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Yu X, Li X, Xia S, Lu L, Fan J, Wang Y, Fu Y, Suo C, Man Q, Xiong L. A study of clinical and serological correlation of early myocardial injury in elderly patients infected with the Omicron variant. Front Cardiovasc Med 2024; 11:1268499. [PMID: 38420262 PMCID: PMC10899444 DOI: 10.3389/fcvm.2024.1268499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Myocardial injury in elderly Omicron variant patients is a leading cause of severe disease and death. This study focuses on elucidating the clinical characteristics and potential risk factors associated with myocardial injury in elderly patients infected with the Omicron variant. Methods Myocardial injury was defined based on elevated cardiac troponin concentrations exceeding the 99th percentile upper reference limit. Among 772 elderly Omicron-infected patients, categorized into myocardial injury (n = 263) and non-myocardial injury (n = 509) groups. The stratified log-rank statistic was used to compare the probability of patients developing intensive care. Receiver operating characteristic curves were used to determine the best cut-off values of clinical and laboratory data for predicting myocardial injury. Univariate and multivariate logistic regression was adopted to analyze the risk factors for myocardial injury. Results The occurrence of myocardial injury in Omicron variant-infected geriatric patients was up to 34.07% and these patients may have a higher rate of requiring intensive care (P < 0.05). By comparing myocardial injury patients with non-myocardial injury patients, notable differences were observed in age, pre-existing medical conditions (e.g., hypertension, coronary heart disease, cerebrovascular disease, arrhythmia, chronic kidney disease, and heart failure), and various laboratory biomarkers, including cycle threshold-ORF1ab gene (Ct-ORF1ab), cycle threshold-N gene (Ct-N), white blood cell count, neutrophil (NEUT) count, NEUT%, lymphocyte (LYM) count, LYM%, and D-dimer, interleukin-6, procalcitonin, C-reactive protein, serum amyloid A, total protein, lactate dehydrogenase, aspartate aminotransferase, glomerular filtration rate, blood urea nitrogen, and serum creatinine (sCr) levels (P < 0.05). Furthermore, in the multivariable logistic regression, we identified potential risk factors for myocardial injury in Omicron variant-infected elderly patients, including advanced age, pre-existing coronary artery disease, interleukin-6 > 22.69 pg/ml, procalcitonin > 0.0435 ng/ml, D-dimer > 0.615 mg/L, and sCr > 81.30 μmol/L. Conclusion This study revealed the clinical characteristics and potential risk factors associated with myocardial injury that enable early diagnosis of myocardial injury in Omicron variant-infected elderly patients, providing important reference indicators for early diagnosis and timely clinical intervention.
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Affiliation(s)
- Xueying Yu
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaoguang Li
- Department of Thyroid, Breast and Vascular Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shuai Xia
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Fudan University, Shanghai, China
| | - Lu Lu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Fudan University, Shanghai, China
| | - Jiahui Fan
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ying Wang
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Fu
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chen Suo
- Department of Epidemiology and Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Shanghai, China
| | - Qiuhong Man
- Department of Clinical Laboratory, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lize Xiong
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China
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Gonnell AM, Resendes NM, Quinones AD, Chada A, Gomez C, Oomrigar S, Ruiz JG. Association between the Neutrophil-to-Lymphocyte Ratio and Inpatient Mortality in Hospitalized Older Veterans with COVID-19 Infection. South Med J 2023; 116:863-870. [PMID: 37913804 DOI: 10.14423/smj.0000000000001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Determine the association of high neutrophil-to-lymphocyte ratio (NLR) values with inpatient mortality and other outcomes in older veterans hospitalized with coronavirus disease 2019 (COVID-19). METHODS This was a retrospective, multicenter, cohort study of hospitalized adults, with laboratory-confirmed COVID-19 infection who were studied for 1 year after discharge or until death. The NLR was categorized into tertiles, and we determined frailty status with the 31-item Veterans Affairs Frailty Index. Multivariate logistic regression and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were performed to assess the association between NLR and clinical outcomes. RESULTS The study included 615 hospitalized adult veterans, mean age 66.12 (standard deviation 14.79) years, 93.82% (n = 577) male, 57.56% (n = 354) White, 81.0% (n = 498) non-Hispanic, median body mass index of 30.70 (interquartile range 25.64-34.99, standard deviation 7.13), and median length of stay of 8 days (interquartile range 3-15). Individuals in the middle and upper tertile groups had higher inpatient mortality (8.37%, n = 17 and 18.36%, n = 38, respectively) as compared with the lower tertile (2.93%, n = 6, P < 0.001). Compared with the lowest tertile, the middle and upper tertiles had a higher risk of inpatient mortality (aOR 3.75, 95% CI 1.38-10.21, P = 0.01, and aOR 8.13, 95% CI 3.18-20.84, P < 0.001, respectively). The highest tertile had a higher odds of intensive care unit admission (aOR 4.47, 95% CI 2.33-8.58, P < 0.001) and intensive care unit transfer (aOR 3.54, 95% CI 1.84-6.81, P < 0.001). CONCLUSIONS The NLR score is a clinically useful tool to predict in-hospital mortality in older patients with COVID-19.
