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Aydeniz E, van Bussel BCT, de Jongh S, Schellens J, Heines SJH, van Kuijk SMJ, Tas J, van Rosmalen F, van der Horst ICC, Bergmans DCJJ. Serial electrical impedance tomography course in different treatment groups; The MaastrICCht cohort. J Crit Care 2024; 80:154506. [PMID: 38113747 DOI: 10.1016/j.jcrc.2023.154506] [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: 06/01/2023] [Revised: 10/16/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE To describe the effect of dexamethasone and tocilizumab on regional lung mechanics over admission in all mechanically ventilated COVID-19 patients. MATERIALS AND METHODS Dynamic compliance, alveolar overdistension and collapse were serially determined using electric impedance tomography (EIT). Patients were categorized into three groups; no anti-inflammatory therapy, dexamethasone therapy, dexamethasone + tocilizumab therapy. The EIT variables were (I) visualized using polynomial regression, (II) evaluated throughout admission using linear mixed-effects models, and (III) average respiratory variables were compared. RESULTS Visual inspection of EIT variables showed a pattern of decreasing dynamic compliance. Overall, optimal set PEEP was lower in the dexamethasone group (-1.4 cmH2O, -2.6; -0.2). Clinically applied PEEP was lower in the dexamethasone and dexamethasone + tocilizumab group (-1.5 cmH2O, -2.6; -0.2; -2.2 cmH2O, -5.1; 0.6). Dynamic compliance, alveolar overdistension, and alveolar collapse at optimal set PEEP did not significantly differ between the three groups. CONCLUSION Optimal and clinically applied PEEP were lower in the dexamethasone and dexamethasone + tocilizumab groups. The results suggest that the potential beneficial effects of these therapies do not affect lung mechanics favorably. However, this study cannot fully rule out any beneficial effect of anti-inflammatory treatment on pulmonary function due to its observational nature.
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Affiliation(s)
- Eda Aydeniz
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Intensive Care Medicine, Laurentius Hospital Roermond, Roermond, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Sebastiaan de Jongh
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joep Schellens
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Serge J H Heines
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jeanette Tas
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Frank van Rosmalen
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Dennis C J J Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
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Zhang Z, Wang C, Li Z, Liu Y, Nie Y, Zhang J, Li D. Efficacy of respiratory rehabilitation in patients with COVID-19: a retrospective study. BMC Pulm Med 2024; 24:152. [PMID: 38532376 DOI: 10.1186/s12890-024-02969-z] [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: 12/14/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of confirmed cases and deaths globally. The purpose of this study was to investigate the therapeutic effect of airway clearance technology combined with prone ventilation on patients infected with COVID-19. METHODS 38 patients with COVID-19 (severe) who were treated in the intensive rehabilitation group of Shengli Oilfield Central Hospital. They were randomly divided into a control group and an observation group. The control group received prone position ventilation intervention, and the observation group received airway clearance technology combined with prone position ventilation intervention. The changes of oxygen and index, procalcitonin (PCT), interleukin-6 (IL-6) and chest X-ray image indexes were compared between the two groups. RESULT There was no significant difference in age, gender and other general data between the control group and the observation group. The results showed that oxygen index, PCT, IL-6 and chest X-ray image index in the observation group were better than that indexes in the control group. CONCLUSION Airway clearance technology combined with prone ventilation intervention in patients with COVID-19 can improve the total effective rate and oxygenation index, improve the inflammatory indicators and respiratory function of patients. And it may be widely promoted and used in the treatment of patients with COVID-19 (severe).
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Affiliation(s)
- Zhiyou Zhang
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Congcong Wang
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Zhendong Li
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Yueyang Liu
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Yutong Nie
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Jianwei Zhang
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Dawei Li
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China.
