris Cité, Paris, France
| | | | - Olga Pires
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Marta Mendes
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Bárbara Oliveira
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Marta Braga
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Joana Rita Lopes
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Rui Domingues
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Ricardo Costa
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Luís Neves Silva
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Ana Rita Matos
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Cristina Ângela
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
| | - Patrício Costa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Alexandre Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
- Clinical Academic Center-Braga, Braga, Portugal
| | - Carlos Capela
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Internal Medicine, Hospital of Braga, Braga, Portugal
- Clinical Academic Center-Braga, Braga, Portugal
| | - Jorge Pedrosa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - António Gil Castro
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jérôme Estaquier
- INSERM-U1124, Université Paris Cité, Paris, France.
- CHU de Québec - Université Laval Research Center, Québec City, Québec, Canada.
| | - Ricardo Silvestre
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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12
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Schmidt W, Pawlak-Buś K, Jóźwiak B, Leszczyński P. Identification of Clinical Response Predictors of Tocilizumab Treatment in Patients with Severe COVID-19 Based on Single-Center Experience. J Clin Med 2023; 12:jcm12062429. [PMID: 36983429 PMCID: PMC10051490 DOI: 10.3390/jcm12062429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Hyperinflammation in COVID-19 plays a crucial role in pathogenesis and severity; thus, many immunomodulatory agents are applied in its treatment. We aimed to identify good clinical response predictors of tocilizumab (TCZ) treatment in severe COVID-19, among clinical, laboratory, and radiological variables. We conducted a prospective, observational study with 120 patients with severe COVID-19 not improving despite dexamethasone (DEX) treatment. We used parametric and non-parametric statistics, univariate logistic regression, receiver operating characteristic (ROC) curves, and nonlinear factors tertile analysis. In total, 86 (71.7%) patients achieved the primary outcome of a good clinical response to TCZ. We identified forty-nine predictive factors with potential utility in patient selection and treatment monitoring. The strongest included time from symptom onset between 9 and 12 days, less than 70% of estimated radiological lung involvement, and lower activity of lactate dehydrogenase. Additional predictors were associated with respiratory function, vitamin D concentration, comorbidities, and inflammatory/organ damage biomarkers. Adverse events analysis proved the safety of such a regimen. Our study confirmed that using TCZ early in the hyperinflammatory phase, before severe respiratory failure development, is most beneficial. Considering the described predictive factors, employing simple and widely available laboratory, radiological, and clinical tools can optimize patient selection for immunomodulatory treatment with TCZ.
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Affiliation(s)
- Wiktor Schmidt
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Katarzyna Pawlak-Buś
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Barbara Jóźwiak
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
| | - Piotr Leszczyński
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
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13
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Stewart I, Jacob J, George PM, Molyneaux PL, Porter JC, Allen RJ, Aslani S, Baillie JK, Barratt SL, Beirne P, Bianchi SM, Blaikley JF, Chalmers JD, Chambers RC, Chadhuri N, Coleman C, Collier G, Denneny EK, Docherty A, Elneima O, Evans RA, Fabbri L, Gibbons MA, Gleeson FV, Gooptu B, Greening NJ, Guio BG, Hall IP, Hanley NA, Harris V, Harrison EM, Heightman M, Hillman TE, Horsley A, Houchen-Wolloff L, Jarrold I, Johnson SR, Jones MG, Khan F, Lawson R, Leavy O, Lone N, Marks M, McAuley H, Mehta P, Parekh D, Hanley KP, Platé M, Pearl J, Poinasamy K, Quint JK, Raman B, Richardson M, Rivera-Ortega P, Saunders L, Saunders R, Semple MG, Sereno M, Shikotra A, Simpson AJ, Singapuri A, Smith DJF, Spears M, Spencer LG, Stanel S, Thickett DR, Thompson AAR, Thorpe M, Walsh SLF, Walker S, Weatherley ND, Weeks ME, Wild JM, Wootton DG, Brightling CE, Ho LP, Wain LV, Jenkins GR. Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study. Am J Respir Crit Care Med 2023; 207:693-703. [PMID: 36457159 PMCID: PMC10037479 DOI: 10.1164/rccm.202203-0564oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage. Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata. Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up. Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis. Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.