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Affiliation(s)
- Amy M Gonnell
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
| | - Natasha M Resendes
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
| | - Alma Diaz Quinones
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
| | - Andria Chada
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
| | - Christian Gomez
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
| | - Shivaan Oomrigar
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
| | - Jorge G Ruiz
- From the Miami Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center (GRECC), Bruce W. Carter Miami Veterans Affairs Medical Center, Miami, Florida
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Espinar-Buitrago MS, Tarancon-Diez L, Vazquez-Alejo E, Magro-Lopez E, Genebat M, Romero-Candau F, Leal M, Muñoz-Fernandez MA. The use of alpha 1 thymosin as an immunomodulator of the response against SARS-Cov2. Immun Ageing 2023; 20:32. [PMID: 37408063 DOI: 10.1186/s12979-023-00351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/06/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Since the beginning of SARS-CoV2 pandemic, the mortality rate among elderly patients (60-90 years) has been around 50%, so age has been a determining factor of a worse COVID-19 prognosis. Associated with age, the thymic function involution and depletion plays an important role, that could be related to a dysregulated and ineffective innate and adaptive immune response against SARS-CoV2. Our study aims to further in vitro effect of human Thymosin-alpha-1 (α1Thy) treatment on the immune system in population groups with different thymic function levels in the scenario of SARS-CoV2 infection. RESULTS Activation markers such as CD40, CD80 and TIM-3 were upregulated in α1Thy presence, especially in plasmacytoid dendritic cells (pDCs) and, with increased TNFα production was observed compared to untreated condition. Co-cultures of CD4 + and CD8 + T cells with DCs treated with α1Thy in response to SARS-CoV2 peptides showed a decrease in the cytokine production compared to the condition without α1Thy pre-treated. A decrease in CD40L activation co-receptor expression in CD8 + LTs was also observed, as well as an increase in PD1 in CD4 + TLs expression in both age groups. In fact, there are no age-related differences in the immunomodulatory effect of the hormone, and it seems that effector memory and terminally differentiated memory T lymphocyte subsets were the most actively influenced by the immunomodulatory α1Thy effect. Finally, the polyfunctionality measured in SARS-CoV2 Specific-T cells response was maintained in α1Thy presence in total and memory subpopulations CD4 + and CD8 + T-cells, despite decreased proinflammatory cytokines production. CONCLUSION The hormone α1Thy could reduce, through the modulation of DCs, the amount of proinflammatory cytokines produced by T cells. Moreover, α1Thy improve lymphocyte functionality and could become a beneficial therapeutic alternative as an adjuvant in SARS-CoV2 treatment either in the acute phase after infection or reinfection. In addition, the effect on the T immune response means that α1Thy can be incorporated into the vaccination regimen, especially in the most immunologically vulnerable individuals such as the elderly. SUBJECTS Thymosin alpha 1, Dendritic cells, SARS-CoV2-specific T cells response, Immunomodulation.
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Affiliation(s)
- M S Espinar-Buitrago
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - L Tarancon-Diez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - E Vazquez-Alejo
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - E Magro-Lopez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain
| | - M Genebat
- Department of Internal Medicine, Hospital Fátima, 41012, Sevilla, Spain
| | - F Romero-Candau
- Department of Internal Medicine, Hospital Viamed Santa Ángela de la Cruz, 41014, Seville, Spain
| | - M Leal
- Department of Internal Medicine, Hospital Viamed Santa Ángela de la Cruz, 41014, Seville, Spain
- Home Residencia de la Santa Caridad, 41001, Seville, Spain
| | - M A Muñoz-Fernandez
- Immunology Section, Laboratorio Inmuno-Biología Molecular (LIBM), Hospital General Universitario Gregorio Marañón (HGUGM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28009, Madrid, Spain.
- Centro de Investigación Biomédica en Red Bioingeniería, Biomateriales y Nanotecnología (CIBER-BBN), Madrid, Spain.