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Karampitsakos T, Papaioannou O, Tsiri P, Katsaras M, Katsimpris A, Kalogeropoulos AP, Malakounidou E, Zarkadi E, Tsirikos G, Georgiopoulou V, Sotiropoulou V, Koulousousa E, Chourpiliadi C, Matsioulas A, Lagadinou M, Sampsonas F, Akinosoglou K, Marangos M, Tzouvelekis A. Tocilizumab versus baricitinib in hospitalized patients with severe COVID-19: an open label, randomized controlled trial. Clin Microbiol Infect 2023; 29:372-378. [PMID: 36273769 PMCID: PMC9636985 DOI: 10.1016/j.cmi.2022.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/08/2022] [Accepted: 10/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Randomized controlled trials comparing tocilizumab and baricitinib in patients with coronavirus disease 2019 (COVID-19) are needed. This was an open-label, randomized controlled trial aiming to address this unmet need. METHODS To determine whether baricitinib was non-inferior to tocilizumab, we assessed whether the upper boundary of the two-sided 95% CI of the hazard ratio (HR) did not exceed 1.50. The primary outcome was mechanical ventilation or death by day 28. Secondary outcomes included time to hospital discharge by day 28 and change in WHO progression scale at day 10. RESULTS We assigned 251 patients with COVID-19 and a PaO2/FiO2 ratio of <200 to receive either tocilizumab (n = 126) or baricitinib (n = 125) plus standard of care. Baricitinib was non-inferior to tocilizumab for the primary composite outcome of mechanical ventilation or death by day 28 (mechanical ventilation or death for patients who received baricitinib, 39.2% [n = 49/125]; mechanical ventilation or death for patients who received tocilizumab, 44.4% [n = 56/126]; HR, 0.83; 95% CI, 0.56-1.21; p 0.001 for non-inferiority). Baricitinib was non-inferior to tocilizumab for the time to hospital discharge within 28 days (patients who received baricitinib- discharged alive: 58.4% [n = 73/125] vs. patients who received tocilizumab- discharged alive: 52.4% [n = 66/126]; HR, 0.85; 95% CI, 0.61-1.18; p < 0.001 for non-inferiority). There was no significant difference between the baricitinib and tocilizumab arms in the change in WHO scale at day 10 (0.0 [95% CI, 0.0-0.0] vs. 0.0 [95% CI, 0.0-1.0]; p 0.83). DISCUSSION In the setting of this trial, baricitinib was non-inferior to tocilizumab with regards to the composite outcome of mechanical ventilation or death by day 28 and the time to discharge by day 28 in patients with severe COVID-19.
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Affiliation(s)
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | - Panagiota Tsiri
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | - Matthaios Katsaras
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | - Andreas Katsimpris
- 'G.Gennimatas' Hospital, National and Kapodistrian University of Athens, Athens, Greece; Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | | | - Elli Malakounidou
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | - Eirini Zarkadi
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | - Georgios Tsirikos
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | | | | | - Electra Koulousousa
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | | | | | - Maria Lagadinou
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece
| | | | - Markos Marangos
- Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Rio, Greece.
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Karampitsakos T, Sotiropoulou V, Katsaras M, Tsiri P, Georgakopoulou VE, Papanikolaou IC, Bibaki E, Tomos I, Lambiri I, Papaioannou O, Zarkadi E, Antonakis E, Pandi A, Malakounidou E, Sampsonas F, Makrodimitri S, Chrysikos S, Hillas G, Dimakou K, Tzanakis N, Sipsas NV, Antoniou K, Tzouvelekis A. Post-COVID-19 interstitial lung disease: Insights from a machine learning radiographic model. Front Med (Lausanne) 2023; 9:1083264. [PMID: 36733935 PMCID: PMC9886681 DOI: 10.3389/fmed.2022.1083264] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Post-acute sequelae of COVID-19 seem to be an emerging global crisis. Machine learning radiographic models have great potential for meticulous evaluation of post-COVID-19 interstitial lung disease (ILD). Methods In this multicenter, retrospective study, we included consecutive patients that had been evaluated 3 months following severe acute respiratory syndrome coronavirus 2 infection between 01/02/2021 and 12/5/2022. High-resolution computed tomography was evaluated through Imbio Lung Texture Analysis 2.1. Results Two hundred thirty-two (n = 232) patients were analyzed. FVC% predicted was ≥80, between 60 and 79 and <60 in 74.2% (n = 172), 21.1% (n = 49), and 4.7% (n = 11) of the cohort, respectively. DLCO% predicted