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Affiliation(s)
- Iain Stewart
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Peter M. George
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Philip L. Molyneaux
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Richard J. Allen
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | | | | | - Paul Beirne
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, United Kingdom
| | - Stephen M. Bianchi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | | | | | | | | | | | | | | | - Omer Elneima
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Rachael A. Evans
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Laura Fabbri
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Fergus V. Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Bibek Gooptu
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Neil J. Greening
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Beatriz Guillen Guio
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ian P. Hall
- University of Nottingham, Nottingham, United Kingdom
| | | | - Victoria Harris
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | | | | | - Alex Horsley
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Mark G. Jones
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fasihul Khan
- University of Nottingham, Nottingham, United Kingdom
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Olivia Leavy
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Michael Marks
- University College London Hospital, London, United Kingdom
| | - Hamish McAuley
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Puja Mehta
- University College London Hospital, London, United Kingdom
| | - Dhruv Parekh
- University of Birmingham, Brimingham, United Kingdom
| | - Karen Piper Hanley
- University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Manuela Platé
- University College London Hospital, London, United Kingdom
| | - John Pearl
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Jennifer K. Quint
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Betty Raman
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Ruth Saunders
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | - Marco Sereno
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Aarti Shikotra
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | - Amisha Singapuri
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - David J. F. Smith
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark Spears
- Perth Royal Infirmary, NHS Tayside, Perth, United Kingdom; and
| | - Lisa G. Spencer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stefan Stanel
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Simon L. F. Walsh
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Mark E. Weeks
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jim M. Wild
- University of Sheffield, Sheffield, United Kingdom
| | | | | | - Ling-Pei Ho
- University of Oxford, Oxford, United Kingdom
| | - Louise V. Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Gisli R. Jenkins
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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14
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Kewalramani N, Heenan KM, McKeegan D, Chaudhuri N. Post-COVID Interstitial Lung Disease—The Tip of the Iceberg. Immunol Allergy Clin North Am 2023; 43:389-410. [PMID: 37055095 PMCID: PMC9982726 DOI: 10.1016/j.iac.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
The proportion of symptomatic patients with post-coronavirus 2019 (COVID-19) condition (long COVID) represents a significant burden on the individual as well as on the health care systems. A greater understanding of the natural evolution of symptoms over a longer period and the impacts of interventions will improve our understanding of the long-term impacts of the COVID-19 disease. This review will discuss the emerging evidence for the development of post-COVID interstitial lung disease focusing on the pathophysiological mechanisms, incidence, diagnosis, and impact of this potentially new and emerging respiratory disease.