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de la Torre Fonseca LM, Cedeño RA, Díaz VAJ, Cedeño FIL, Juan-Salvadores P. Cardiovascular Complications in Patients Hospitalized for COVID-19: A Cohort Study in Havana, Cuba. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 52:10-15. [PMID: 36822976 PMCID: PMC9940473 DOI: 10.1016/j.carrev.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION AND OBJECTIVE At least one in ten patients infected with COVID develop cardiovascular complications during hospitalization, increasing the number of deaths from this cause. However, the determinants of risk are not clearly elucidated. This study aims to determine whether there is a relationship between in-hospital cardiac complications and cardiovascular history and hospital evolution. METHODS Prospective cohort study of 373 patients with a positive diagnosis of SARS-CoV-2 admitted to an Intensive Care Unit between March and October 2021. RESULTS Median age was 69 (IQR: 57-77), 29.2 % of patients presented cardiovascular complications: 21.2 % electrical, 5.9 % acute coronary syndrome and 1.9 % pulmonary thromboembolism. Age RR: 1.02 (95 % CI: 1.00-1.04; p = 0.020) and history of ischemic heart disease RR: 2.23 (95 % CI: 1.27-3.92; p = 0.005) were identified as independent predictors of in-hospital cardiac complications. CONCLUSIONS Age and history of ischemic heart disease were identified as independent predictor variables of cardiovascular complications in patients admitted with severe COVID-19 involvement; being significantly associated with lower survival.
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Affiliation(s)
| | - Robert Alarcón Cedeño
- Interventional Cardiology Unit, Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Spain
| | - Víctor Alfonso Jiménez Díaz
- Cardiovascular Research Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain.
| | | | - Pablo Juan-Salvadores
- Cardiovascular Research Unit, Cardiology Department, Hospital Alvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain; Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.
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Singh M, Pushpakumar S, Bard N, Zheng Y, Homme RP, Mokshagundam SPL, Tyagi SC. Simulation of COVID-19 symptoms in a genetically engineered mouse model: implications for the long haulers. Mol Cell Biochem 2023; 478:103-119. [PMID: 35731343 PMCID: PMC9214689 DOI: 10.1007/s11010-022-04487-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 01/24/2023]
Abstract
The ongoing pandemic (also known as coronavirus disease-19; COVID-19) by a constantly emerging viral agent commonly referred as the severe acute respiratory syndrome corona virus 2 or SARS-CoV-2 has revealed unique pathological findings from infected human beings, and the postmortem observations. The list of disease symptoms, and postmortem observations is too long to mention; however, SARS-CoV-2 has brought with it a whole new clinical syndrome in "long haulers" including dyspnea, chest pain, tachycardia, brain fog, exercise intolerance, and extreme fatigue. We opine that further improvement in delivering effective treatment, and preventive strategies would be benefited from validated animal disease models. In this context, we designed a study, and show that a genetically engineered mouse expressing the human angiotensin converting enzyme 2; ACE-2 (the receptor used by SARS-CoV-2 agent to enter host cells) represents an excellent investigative resource in simulating important clinical features of the COVID-19. The ACE-2 mouse model (which is susceptible to SARS-CoV-2) when administered with a recombinant SARS-CoV-2 spike protein (SP) intranasally exhibited a profound cytokine storm capable of altering the physiological parameters including significant changes in cardiac function along with multi-organ damage that was further confirmed via histological findings. More importantly, visceral organs from SP treated mice revealed thrombotic blood clots as seen during postmortem examination. Thus, the ACE-2 engineered mouse appears to be a suitable model for studying intimate viral pathogenesis thus paving the way for identification, and characterization of appropriate prophylactics as well as therapeutics for COVID-19 management.
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Affiliation(s)
- Mahavir Singh
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA.
