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Kawamura K, Osawa A, Tanimoto M, Kagaya H, Matsuura T, Arai H. Clinical frailty scale is useful in predicting return-to-home in patients admitted due to coronavirus disease. BMC Geriatr 2023; 23:433. [PMID: 37442988 PMCID: PMC10347876 DOI: 10.1186/s12877-023-04133-4] [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: 03/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The spread of the novel severe acute respiratory syndrome coronavirus 2 infection has been prolonged, with the highly contagious Omicron variant becoming the predominant variant by 2022. Many patients admitted to dedicated coronavirus disease 2019 (COVID-19) wards (COVID-19 treatment units) develop disuse syndrome while being treated in the hospital, and their ability to perform activities of daily living declines, making it difficult for hospitals to discharge them. This study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to a COVID-19 treatment units. METHODS This study retrospectively examined the in-patient medical records of 138 patients (82.7 ± 7.6 years old) admitted to a COVID-19 treatment unit from January to December 2022. The end-point was to determine the patients' ability to be discharged from the unit directly to home; such patients were classified into the 'Home discharge' group and compared with those in the 'Difficulty in discharge' group. The degree of frailty was determined based on the Clinical Frailty Scale (CFS), and the relationship with the endpoint was analysed. A receiver operating characteristic (ROC) curve was created and the cut-off value was calculated with the possibility of home discharge as the state variable and CFS as the test variable. Logistic regression analysis was conducted with the possibility of home discharge as the dependent variable and CFS as the independent variable. RESULTS There were 75 patients in the Home discharge group and 63 in the Difficulty in discharge group. ROC analysis showed a CFS cut-off value of 6 or more, with a sensitivity of 70.7% and a specificity of 84.1%. The results of the logistic regression analysis showed a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44. CONCLUSIONS Based on the evaluation of the degree of frailty conducted in the COVID-19 treatment unit, it was possible to accurately predict whether a patient could be discharged directly to home after treatment CFS could be an effective screening tool to easily detect patients requiring ongoing hospitalisation even after the acute phase of treatment.
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Affiliation(s)
- Koki Kawamura
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan.
| | - Aiko Osawa
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Masanori Tanimoto
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Hitoshi Kagaya
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Toshihiro Matsuura
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, 474-8511, Aichi, Japan
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Phan TT, Mirat W, Brossier S, Boutin E, Fabre J, Hoonakker JD, Bastuji-Garin S, Renard V, Ferrat E. Initial characteristics and course of disease in patients with suspected COVID-19 managed in general practice: a prospective, multicentre cohort study. BMJ Open 2023; 13:e068424. [PMID: 37225268 DOI: 10.1136/bmjopen-2022-068424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES To describe and compare the initial clinical characteristics of a cohort of patients with suspected COVID-19 managed by general practitioners (GPs); to assess whether 3-month persistent symptoms were more frequent among confirmed cases than among no-COVID cases; and to identify factors predictive of persistent symptoms and adverse outcomes among confirmed cases. DESIGN AND SETTING A comparative, prospective, multicentre cohort study in primary care in the Paris region of France. PARTICIPANTS 521 patients aged ≥18 with suspected COVID-19 were enrolled between March and May 2020. OUTCOME MEASURES Initial symptoms, COVID-19 status, persistent symptoms 3 months after inclusion and a composite criterion for potentially COVID-19-related events (hospitalisation, death, emergency department visits). The final COVID-19 status ('confirmed', 'no-COVID' and 'uncertain' cases) was determined by the GP after the receipt of the laboratory test results. RESULTS 516 patients were analysed; 166 (32.2%) were classified into the 'confirmed COVID' group, 180 (34.9%) into the 'no-COVID' group and 170 (32.9%) in the 'uncertain COVID' group. Confirmed cases were more likely to have persistent symptoms than no-COVID cases (p=0.09); initial fever/feeling feverish and anosmia were independently associated with persistent symptoms. At 3 months, we observed 16 (9.8%) COVID-19-related hospital admissions, 3 (1.8%) intensive care unit admissions, 13 (37.1%) referrals to an emergency department and no death. Age >70 and/or at least one comorbidity (OR 6.53; 95% CI 1.13-37.84; p=0.036), abnormalities in a lung examination (15.39; 95% CI 1.61-146.77; p=0.057) and two or more systemic symptoms (38.61; 95% CI 2.30-647.40; p=0.011) were associated with the composite criterion. CONCLUSIONS Although most patients with COVID-19 in primary care had mild disease with a benign course, almost one in six had persistent symptoms at 3 months. These symptoms were more frequent in the 'confirmed COVID' group. Our findings need to be confirmed in a prospective study with longer follow-up.