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Affiliation(s)
- Namrata Kewalramani
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Switzerland,Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland,Corresponding author. Department of Biomedical Research, Lung Precision Medicine, Room 340, Murtenstrasse 24, Bern 3008. Switzerland
| | - Kerri-Marie Heenan
- Department of Respiratory Medicine, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, UK
| | - Denise McKeegan
- Department of Respiratory Medicine, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, UK
| | - Nazia Chaudhuri
- University of Ulster Magee Campus, Northland Road, Londonderry, Northern Ireland, UK
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15
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Fabbri L, Moss S, Khan FA, Chi W, Xia J, Robinson K, Smyth AR, Jenkins G, Stewart I. Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis. Thorax 2023; 78:191-201. [PMID: 35338102 PMCID: PMC8977456 DOI: 10.1136/thoraxjnl-2021-218275] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Persisting respiratory symptoms in COVID-19 survivors may be related to development of pulmonary fibrosis. We assessed the proportion of chest CT scans and pulmonary function tests consistent with parenchymal lung disease in the follow-up of people hospitalised with COVID-19 and viral pneumonitis. METHODS Systematic review and random effects meta-analysis of proportions using studies of adults hospitalised with SARS-CoV-2, SARS-CoV, MERS-CoV or influenza pneumonia and followed up within 12 months. Searches performed in MEDLINE and Embase. Primary outcomes were proportion of radiological sequelae on CT scans; restrictive impairment; impaired gas transfer. Heterogeneity was explored in meta-regression. RESULTS Ninety-five studies (98.9% observational) were included in qualitative synthesis, 70 were suitable for meta-analysis including 60 SARS-CoV-2 studies with a median follow-up of 3 months. In SARS-CoV-2, the overall estimated proportion of inflammatory sequelae was 50% during follow-up (0.50; 95% CI 0.41 to 0.58; I2=95%), fibrotic sequelae were estimated in 29% (0.29; 95% CI 0.22 to 0.37; I2=94.1%). Follow-up time was significantly associated with estimates of inflammatory sequelae (-0.036; 95% CI -0.068 to -0.004; p=0.029), associations with fibrotic sequelae did not reach significance (-0.021; 95% CI -0.051 to 0.009; p=0.176). Impaired gas transfer was estimated at 38% of lung function tests (0.38 95% CI 0.32 to 0.44; I2=92.1%), which was greater than restrictive impairment (0.17; 95% CI 0.13 to 0.23; I2=92.5%), neither were associated with follow-up time (p=0.207; p=0.864). DISCUSSION Sequelae consistent with parenchymal lung disease were observed following COVID-19 and other viral pneumonitis. Estimates should be interpreted with caution due to high heterogeneity, differences in study casemix and initial severity. PROSPERO REGISTRATION NUMBER CRD42020183139.
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Affiliation(s)
- Laura Fabbri
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Samuel Moss
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Fasihul A Khan
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Wenjie Chi
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jun Xia
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Karen Robinson
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alan Robert Smyth
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
| | - Gisli Jenkins
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Iain Stewart
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
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16
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Lutchmansingh DD, Higuero Sevilla JP, Possick JD, Gulati M. "Long Haulers". Semin Respir Crit Care Med 2023; 44:130-142. [PMID: 36646091 DOI: 10.1055/s-0042-1759568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Post-COVID conditions continue to afflict patients long after acute severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) infection. Over 50 symptoms across multiple organ systems have been reported, with pulmonary, cardiovascular, and neuropsychiatric sequelae occurring most frequently. Multiple terms have been used to describe post-COVID conditions including long COVID, long-haul COVID, postacute coronavirus disease 2019 (COVID-19), postacute sequelae of SARS-CoV-2 infection, long-term effects of COVID, and chronic COVID-19; however, standardized assessments and treatment algorithms for patients have generally been lacking. This review discusses the epidemiology and risk factors for post-COVID conditions and provides a general overview of the diagnostic assessment and treatment of specific manifestations. Data derived from the multitude of observational studies and scientific investigations into pathogenesis are providing a clearer understanding of the distinct phenotypes of post-COVID conditions. Insight gained from these studies and ongoing interventional trials continues to lead to the development of clinical protocols directed toward improving COVID-19 survivors' quality of life and preventing or reducing long-term morbidity.