| | - Sathnur Pushpakumar
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Nia Bard
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Yuting Zheng
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Rubens P Homme
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Sri Prakash L Mokshagundam
- Division of Endocrinology, Metabolism and Diabetes and Robley Rex VA Medical Center, University of Louisville School of Medicine, Louisville, KY, 40202, USA
| | - Suresh C Tyagi
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, 40202, USA
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Castro-Fuentes CA, Reyes-Montes MDR, Frías-De-León MG, Valencia-Ledezma OE, Acosta-Altamirano G, Duarte-Escalante E. Aspergillus-SARS-CoV-2 Coinfection: What Is Known? Pathogens 2022; 11:1227. [PMID: 36364979 PMCID: PMC9694759 DOI: 10.3390/pathogens11111227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 07/30/2023] Open
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) has had a high incidence. In addition, it has been associated with prolonged hospital stays, as well as several predisposing risk factors, such as fungal factors (nosocomial organism, the size of the conidia, and the ability of the Aspergillus spp. of colonizing the respiratory tract), environmental factors (remodeling in hospitals, use of air conditioning and negative pressure in intensive care units), comorbidities, and immunosuppressive therapies. In addition to these factors, SARS-CoV-2 per se is associated with significant dysfunction of the patient's immune system, involving both innate and acquired immunity, with reduced CD4+ and CD8+ T cell counts and cytokine storm. Therefore, this review aims to identify the factors influencing the fungus so that coinfection with SARS-CoV-2 can occur. In addition, we analyze the predisposing factors in the fungus, host, and the immune response alteration due to the pathogenicity of SARS-CoV-2 that causes the development of CAPA.
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Affiliation(s)
- Carlos Alberto Castro-Fuentes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico
| | - María del Rocío Reyes-Montes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico
| | - María Guadalupe Frías-De-León
- Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - Omar E. Valencia-Ledezma
- Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - Gustavo Acosta-Altamirano
- Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - Esperanza Duarte-Escalante
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico
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Aouissi HA, Kechebar MSA, Ababsa M, Roufayel R, Neji B, Petrisor AI, Hamimes A, Epelboin L, Ohmagari N. The Importance of Behavioral and Native Factors on COVID-19 Infection and Severity: Insights from a Preliminary Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10071341. [PMID: 35885867 PMCID: PMC9323463 DOI: 10.3390/healthcare10071341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has had a major impact on a global scale. Understanding the innate and lifestyle-related factors influencing the rate and severity of COVID-19 is important for making evidence-based recommendations. This cross-sectional study aims at establishing a potential relationship between human characteristics and vulnerability/resistance to SARS-CoV-2. We hypothesize that the impact of the virus is not the same due to cultural and ethnic differences. A cross-sectional study was performed using an online questionnaire. The methodology included the development of a multi-language survey, expert evaluation, and data analysis. Data were collected using a 13-item pre-tested questionnaire based on a literature review between 9 December 2020 and 21 July 2021. Data were statistically analyzed using logistic regression. For a total of 1125 respondents, 332 (29.5%) were COVID-19 positive; among them, 130 (11.5%) required home-based treatment, and 14 (1.2%) intensive care. The significant and most influential factors on infection included age, physical activity, and health status (p < 0.05), i.e., better physical activity and better health status significantly reduced the possibility of infection, while older age significantly increased it. The severity of infection was negatively associated with the acceptance (adherence and respect) of preventive measures and positively associated with tobacco (p < 0.05), i.e., smoking regularly significantly increases the severity of COVID-19 infection. This suggests the importance of behavioral factors compared to innate ones. Apparently, individual behavior is mainly responsible for the spread of the virus. Therefore, adopting a healthy lifestyle and scrupulously observing preventive measures, including vaccination, would greatly limit the probability of infection and prevent the development of severe COVID-19.
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Affiliation(s)
- Hani Amir Aouissi
- Scientific and Technical Research Center on Arid Regions (CRSTRA), Biskra 07000, Algeria; (M.S.A.K.); (M.A.)
- Laboratoire de Recherche et d’Etude en Aménagement et Urbanisme (LREAU), Université des Sciences et de la Technologie (USTHB), Algiers 16000, Algeria
- Environmental Research Center (CRE), Badji-Mokhtar Annaba University, Annaba 23000, Algeria
- Correspondence: (H.A.A.); (R.R.); Tel.: +21-3662387144 (H.A.A.)
| | - Mohamed Seif Allah Kechebar
- Scientific and Technical Research Center on Arid Regions (CRSTRA), Biskra 07000, Algeria; (M.S.A.K.); (M.A.)
| | - Mostefa Ababsa
- Scientific and Technical Research Center on Arid Regions (CRSTRA), Biskra 07000, Algeria; (M.S.A.K.); (M.A.)
| | - Rabih Roufayel
- College of Engineering and Technology, American University of the Middle East, Kuwait;
- Correspondence: (H.A.A.); (R.R.); Tel.: +21-3662387144 (H.A.A.)