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Affiliation(s)
- Tan-Trung Phan
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Maison de Sante Pluriprofessionnelle Universitaire (MSPU) Fontainebleau, F-77300 Fontainebleau, France
| | - William Mirat
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Maison de Sante Pluriprofessionnelle Universitaire (MSPU) Torcy, F-77200 Torcy, France
| | - Sophie Brossier
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Maison de Sante Pluriprofessionnelle Universitaire (MSPU) Fontainebleau, F-77300 Fontainebleau, France
| | - Emmauelle Boutin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopital Henri-Mondor, Clinical Research Unit (URC Mondor), F-94010 Creteil, France
| | - Julie Fabre
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Maison de Sante Pluriprofessionnelle Universitaire (MSPU) Coulommiers, F-77120 Coulommiers, France
| | - Jean-Denis Hoonakker
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Maison de Sante Pluriprofessionnelle Universitaire (MSPU) Nemours, F-77140 Nemours, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- AP-HP, Hopital Henri-Mondor, Public Health Department, F-94010 Creteil, France
| | - Vincent Renard
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
| | - Emilie Ferrat
- Univ Paris Est Creteil, Department of General Practice, F-94010 Creteil, France
- Univ Paris Est Creteil, INSERM, IMRB, F-94010 Creteil, France
- Maison de Sante Pluriprofessionnelle Universitaire (MSPU) Saint-Maur-des-Fosses, F-94100 Saint-Maur-des-Fosses, France
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Impact of Bacterial Infections on COVID-19 Patients: Is Timing Important? Antibiotics (Basel) 2023; 12:antibiotics12020379. [PMID: 36830290 PMCID: PMC9952118 DOI: 10.3390/antibiotics12020379] [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: 12/06/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Along with important factors that worsen the clinical outcome of COVID-19, it has been described that bacterial infections among patients positive for a SARS-CoV-2 infection can play a dramatic role in the disease process. Co-infections or community-acquired infections are recognized within the first 48 h after the admission of patients. Superinfections occur at least 48 h after admission and are considered to contribute to a worse prognosis. Microbiologic parameters differentiate infections that happen after the fifth day of hospitalization from those appearing earlier. Specifically, after the fifth day, the detection of resistant bacteria increases and difficult microorganisms emerge. OBJECTIVES The aim of the study was to evaluate the impact of bacterial infections in patients with COVID-19 on the length of the hospital stay and mortality. METHODS A total of 177 patients hospitalized due to COVID-19 pneumonia were consecutively sampled during the third and fourth wave of the pandemic at a University Hospital in Greece. A confirmed bacterial infection was defined as positive blood, urinary, bronchoalveolar lavage (BAL) or any other infected body fluid. Patients with confirmed infections were further divided into subgroups according to the time from admission to the positive culture result. RESULTS When comparing the groups of patients, those with a confirmed infection had increased odds of death (odds ratio: 3.634; CI 95%: 1.795-7.358; p < 0.001) and a longer length of hospital stay (median 13 vs. 7 days). A late onset of infection was the most common finding in our cohort and was an independent risk factor for in-hospital death. Mortality and the length of hospital stay significantly differed between the subgroups. CONCLUSION In this case series, microbial infections were an independent risk factor for a worse outcome among patients with COVID-19. Further, a correlation between the onset of infection and a negative outcome in terms of non-infected, community-acquired, early hospital-acquired and late hospital-acquired infections was identified. Late hospital-acquired infections increased the mortality of COVID-19 patients whilst superinfections were responsible for an extended length of hospital stay.