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Affiliation(s)
- Denyse D Lutchmansingh
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jean Paul Higuero Sevilla
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer D Possick
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mridu Gulati
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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17
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Stanel SC, Rivera-Ortega P. Present and future perspectives in early diagnosis and monitoring for progressive fibrosing interstitial lung diseases. Front Med (Lausanne) 2023; 10:1114722. [PMID: 36873896 PMCID: PMC9975385 DOI: 10.3389/fmed.2023.1114722] [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: 12/02/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
Progressive fibrosing interstitial lung diseases (PF-ILDs) represent a group of conditions of both known and unknown origin which continue to worsen despite standard treatments, leading to respiratory failure and early mortality. Given the potential to slow down progression by initiating antifibrotic therapies where appropriate, there is ample opportunity to implement innovative strategies for early diagnosis and monitoring with the goal of improving clinical outcomes. Early diagnosis can be facilitated by standardizing ILD multidisciplinary team (MDT) discussions, implementing machine learning algorithms for chest computed-tomography quantitative analysis and novel magnetic-resonance imaging techniques, as well as measuring blood biomarker signatures and genetic testing for telomere length and identification of deleterious mutations in telomere-related genes and other single-nucleotide polymorphisms (SNPs) linked to pulmonary fibrosis such as rs35705950 in the MUC5B promoter region. Assessing disease progression in the post COVID-19 era also led to a number of advances in home monitoring using digitally-enabled home spirometers, pulse oximeters and other wearable devices. While validation for many of these innovations is still in progress, significant changes to current clinical practice for PF-ILDs can be expected in the near future.
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Affiliation(s)
- Stefan Cristian Stanel
- Interstitial Lung Disease (ILD) Unit, North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, United Kingdom.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Pilar Rivera-Ortega
- Interstitial Lung Disease (ILD) Unit, North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, United Kingdom
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18
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George PM, Reed A, Desai SR, Devaraj A, Faiez TS, Laverty S, Kanwal A, Esneau C, Liu MKC, Kamal F, Man WDC, Kaul S, Singh S, Lamb G, Faizi FK, Schuliga M, Read J, Burgoyne T, Pinto AL, Micallef J, Bauwens E, Candiracci J, Bougoussa M, Herzog M, Raman L, Ahmetaj-Shala B, Turville S, Aggarwal A, Farne HA, Dalla Pria A, Aswani AD, Patella F, Borek WE, Mitchell JA, Bartlett NW, Dokal A, Xu XN, Kelleher P, Shah A, Singanayagam A. A persistent neutrophil-associated immune signature characterizes post-COVID-19 pulmonary sequelae. Sci Transl Med 2022; 14:eabo5795. [PMID: 36383686 DOI: 10.1126/scitranslmed.abo5795] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Interstitial lung disease and associated fibrosis occur in a proportion of individuals who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through unknown mechanisms. We studied individuals with severe coronavirus disease 2019 (COVID-19) after recovery from acute illness. Individuals with evidence of interstitial lung changes at 3 to 6 months after recovery had an up-regulated neutrophil-associated immune signature including increased chemokines, proteases, and markers of neutrophil extracellular traps that were detectable in the blood. Similar pathways were enriched in the upper airway with a concomitant increase in antiviral type I interferon signaling. Interaction analysis of the peripheral phosphoproteome identified enriched kinases critical for neutrophil inflammatory pathways. Evaluation of these individuals at 12 months after recovery indicated that a subset of the individuals had not yet achieved full normalization of radiological and functional changes. These data provide insight into mechanisms driving development of pulmonary sequelae during and after COVID-19 and provide a rational basis for development of targeted approaches to prevent long-term complications.