| | - Bilel Neji
- College of Engineering and Technology, American University of the Middle East, Kuwait;
| | - Alexandru-Ionut Petrisor
- Doctoral School of Urban Planning, Ion Mincu University of Architecture and Urbanism, 010014 Bucharest, Romania;
- National Institute for Research and Development in Tourism, 50741 Bucharest, Romania
- National Institute for Research and Development in Constructions, Urbanism and Sustainable Spatial Development URBAN-INCERC, 021652 Bucharest, Romania
| | - Ahmed Hamimes
- Faculty of Medicine, University Salah Boubnider of Constantine 3, Constantine 25000, Algeria;
| | - Loïc Epelboin
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, 97306 Cayenne, France;
- Centre d’Investigation Clinique (CIC INSERM 1424), Centre Hospitalier de Cayenne Andrée Rosemon, 97306 Cayenne, France
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Le Borgne P, Dellenbach Q, Alame K, Noizet M, Gottwalles Y, Chouihed T, Abensur Vuillaume L, Lavoignet CE, Bérard L, Molter L, Gennai S, Kepka S, Lefebvre F, Bilbault P. The Impact of Age on In-Hospital Mortality in Critically Ill COVID-19 Patients: A Retrospective and Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12030666. [PMID: 35328219 PMCID: PMC8947611 DOI: 10.3390/diagnostics12030666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction: For the past two years, healthcare systems worldwide have been battling the ongoing COVID-19 pandemic. Several studies tried to find predictive factors of mortality in COVID-19 patients. We aimed to research age as a predictive factor associated with in-hospital mortality in severe and critical SARS-CoV-2 infection. Methods: Between 1 March and 20 April 2020, we conducted a multicenter and retrospective study on a cohort of severe COVID-19 patients who were all hospitalized in the Intensive Care Unit (ICU). We led our study in nine hospitals of northeast France, one of the pandemic’s epicenters in Europe. Results: The median age of our study population was 66 years (58−72 years). Mortality was 24.6% (CI 95%: 20.6−29%) in the ICU and 26.5% (CI 95%: 22.3−31%) in the hospital. Non-survivors were significantly older (69 versus 64 years, p < 0.001) than the survivors. Although a history of cardio-vascular diseases was more frequent in the non-survivor group (p = 0.015), other underlying conditions and prior level of autonomy did not differ between the two groups. On multivariable analysis, age appeared to be an interesting predictive factor of in-hospital mortality. Thus, age ranges of 65 to 74 years (OR = 2.962, CI 95%: 1.231−7.132, p = 0.015) were predictive of mortality, whereas the group of patients aged over 75 years was not (OR = 3.084, CI 95%: 0.952−9.992, p = 0.06). Similarly, all comorbidities except for immunodeficiency (OR = 4.207, CI 95%: 1.006−17.586, p = 0.049) were not predictive of mortality. Finally, survival follow-up was obtained for the study population. Conclusion: Age appears to be a relevant predictive factor of in-hospital mortality in cases of severe or critical SARS-CoV-2 infection.
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Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Correspondence: ; Tel.: +33-(0)-388-128-690; Fax: +33-(0)-388-128-100
| | - Quentin Dellenbach
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
| | - Karine Alame
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
| | - Marc Noizet
- Emergency Department, Mulhouse Hospital, 68100 Mulhouse, France;
| | | | - Tahar Chouihed
- Emergency Department, Nancy University Hospital, 54500 Nancy, France;
- Centre d’Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France
| | - Laure Abensur Vuillaume
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Emergency Department, Regional Hospital of Metz-Thionville, 57000 Metz, France
| | - Charles-Eric Lavoignet
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Emergency Department, Nord Franche Comté Hospital, 90400 Trevenans, France
| | - Lise Bérard
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
- Emergency Department, Haguenau Hospital, 67500 Haguenau, France
| | - Lise Molter
- Emergency Department, Verdun Hospital, 55107 Verdun, France;
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 51092 Reims, France;
| | - Sabrina Kepka
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
| | - François Lefebvre
- Department of Public Health, University Hospital of Strasbourg, 67200 Strasbourg, France;
| | - Pascal Bilbault
- Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (Q.D.); (K.A.); (S.K.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
- CREMS Network (Clinical Research in Emergency Medicine and Sepsis), 67201 Wolfisheim, France; (L.A.V.); (C.-E.L.); (L.B.)