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Kanaeva TV, Karoli NA. Prognostic biomarkers for cardiovascular injury in patients with COVID-19: a review. SECHENOV MEDICAL JOURNAL 2023. [DOI: 10.47093/2218-7332.2022.13.3.14-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Investigations into the causes of adverse outcomes of the novel coronavirus infection (COVID-19) have been ongoing since the beginning of the pandemic. There is evidence that coronavirus-induced cardiovascular injury is as important to a risk of adverse outcome as respiratory injury. Many studies have shown that concomitant cardiovascular disease aggravates the course of COVID-19. However, in some patients who did not have cardiovascular diseases before COVID-19, they are detected during hospitalization or after discharge from the hospital. The review examines data on the effect of serum biomarkers of cardiovascular disease determined during COVID-19 on the risk of adverse outcomes in the near and long-term follow-up periods. Among such biomarkers are considered: troponins, N-terminal pro B-type natriuretic peptide, creatine phosphokinase-MB, lactate dehydrogenase, myoglobin, growth stimulation expressed gene 2, pentraxin 3, angiotensin II, as well as D-dimer and homocysteine. Threshold values have been set for some of these biomarkers, which allow predicting the risk of an unfavorable outcome. At the same time, in most prognostic models, these markers are considered in association with cytokine storm indicators and other risk factors.
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Affiliation(s)
- T. V. Kanaeva
- Saratov State Medical University named after V.I. Razumovsky
| | - N. A. Karoli
- Saratov State Medical University named after V.I. Razumovsky
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Monari C, Pisaturo M, Maggi P, Macera M, Di Caprio G, Pisapia R, Gentile V, Fordellone M, Chiodini P, Coppola N. Early predictors of clinical deterioration in a cohort of outpatients with COVID-19 in southern Italy: A multicenter observational study. J Med Virol 2022; 94:5336-5344. [PMID: 35854433 PMCID: PMC9545617 DOI: 10.1002/jmv.28007] [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: 04/30/2022] [Revised: 06/09/2022] [Accepted: 07/17/2022] [Indexed: 12/15/2022]
Abstract
Data regarding early predictors of clinical deterioration in patients with infection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is still scarce. The aim of the study is to identify early symptoms or signs that may be associated with severe coronavirus disease 2019 (COVID-19). We conducted a multicentre prospective cohort study on a cohort of patients with COVID-19 in home isolation from March 2020 to April 2021. We assessed longitudinal clinical data (fever, dyspnea, need for hospitalization) through video calls at three specific time points: the beginning of symptoms or the day of the first positivity of the nasopharyngeal swab for SARS-CoV-2-RNA (t0 ), and 3 (t3 ) and 7 (t7 ) days after the onset of symptoms. We included 329 patients with COVID-19: 182 (55.3%) males, mean age 53.4 ± 17.4 years, median Charlson comorbidity index (CCI) of 1 (0-3). Of the 329 patients enrolled, 171 (51.98%) had a mild, 81 (24.6%) a moderate, and 77 (23.4%) a severe illness; 151 (45.9%) were hospitalized. Compared to patients with mild COVID-19, moderate and severe patients were older (p < 0.001) and had more comorbidities, especially hypertension (p < 0.001) and cardiovascular diseases (p = 0.01). At t3 and t7 , we found a significant higher rate of persisting fever (≥37°C) among patients with moderate (91.4% and 58.0% at t3 and t7 , respectively; p < 0.001) and severe outcome (75.3% and 63.6%, respectively; p < 0.001) compared to mild COVID-19 outcome (27.5% and 11.7%, respectively; p < 0.001). Factors independently associated with a more severe outcome were persisting fever at t3 and t7 , increasing age, and CCI above 2 points. Persisting fever at t3 and t7 seems to be related to a more severe COVID-19. This data may be useful to assess hospitalization criteria and optimize the use of resources in the outpatient setting.
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Affiliation(s)
- Caterina Monari
- Department of Mental Health and Public Medicine, Infectious Diseases UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine, Infectious Diseases UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Paolo Maggi
- Infectious Disease UnitAORN CasertaCasertaItaly
| | | | | | | | - Valeria Gentile
- Department of Mental Health and Public Medicine, Infectious Diseases UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Mario Fordellone
- Medical Statistics UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Paolo Chiodini
- Medical Statistics UnitUniversity of Campania Luigi VanvitelliNaplesItaly
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Infectious Diseases UnitUniversity of Campania Luigi VanvitelliNaplesItaly
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