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Affiliation(s)
- Peter M George
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Anna Reed
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Sujal R Desai
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Tasnim Shahridan Faiez
- Centre for Molecular Bacteriology and Infection, Department of Infectious Disease, Imperial College London, London SW7 2DD, UK
| | - Sarah Laverty
- Section of Virology, Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | - Amama Kanwal
- Faculty of Health, Medicine and Wellbeing, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Camille Esneau
- Faculty of Health, Medicine and Wellbeing, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michael K C Liu
- Section of Virology, Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | | | - William D-C Man
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
- Faculty of Life Sciences and Medicine, King's College London, London WC2R 2LS, UK
| | - Sundeep Kaul
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
| | - Suveer Singh
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
| | - Georgia Lamb
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
| | - Fatima K Faizi
- Centre for Molecular Bacteriology and Infection, Department of Infectious Disease, Imperial College London, London SW7 2DD, UK
| | - Michael Schuliga
- Faculty of Health, Medicine and Wellbeing, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jane Read
- Faculty of Health, Medicine and Wellbeing, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Thomas Burgoyne
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- UCL Institute of Ophthalmology, University College London, London EC1V 9EL, UK
| | - Andreia L Pinto
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
| | - Jake Micallef
- Belgian Volition SRL, 22 rue Phocas Lejeune, Parc Scientifique Créalys, Isnes 5032, Belgium
| | - Emilie Bauwens
- Belgian Volition SRL, 22 rue Phocas Lejeune, Parc Scientifique Créalys, Isnes 5032, Belgium
| | - Julie Candiracci
- Belgian Volition SRL, 22 rue Phocas Lejeune, Parc Scientifique Créalys, Isnes 5032, Belgium
| | - Mhammed Bougoussa
- Belgian Volition SRL, 22 rue Phocas Lejeune, Parc Scientifique Créalys, Isnes 5032, Belgium
| | - Marielle Herzog
- Belgian Volition SRL, 22 rue Phocas Lejeune, Parc Scientifique Créalys, Isnes 5032, Belgium
| | - Lavanya Raman
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | | | - Stuart Turville
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Anupriya Aggarwal
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Hugo A Farne
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
- The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
- Chest and Allergy Department, St Mary's Hospital, Imperial College NHS Trust, London W2 1NY, UK
| | - Alessia Dalla Pria
- Section of Virology, Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Department of HIV and Genitourinary Medicine, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK
| | - Andrew D Aswani
- Department of Intensive Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
- Santersus AG, Buckhauserstrasse 34, Zurich 8048, Switzerland
| | - Francesca Patella
- Kinomica Ltd, Biohub, Alderley Park, Alderley Edge, Macclesfield, Cheshire SK10 4TG, UK
| | - Weronika E Borek
- Kinomica Ltd, Biohub, Alderley Park, Alderley Edge, Macclesfield, Cheshire SK10 4TG, UK
| | - Jane A Mitchell
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK
| | - Nathan W Bartlett
- Faculty of Health, Medicine and Wellbeing, Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Arran Dokal
- Kinomica Ltd, Biohub, Alderley Park, Alderley Edge, Macclesfield, Cheshire SK10 4TG, UK
| | - Xiao-Ning Xu
- Section of Virology, Department of Infectious Disease, Imperial College London, London W2 1PG, UK
| | - Peter Kelleher
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- Department of HIV and Genitourinary Medicine, Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK
- Immunology of Infection Section, Department of Infectious Disease, Imperial College London, London W2 1PG, UK
- Department of Infection and Immunity Sciences, North West London Pathology NHS Trust, London W2 1NY, UK
| | - Anand Shah
- Royal Brompton and Harefield Clinical Group, Guy's and St. Thomas' NHS Foundation Trust, London SW3 6NR, UK
- MRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Aran Singanayagam
- Centre for Molecular Bacteriology and Infection, Department of Infectious Disease, Imperial College London, London SW7 2DD, UK
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19
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Averyanov AV, Danilevskaya OV. Diffuse Lung Disease in Convalescents of COVID-19. HERALD OF THE RUSSIAN ACADEMY OF SCIENCES 2022; 92:412-417. [PMID: 36091843 PMCID: PMC9447983 DOI: 10.1134/s1019331622040037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 06/15/2023]
Abstract
The most common causes of diffuse interstitial lung damage following COVID-19, often either imitate it but have a different nature or remain due to prolonged persistence of SARS-CoV-2 in the lower respiratory tract. A diagnostic algorithm is proposed to make mostly a correct diagnosis, the key element of which is study of the bronchoalveolar lavage fluid.
