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Wojas-Krawczyk K, Krawczyk P, Błach J, Kucharczyk T, Grenda A, Krzyżanowska N, Szklener K, Horaczyńska-Wojtaś A, Wójcik-Superczyńska M, Chmielewska I, Milanowski J. Immunological insights: assessing immune parameters in medical professionals exposed to SARS-CoV-2. BMC Infect Dis 2024; 24:865. [PMID: 39187767 PMCID: PMC11348584 DOI: 10.1186/s12879-024-09772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 08/20/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The immunological background responsible for the severe course of COVID-19 and the immune factors that protect against SARS-CoV-2 infection are still unclear. The aim of this study was to investigate immune system status in persons with high exposure to SARS-CoV-2 infection. METHODS Seventy-one persons employed in the observation and infectious diseases unit were qualified for the study between November 2020 and October 2021. Symptomatic COVID-19 was diagnosed in 35 persons. Anti-SARS-CoV-2 antibodies were also found in 8 persons. Peripheral blood mononuclear cells subpopulations were analyzed by flow cytometry, and the concentrations of cytokines and anti-SARS-CoV-2 antibodies were determined by ELISA. RESULTS The percentages of cytotoxic T lymphocytes (CTLs), CD28+ and T helper (Th) cells with invariant T-cell receptors were significantly higher in persons with symptomatic COVID-19 than in those who did not develop COVID-19' symptoms. Conversely, symptomatic COVID-19 persons had significantly lower percentages of: a) CTLs in the late stage of activation (CD8+/CD95+), b) NK cells, c) regulatory-like Th cells (CD4+/CTLA-4+), and d) Th17-like cells (CD4+/CD161+) compared to asymptomatic COVID-19' persons. Additionally, persons with anti-SARS-CoV-2 antibodies had a significantly higher lymphocyte count and IL-6 concentration than persons without these antibodies. CONCLUSION Numerous lymphocyte populations are permanently altered by SARS-CoV-2 infection. High percentages of both populations: NK cells-as a part of the non-specific response, and T helper cells' as those regulating the immune response, could protect against the acute COVID-19 symptoms development. Understanding the immune background of COVID-19 may improve the prevention of this disease by identifying people at risk of a severe course of infection. TRIAL REGISTRATION This is a retrospective observational study without a trial registration number.
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Affiliation(s)
- Kamila Wojas-Krawczyk
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland.
| | - Paweł Krawczyk
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
| | - Justyna Błach
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
- Department of Clinical Immunology Medical University of Lublin, Lublin, Poland
| | - Tomasz Kucharczyk
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
| | - Anna Grenda
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
| | - Natalia Krzyżanowska
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
| | - Katarzyna Szklener
- Department of Clinical Oncology and Chemotherapy Medical University of Lublin, Lublin, Poland
| | - Anna Horaczyńska-Wojtaś
- Department of Pediatric Otolaryngology, Phoniatrics and Audiology, University Children's Hospital, Lublin, Poland
| | - Magdalena Wójcik-Superczyńska
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
| | - Izabela Chmielewska
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
| | - Janusz Milanowski
- Department of Pneumonology, Oncology and Allergology Medical University of Lublin, Jaczewskiego 8, Lublin, 20-954, Poland
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Pradelle A, Mainbourg S, Provencher S, Massy E, Grenet G, Lega JC. Deaths induced by compassionate use of hydroxychloroquine during the first COVID-19 wave: an estimate. Biomed Pharmacother 2024; 171:116055. [PMID: 38171239 DOI: 10.1016/j.biopha.2023.116055] [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: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND During the first wave of COVID-19, hydroxychloroquine (HCQ) was used off-label despite the absence of evidence documenting its clinical benefits. Since then, a meta-analysis of randomised trials showed that HCQ use was associated with an 11% increase in the mortality rate. We aimed to estimate the number of HCQ-related deaths worldwide. METHODS AND FINDINGS We estimated the worldwide in-hospital mortality attributable to HCQ use by combining the mortality rate, HCQ exposure, number of hospitalised patients, and the increased relative risk of death with HCQ. The mortality rate in hospitalised patients for each country was calculated using pooled prevalence estimated by a meta-analysis of published cohorts. The HCQ exposure was estimated using median and extreme estimates from the same systematic review. The number of hospitalised patients during the first wave was extracted from dedicated databases. The systematic review included 44 cohort studies (Belgium: k = 1, France: k = 2, Italy: k = 12, Spain: k = 6, Turkey: k = 3, USA: k = 20). HCQ prescription rates varied greatly from one country to another (range 16-84%). Overall, using median estimates of HCQ use in each country, we estimated that 16,990 HCQ-related in-hospital deaths (range 6267-19256) occurred in the countries with available data. The median number of HCQ-related deaths in Belgium, Turkey, France, Italy, Spain, and the USA was 240 (range not estimable), 95 (range 92-128), 199 (range not estimable), 1822 (range 1170-2063), 1895 (range 1475-2094) and 12739 (3244- 15570), respectively. CONCLUSIONS Although our estimates are limited by their imprecision, these findings illustrate the hazard of drug repurposing with low-level evidence.