was ≥80, between 60 and 79 and <60 in 69.4% (n = 161), 15.5% (n = 36), and 15.1% (n = 35), respectively. Extent of ground glass opacities was ≥30% in 4.3% of patients (n = 10), between 5 and 29% in 48.7% of patients (n = 113) and <5% in 47.0% of patients (n = 109). The extent of reticulation was ≥30%, 5-29% and <5% in 1.3% (n = 3), 24.1% (n = 56), and 74.6% (n = 173) of the cohort, respectively. Patients (n = 13, 5.6%) with fibrotic lung disease and persistent functional impairment at the 6-month follow-up received antifibrotics and presented with an absolute change of +10.3 (p = 0.01) and +14.6 (p = 0.01) in FVC% predicted at 3 and 6 months after the initiation of antifibrotic. Conclusion Post-COVID-19-ILD represents an emerging entity. A substantial minority of patients presents with fibrotic lung disease and might experience benefit from antifibrotic initiation at the time point that fibrotic-like changes are "immature." Machine learning radiographic models could be of major significance for accurate radiographic evaluation and subsequently for the guidance of therapeutic approaches.
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Affiliation(s)
| | - Vasilina Sotiropoulou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Matthaios Katsaras
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Panagiota Tsiri
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | | | - Eleni Bibaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ioannis Tomos
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Irini Lambiri
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Eirini Zarkadi
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | - Aggeliki Pandi
- Department of Respiratory Medicine, Corfu General Hospital, Corfu, Greece
| | - Elli Malakounidou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Sotiria Makrodimitri
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Athens, Greece
| | - Serafeim Chrysikos
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Georgios Hillas
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Katerina Dimakou
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos V. Sipsas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Athens, Greece,Medical School, National and Kapodistrian University of Athens, Zografou, Greece
| | - Katerina Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece,*Correspondence: Argyris Tzouvelekis, ,
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5
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Comarmond C, Drumez E, Labreuche J, Hachulla E, Thomas T, Flipo RM, Seror R, Avouac J, Balandraud N, Desbarbieux R, Felten R, Gilson M, Guyot MH, Hittinger-Roux A, Pham T, Renard M, Roux N, Sobanski V, Tournadre A, Richez C, Cacoub P. COVID-19 presentation and outcomes in patients with inflammatory rheumatic and musculoskeletal diseases receiving IL6-receptor antagonists prior to SARS-CoV-2 infection. J Transl Autoimmun 2023; 6:100190. [PMID: 36684808 PMCID: PMC9839461 DOI: 10.1016/j.jtauto.2023.100190] [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: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Objective COVID-19 outcome may be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases (RMD) receiving immunosuppressive therapy. We aimed to investigate whether RMD patients on anti-IL6 therapy prior to SARS-CoV-2 infection have less severe disease and better outcomes of COVID-19. Methods We conducted a retrospective national, multicentre cohort study using data from the French RMD COVID-19 cohort. We compared the severity and outcome of highly suspected or confirmed COVID-19 infection in RMD patients previously treated with tocilizumab or sarilumab (anti-IL6 group) with patients who did not receive anti-IL6 therapy (no anti-IL6 group). Results Data were collected for 1883 patients with mean age of 55.2 years [SD 16.7] and 1256 (66.7%) female. Two hundred ten (11.1%) developed severe COVID-19 and 115 (6.4%) died. After adjusting for potential confounding factors, severe COVID-19 was less frequent in the anti-IL6 group compared with the no anti-IL6 group (aOR for moderate vs. mild severity, 0.23 [95% CI, 0.10 to 0.54], p ≤ 0.01 and aOR for severe vs. mild, 0.29 [95% CI, 0.10 to 0.81], p ≤ 0.01). No significant differences were found for the evolution of COVID-19 between the anti-IL6 group and the no anti-IL6 group (aOR for recovery with sequelae vs recovery without sequelae, 0.78 [95% CI, 0.41 to 1.48] and aOR for death vs recovery without sequelae, 0.29 [95% CI, 0.07 to 1.30]). Conclusion RMD patients receiving anti-IL6 therapy prior to SARS-CoV-2 infection have less severe forms of COVID-19. No difference was observed in COVID-19 evolution, i.e., sequelae or death, between the groups.