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Affiliation(s)
- A. V. Averyanov
- Pulmonology Research Institute, Federal Medical‒Biological Agency, Moscow, Russia
| | - O. V. Danilevskaya
- Pulmonology Research Institute, Federal Medical‒Biological Agency, Moscow, Russia
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20
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Real-Life Use of Tocilizumab in the Treatment of Severe COVID-19 Pneumonia. Adv Virol 2022; 2022:7060466. [PMID: 35721667 PMCID: PMC9203205 DOI: 10.1155/2022/7060466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/09/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) can progress to severe respiratory compromise and lead to mortality due to induction of cytokine storm. Tocilizumab (TCZ) is approved by the FDA for the treatment of cytokine release syndrome (CRS). This study aims to analyze the outcomes among patients who received TCZ in the United Arab Emirates. Methods A retrospective cohort study was conducted among COVID-19 patients who received TCZ in a tertiary care hospital from May 2020 to August 2021. For analysis, patients were divided into two groups based on survival and clinical improvement. Results Overall, 80% of patients receiving TCZ were discharged by day 28. There was a gradual improvement in oxygen requirements in our patients with a majority of them on room air by day 28. Age more than 50 years (P=0.034) and comorbidities such as cardiovascular disease (CVD) (P=0.002) and renal insufficiency (P=0.013) were significantly associated with mortality. Discussion. In our analysis, patients who were mechanically ventilated at the time of administration of TCZ had a significantly higher risk of death by day 28. In both survived and improved groups, younger patients had better outcomes than older patients. Patients who received TCZ earlier during therapy from the onset of symptoms had better survival outcomes. There was only one death among 14 patients who received vaccination. There was no significant difference in mortality among patients with comorbidities such as diabetes, hypertension, dyslipidemia, obesity, and pulmonary diseases, hypothesizing that administration of TCZ improves the outcomes in COVID-19 patients with these comorbidities.
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21
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Huntley CC, Patel K, Bil Bushra SES, Mobeen F, Armitage MN, Pye A, Knight CB, Mostafa A, Kershaw M, Mughal AZ, McKemey E, Turner AM, Burge PS, Walters GI. Pulmonary function test and computed tomography features during follow-up after SARS, MERS and COVID-19: a systematic review and meta-analysis. ERJ Open Res 2022; 8:00056-2022. [PMID: 35642193 PMCID: PMC9035766 DOI: 10.1183/23120541.00056-2022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background The COVID-19 pandemic follows severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remain unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19. Methods This systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random-effects model) and proportion of CT features (Freeman-Tukey transformation random-effects model) were performed. Findings Persistent reduction in the diffusing capacity for carbon monoxide following SARS and COVID-19 infection is seen at 6 months follow-up, and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity, linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation are reported less often. Severe/critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/moderate infection. Interpretation Persistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome. It is yet to be determined if this is a regressive or progressive disease.
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Affiliation(s)
- Christopher C. Huntley
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK,Institute of Applied Health Research, University of Birmingham, Birmingham, UK,Corresponding author: Christopher C. Huntley ()
| | - Ketan Patel
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,UHB NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Anita Pye
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,UHB NHS Foundation Trust, Birmingham, UK
| | - P. Sherwood Burge
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK
| | - Gareth I. Walters
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, UK,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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Leung AN. COVID-19 Pandemic: The Road to Recovery. Radiology 2022; 304:471-472. [PMID: 35348383 PMCID: PMC8988168 DOI: 10.1148/radiol.220488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ann N Leung
- Department of Radiology Stanford University Medical Center
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23
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Salvi S, Ghorpade D, Dhoori S, Dhar R, Dumra H, Chhajed P, Bhattacharya P, Rajan S, Talwar D, Christopher D, Mohan M, Udwadia Z. Role of antifibrotic drugs in the management of post-COVID-19 interstitial lung disease: A review of literature and report from an expert working group. Lung India 2022; 39:177-186. [PMID: 35259802 PMCID: PMC9053913 DOI: 10.4103/lungindia.lungindia_659_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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