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9
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Jing X, Xu M, Song D, Yue T, Wang Y, Zhang P, Zhong Y, Zhang M, Lam TTY, Faria NR, De Clercq E, Li G. Association between inflammatory cytokines and anti-SARS-CoV-2 antibodies in hospitalized patients with COVID-19. Immun Ageing 2022; 19:12. [PMID: 35248063 PMCID: PMC8897556 DOI: 10.1186/s12979-022-00271-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 patients may experience "cytokine storm" when human immune system produces excessive cytokines/chemokines. However, it remains unclear whether early responses of inflammatory cytokines would lead to high or low titers of anti-SARS-CoV-2 antibodies. METHODS This retrospective study enrolled a cohort of 272 hospitalized patients with laboratory-confirmed SARS-CoV-2. Laboratory assessments of serum cytokines (IL-2R, IL-6, IL-8, IL-10, TNF-α), anti-SARS-CoV-2 IgG/IgM antibodies, and peripheral blood biomarkers were conducted during hospitalization. RESULTS At hospital admission, 36.4% patients were severely ill, 51.5% patients were ≥ 65 years, and 60.3% patients had comorbidities. Higher levels of IL-2R and IL-6 were observed in older patients (≥65 years). Significant differences of IL-2R (week 2 to week ≥5 from symptom onset), IL-6 (week 1 to week ≥5), IL-8 (week 2 to week ≥5), and IL-10 (week 1 to week 3) were observed between moderately-ill and severely ill patients. Anti-SARS-CoV-2 IgG titers were significantly higher in severely ill patients than in moderately ill patients, but such difference was not observed for IgM. High titers of early-stage IL-6, IL-8, and TNF-α (≤2 weeks after symptom onset) were positively correlated with high titers of late-stage IgG (≥5 weeks after symptom onset). Deaths were mostly observed in severely ill older patients (45.9%). Survival analyses revealed risk factors of patient age, baseline COVID-19 severity, and baseline IL-6 that affected survival time, especially in severely ill older patients. CONCLUSION Early responses of elevated cytokines such as IL-6 reflect the active immune responses, leading to high titers of IgG antibodies against COVID-19.
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Affiliation(s)
- Xixi Jing
- grid.216417.70000 0001 0379 7164Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Min Xu
- grid.452708.c0000 0004 1803 0208Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011 China
| | - Deye Song
- grid.452708.c0000 0004 1803 0208Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Tingting Yue
- grid.216417.70000 0001 0379 7164Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Yali Wang
- grid.216417.70000 0001 0379 7164Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Pan Zhang
- grid.216417.70000 0001 0379 7164Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078 China
| | - Yanjun Zhong
- grid.452708.c0000 0004 1803 0208Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, 410011 China
| | - Min Zhang
- grid.216417.70000 0001 0379 7164Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, 410011 Hunan China
| | - Tommy Tsan-Yuk Lam
- grid.194645.b0000000121742757State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong, SAR China
| | - Nuno Rodrigues Faria
- grid.7445.20000 0001 2113 8111Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK ,grid.4991.50000 0004 1936 8948Department of Zoology, University of Oxford, Oxford, UK
| | - Erik De Clercq
- grid.415751.3Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium
| | - Guangdi Li
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078, China.
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10
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Kim JI, Im Y, Song JE, Jang SJ. Healthcare Considerations for Special Populations during the COVID-19 Pandemic: A Review. J Korean Acad Nurs 2021; 51:511-524. [PMID: 34737245 DOI: 10.4040/jkan.21156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/21/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has emerged as a threat to human health and public safety. People of all ages are susceptible to severe acute respiratory syndrome coronavirus 2 infection. However, the clinical manifestations of this infection differ by age. This study purposes to describe healthcare considerations for special populations, such as children, pregnant and lactating women, and older adults, who may have unique healthcare needs, in the pandemic situation. To realize the research purpose, we conducted a review of the practice guidelines of public documents and qualified studies that were published online/offline during a specific period. The review identified current knowledge on care for newborns, children in schools, pregnant women (from antenatal to postpartum care), and older adults suffering from high-risk conditions. Subsequently, we summarize vaccination guidance for special populations and, finally, discuss the issues currently affecting special populations. Therefore, this current knowledge on care for special populations helps nurses to provide accurate information on vaccinations aimed at preventing COVID-19 and protecting the masses from infection. Currently, the scarcity of information on COVID-19 variants necessitates further research on measures to reduce pandemic spread.
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Affiliation(s)
- Jeung-Im Kim
- School of Nursing, Soonchunhyang University, Cheonan, Korea
| | - YeoJin Im
- College of Nursing Science · East-West Nursing Research Institute, Kyung Hee University, Seoul, Korea
| | - Ju-Eun Song
- College of Nursing · Research Institute of Nursing Science, Ajou University, Suwon, Korea.
| | - Sun Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea.
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