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Affiliation(s)
- Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université de Paris, 75010, Paris, France,Corresponding author.
| | - Elodie Drumez
- ULR 2694 METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Julien Labreuche
- ULR 2694 METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Eric Hachulla
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286—INFINITE: Institute for Translational Research in Inflammation, France
| | - Thierry Thomas
- Rheumatology, CHU de Saint-Etienne - Hôpital Nord, France
| | | | - Raphaëlle Seror
- Rheumatology, APHP - Hôpital Bicêtre, Kremlin-Bicêtre, France
| | - Jérôme Avouac
- Rheumatology, APHP - Hôpital Cochin, Université de, Paris, France
| | | | | | - Renaud Felten
- Rheumatology, CHRU de Strasbourg - Hôpital de Hautepierre, France
| | | | | | | | - Thao Pham
- Rheumatology, APHM - Hôpital Sainte-Marguerite, Marseille, France
| | - Myriam Renard
- Rheumatology, CH Métropole-Savoie - Hôpital Reine Hortense, France
| | - Nicolas Roux
- Rheumatology, Hôpitaux Privés de Metz - Hôpital Belle-Isle, France
| | - Vincent Sobanski
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, U1286—INFINITE: Institute for Translational Research in Inflammation, France
| | - Anne Tournadre
- Rheumatology, CHU de Clermont-Ferrand - Hôpital Gabriel Montpied, France
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Sorbonne Université, UMR 959, 75013, Paris, France,Corresponding author.
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Arias M, Oliveros H, Lechtig S, Bustos RH. Biologics in COVID-19 So Far: Systematic Review. Pharmaceuticals (Basel) 2022; 15:ph15070783. [PMID: 35890081 PMCID: PMC9321859 DOI: 10.3390/ph15070783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 12/17/2022] Open
Abstract
This systematic review aimed to reevaluate the available evidence of the use of biologics as treatment candidates for the treatment of severe and advanced COVID-19 disease; what are the rationale for their use, which are the most studied, and what kind of efficacy measures are described? A search through Cochrane, Embase, Pubmed, Medline, medrxiv.org, and Google scholar was performed on the use of biologic interventions in COVID-19/SARS-CoV-2 infection, viral pneumonia, and sepsis, until 11 January 2022. Throughout the research, we identified 4821 records, of which 90 were selected for qualitative analysis. Amongst the results, we identified five popular targets of use: IL6 and IL1 inhibitors, interferons, mesenchymal stem cells treatment, and anti-spike antibodies. None of them offered conclusive evidence of their efficacy with consistency and statistical significance except for some studies with anti-spike antibodies; however, Il6 and IL1 inhibitors as well as interferons show encouraging data in terms of increased survival and favorable clinical course that require further studies with better methodology standardization.
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Affiliation(s)
- Milton Arias
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Autopista Norte de Bogotá, Chía 140013, Colombia; (M.A.); (S.L.)
| | - Henry Oliveros
- Department of Epidemiology, Health Research Group, Faculty of Medicine, Universidad de La Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá, Chía 140013, Colombia;
| | - Sharon Lechtig
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Autopista Norte de Bogotá, Chía 140013, Colombia; (M.A.); (S.L.)
| | - Rosa-Helena Bustos
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Autopista Norte de Bogotá, Chía 140013, Colombia; (M.A.); (S.L.)