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Affiliation(s)
- Alexiane Pradelle
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France
| | - Sabine Mainbourg
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Unité bases de données cliniques et épidémiologiques, Hospices Civils de Lyon, Lyon F-69310, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France
| | - Steeve Provencher
- Pulmonary Hypertension Research Group (http://phrg.ca), Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Department of medicine, Université Laval, Québec City, Canada
| | - Emmanuel Massy
- Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France
| | - Guillaume Grenet
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France
| | - Jean-Christophe Lega
- Univ Lyon, Université Claude Bernard University of Lyon 1, Equipe Evaluation et Modélisation des Effets Thérapeutiques, Laboratoire de Biométrie et Biologie Évolutive, UMR CNRS 5558 LBBE, Lyon F-69100, France; Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon F69000, France; Service de rhumatologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite F69000, France; Service hospitalo-universitaire de pharmacotoxicologie, Hospices Civils de Lyon, Lyon F69000, France.
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Cassibba S, Ippolito S, Pellegrini S, Trevisan R, Rossini A. Does denosumab exert a protective effect against COVID-19? Results of a large cohort study. Front Endocrinol (Lausanne) 2023; 14:1283101. [PMID: 38144562 PMCID: PMC10740200 DOI: 10.3389/fendo.2023.1283101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Denosumab is a monoclonal antibody blocking the receptor activator of nuclear factor kappa-B/receptor activator of nuclear factor kappa-B ligand (RANK/RANKL) pathway, thus inhibiting osteoclastogenesis. Since RANK and RANKL are also involved in the immune system activation, denosumab might interfere with the response against infections. Our study aimed to explore the relationship between denosumab treatment and coronavirus disease 2019 (COVID-19). Design and methods The occurrence and severity of COVID-19 were recorded in consecutive patients referred to the Endocrinology Department of Papa Giovanni XXIII Hospital, Bergamo, from 1 January 2020 to 1 January 2021. Patients treated with denosumab were compared to outpatient controls. Patients' features were summarized by descriptive statistics. Multivariate logistic regression assessed the relationship between denosumab and COVID-19, adjusting for potential confounders. Subgroup analyses according to age, sex, body mass index (BMI), smoking status, and vitamin D levels were performed. Results The final population included 331 patients treated with denosumab and 357 controls. COVID-19 incidence was lower in the denosumab group (7.6% vs. 14.6%, p = 0.004). COVID-19 severity was similar in both groups. Multiple logistic regression confirmed an association between denosumab and a reduced occurrence of symptomatic COVID-19 [odds ratio (OR) 0.46, 95% CI 0.21-0.98, p = 0.049]. Subgroup analyses suggested a potential protective effect of denosumab in patients over 75 years (OR 0.12, 95% CI 0.02-0.6, p = 0.011), with a significant interaction between denosumab and age categories (p = 0.047). Conclusion Our study confirms that denosumab may be safely continued in COVID-19 patients. RANK/RANKL inhibition seems associated with a reduced incidence of symptomatic COVID-19, particularly among the elderly.
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Affiliation(s)
- Sara Cassibba
- Endocrinology and Diabetes Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Ippolito
- Endocrinology and Diabetes Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Pellegrini
- Endocrinology and Diabetes Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Roberto Trevisan
- Endocrinology and Diabetes Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | - Alessandro Rossini
- Endocrinology and Diabetes Unit, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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4
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Dezzani EO. Pneumological problems in surgical practice. Minerva Surg 2023; 78:469-480. [PMID: 37870534 DOI: 10.23736/s2724-5691.23.10122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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5
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Novelli L, Raimondi F, Carioli G, Carobbio A, Pappacena S, Biza R, Trapasso R, Anelli M, Amoroso M, Allegri C, Malandrino L, Imeri G, Conti C, Beretta M, Gori M, D'Elia E, Senni M, Lorini FL, Rizzi M, Cosentini R, Rambaldi A, Masciulli A, Gavazzi A, Solidoro P, Sironi S, Fagiuoli S, Barbui T, Marco FD. One-year mortality in COVID-19 is associated with patients' comorbidities rather than pneumonia severity. Respir Med Res 2023; 83:100976. [PMID: 36473331 PMCID: PMC9691276 DOI: 10.1016/j.resmer.2022.100976] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/15/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND In patients with pneumonia or acute respiratory distress syndrome who survived hospitalization, one-year mortality can affect up to one third of discharged patients. Therefore, significant long-term mortality after COVID-19 respiratory failure could be expected. The primary outcome of the present study was one-year all-cause mortality in hospitalized COVID-19 patients. METHODS Observational study of COVID-19 patients hospitalized at Papa Giovanni XXIII Hospital (Bergamo, Italy), during the first pandemic wave. RESULTS A total of 1326 COVID-19 patients were hospitalized. Overall one-year mortality was 33.6% (N 446/1326), with the majority of deaths occurring during hospitalization (N=412, 92.4%). Thirty-four patients amongst the 914 discharged (3.7%) subsequentely died within one year. A third of these patients died for advanced cancer, while death without a cause other than COVID-19 was uncommon (8.8% of the overall post-discharge mortality). In-hospital late mortality (i.e. after 28 days of admission) interested a population with a lower age, and fewer comorbidities, more frequentely admitted in ICU. Independent predictors of post-discharge mortality were age over 65 years (HR 3.19; 95% CI 1.28-7.96, p-value=0.013), presence of chronic obstructive pulmonary disease (COPD) (HR 2.52; 95% CI 1.09-5.83, p-value=0.031) or proxy of cardiovascular disease (HR 4.93; 95% CI 1.45-16.75, p-value=0.010), and presence of active cancer (HR 3.64; 95% CI 1.50-8.84, p-value=0.004), but not pneumonia severity. CONCLUSIONS One-year post-discharge mortality depends on underlying patients' comorbidities rather than COVID-19 pneumonia severity per se. Awareness among physicians of predictors of post-discharge mortality might be helpful in structuring a follow-up program for discharged patients.