- Correspondence: ; Tel.: +57-1608615555
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7
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Pagkratis K, Chrysikos S, Antonakis E, Pandi A, Kosti CN, Markatis E, Hillas G, Digalaki A, Koukidou S, Chaini E, Afthinos A, Dimakou K, Papanikolaou IC. Predictors of Mortality in Tocilizumab-Treated Severe COVID-19. Vaccines (Basel) 2022; 10:vaccines10060978. [PMID: 35746585 PMCID: PMC9230711 DOI: 10.3390/vaccines10060978] [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: 05/02/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose: Tocilizumab is associated with positive outcomes in severe COVID-19. We wanted to describe the characteristics of nonresponders to treatment. Methods: This was a retrospective multicenter study in two respiratory departments investigating adverse outcomes at 90 days from diagnosis in subjects treated with tocilizumab (8 mg/kg intravenously single dose) for severe progressive COVID-19. Results: Of 121 subjects, 62% were males, and 9% were fully vaccinated. Ninety-six (79.4%) survived, and 25 died (20.6%). Compared to survivors (S), nonsurvivors (NS) were older (median 57 versus 75 years of age), had more comorbidities (Charlson comorbidity index 2 versus 5) and had higher rates of intubation/mechanical ventilation (p < 0.05). On admission, NS had a lower PO2/FiO2 ratio, higher blood ferritin, and higher troponin, and on clinical progression (day of tocilizumab treatment), NS had a lower PO2/FiO2 ratio, decreased lymphocytes, increased neutrophil to lymphocyte ratio, increased ferritin and lactate dehydrogenase (LDH), disease located centrally on computed tomography scan, and increased late c-reactive protein. Cox proportional hazards regression analysis identified age and LDH on deterioration as predictors of death; admission PO2/FiO2 ratio and LDH as predictors of intubation; PO2/FiO2 ratios, LDH, and central lung disease on radiology as predictors of noninvasive ventilation (NIV) (a < 0.05). The log-rank test of mortality yielded the same results (p < 0.001). ROC analysis of the above predictors in a separate validation cohort yielded significant results. Conclusions: Older age and high serum LDH levels are predictors of mortality in tocilizumab-treated severe COVID-19 patients. Hypoxia levels, LDH, and central pulmonary involvement radiologically are associated with intubation and NIV.
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Affiliation(s)
- Konstantinos Pagkratis
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Serafeim Chrysikos
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Emmanouil Antonakis
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Aggeliki Pandi
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Chrysavgi Nikolaou Kosti
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Eleftherios Markatis
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Georgios Hillas
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Antonia Digalaki
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Sofia Koukidou
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Eleftheria Chaini
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Andreas Afthinos
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
| | - Katerina Dimakou
- 5th Respiratory Medicine Department, SOTIRIA Chest Hospital, 11527 Athens, Greece; (S.C.); (C.N.K.); (G.H.); (A.D.); (S.K.); (K.D.)
| | - Ilias C. Papanikolaou
- Pulmonary Department, Corfu General Hospital, 49100 Corfu, Greece; (K.P.); (E.A.); (A.P.); (E.M.); (E.C.); (A.A.)
- Correspondence: ; Tel.: +30-266-136-0694; Fax.: +30-266-136-0488
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8
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Spuch C, López-García M, Rivera-Baltanás T, Cabrera-Alvargonzález JJ, Gadh S, Rodrigues-Amorim D, Álvarez-Estévez T, Mora A, Iglesias-Martínez-Almeida M, Freiría-Martínez L, Pérez-Rodríguez M, Pérez-González A, López-Domínguez A, Longueira-Suarez MR, Sousa-Domínguez A, Araújo-Ameijeiras A, Mosquera-Rodríguez D, Crespo M, Vila-Fernández D, Regueiro B, Olivares JM. Efficacy and Safety of Lithium Treatment in SARS-CoV-2 Infected Patients. Front Pharmacol 2022; 13:850583. [PMID: 35496309 PMCID: PMC9046673 DOI: 10.3389/fphar.2022.850583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/14/2022] [Indexed: 12/15/2022] Open
Abstract
At the beginning of the pandemic, we observed that lithium carbonate had a positive effect on the recovery of severely ill patients with COVID-19. Lithium is able to inhibit the replication of several types of viruses, some of which are similar to the SARS-CoV-2 virus, increase the immune response and reduce inflammation by preventing or reducing the cytokine storm. Previously, we published an article with data from six patients with severe COVID-19 infection, where we proposed that lithium carbonate could be used as a potential treatment for COVID-19. Now, we set out to conduct a randomized clinical trial number EudraCT 2020–002008–37 to evaluate the efficacy and safety of lithium treatment in patients infected with severe SARS-CoV-2. We showed that lithium was able to reduce the number of days of hospital and intensive care unit admission as well as the risk of death, reduces inflammatory cytokine levels by preventing cytokine storms, and also reduced the long COVID syndromes. We propose that lithium carbonate can be used to reduce the severity of COVID-19.
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Affiliation(s)
- Carlos Spuch
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- *Correspondence: Carlos Spuch,
| | - Marta López-García
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
| | - J. J Cabrera-Alvargonzález
- Microbiology and Infectology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Sudhir Gadh
- US Navy Medical Corps Commander, Medical Director at Educational Alliance, Medical Director at Rejuvenation Health, New York, NY, United States
| | - Daniela Rodrigues-Amorim
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Norfolk, United States
| | - Tania Álvarez-Estévez
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Almudena Mora
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
| | - Marta Iglesias-Martínez-Almeida
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Universidade de Vigo, Vigo, Spain
| | - Luis Freiría-Martínez
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Universidade de Vigo, Vigo, Spain
| | - Maite Pérez-Rodríguez
- Infectious Diseases Unit and Virology & Pathogenesis Group, Department of Internal Medicine, Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Alexandre Pérez-González
- Infectious Diseases Unit and Virology & Pathogenesis Group, Department of Internal Medicine, Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Ana López-Domínguez
- Infectious Diseases Unit and Virology & Pathogenesis Group, Department of Internal Medicine, Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - María Rebeca Longueira-Suarez
- Infectious Diseases Unit and Virology & Pathogenesis Group, Department of Internal Medicine, Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Adrián Sousa-Domínguez
- Infectious Diseases Unit and Virology & Pathogenesis Group, Department of Internal Medicine, Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Alejandro Araújo-Ameijeiras
- Infectious Diseases Unit and Virology & Pathogenesis Group, Department of Internal Medicine, Hospital Álvaro Cunqueiro, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - David Mosquera-Rodríguez
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Manuel Crespo
- Microbiology and Infectology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Dolores Vila-Fernández
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
| | - Benito Regueiro
- Microbiology and Infectology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
- Microbiology Department, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
- Microbiology and Parasitology Department Medicine and Odontology, Universidade de Santiago, Santiago de Compostela, Spain
| | - Jose Manuel Olivares
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IIS-Galicia Sur), SERGAS-UVIGO, CIBERSAM, Vigo, Spain
- Department of Psychiatry, Hospital Álvaro Cunqueiro, SERGAS, Vigo, Spain
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9
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Karampitsakos T, Papaioannou O, Dimeas I, Tsiri P, Sotiropoulou V, Tomos I, Papanikolaou IC, Katsaras M, Kirgou P, Daniil Z, Gourgoulianis KI, Sampsonas F, Manali E, Papiris S, Bouros D, Tzouvelekis A. Reduced immunogenicity of the mRNA vaccine BNT162b2 in patients with IPF. ERJ Open Res 2022; 8:00082-2022. [PMID: 35509438 PMCID: PMC8990384 DOI: 10.1183/23120541.00082-2022] [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: 02/15/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Abstract
The emergence and spread of 2019 coronavirus disease (COVID-19) are causing a growing global public health crisis. Despite advances in treatment, vaccination remains the best way to contain the pandemic [1]. Vaccines are available by means of conditional marketing approval, full approval and emergency use authorisation pathways [2]. Evidence suggest that immunocompromised individuals, including solid-organ transplant recipients and patients under immunosuppressive treatment, may have increased mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection despite double-dose mRNA vaccine regimens [3]. This is partially attributed to blunted immune responses to vaccination, since only 38–54% of kidney and liver transplant recipients developed detectable SARS-CoV-2 antibodies following the second dose of mRNA vaccines [3, 4]. Patients with #IPF do not mount appreciable anti-spike antibody responses to two doses of #SARSCoV2 mRNA vaccine compared to the general population. National authorities should prioritise patients with IPF for booster doses.https://bit.ly/3K2KXQ0
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