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Affiliation(s)
- Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy,Corresponding author at: Pulmonary Medicine Unit, Medicine Department, ASST Papa Giovanni XXIII, Piazza OMS, 1 - 24127 Bergamo, Italy
| | - Greta Carioli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Alessandra Carobbio
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Simone Pappacena
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Biza
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Roberta Trapasso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Marisa Anelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Mariangela Amoroso
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Chiara Allegri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Malandrino
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
| | - Gianluca Imeri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Caterina Conti
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marta Beretta
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Gori
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Emilia D'Elia
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Senni
- Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Ferdinando Luca Lorini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Intensive Critical Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Rizzi
- Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alessandro Rambaldi
- Department of Health Sciences, University of Milan, Milan, Italy,Hematology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Arianna Masciulli
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Antonello Gavazzi
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Paolo Solidoro
- Unit of Pneumology, Department of Cardiovascular and Thoracic Surgery, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Italy
| | - Sandro Sironi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Gastroenterlogy 1, Hepatology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Tiziano Barbui
- Fondazione per la Ricerca Ospedale Maggiore di Bergamo (FROM), Bergamo, Italy
| | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo, Italy,Department of Health Sciences, University of Milan, Milan, Italy
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Vardavas CI, Mathioudakis AG, Nikitara K, Stamatelopoulos K, Georgiopoulos G, Phalkey R, Leonardi-Bee J, Fernandez E, Carnicer-Pont D, Vestbo J, Semenza JC, Deogan C, Suk JE, Kramarz P, Lamb F, Penttinen P. Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. Eur Respir Rev 2022; 31:220098. [PMID: 36323422 PMCID: PMC9724816 DOI: 10.1183/16000617.0098-2022] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. METHODS We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. FINDINGS We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. INTERPRETATION The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Dolors Carnicer-Pont
- Catalan Institute of Oncology, Barcelona, Spain
- Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), Barcelona, Spain
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, UK
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Piotr Kramarz
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
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R Mohamed E, Ragab D, Taeimah M, Shaltoot H. Risk factors of intensive care admission and mortality in a cohort of 111 Egyptian COVID-19 patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2121479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Enas R Mohamed
- Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Dina Ragab
- Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Taeimah
- Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Heba Shaltoot
- Geriatrics and Gerontology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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8
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Morello F, Bima P, Giamello JD, Baricocchi D, Risi F, Vesan M, Pivetta EE, de Stefano G, Chiarlo M, Veglia S, Schivazappa G, Mengozzi G, Lauria G, Podio S, Nazerian P, Aprà F, Ferreri E, Lupia E. A 4C mortality score based dichotomic rule supports Emergency Department discharge of COVID-19 patients. Minerva Med 2022; 113:916-926. [PMID: 35191293 DOI: 10.23736/s0026-4806.21.07779-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND For COVID-19 patients evaluated in the Emergency Department (ED), decision on hospital admission vs. home discharge is challenging. The 4C mortality score (4CMS) is a prognostication tool integrating key demographic/clinical/biochemical data validated for COVID-19 inpatients. We sought to derive and validate a dichotomic rule based on 4CMS identifying patients with mild outcomes, suitable for safe ED discharge. METHODS Derivation was performed in a prospective cohort of ED patients with suspected COVID-19 from two centers (April 2020). Validation was pursued in a prospective multicenter cohort of ED patients with confirmed COVID-19 from 6 centers (October 2020 to January 2021). Chest X-ray (CXR) images were independently scored. The primary composite outcome was all-cause 30-day mortality or hospital admission. Secondary outcomes were ED re-visit, oxygen therapy and ventilation. RESULTS In a derivation cohort of 838 ED patients with suspected COVID-19, 4CMS≤8 was associated with low outpatient mortality (0.4%) and was thus selected as a feasible discharge rule. In a validation cohort of 521 COVID-19 outpatients, the mean age was 51±17 years; 97 (18.6%) patients had ≥1 CXR infiltrate. The 4CMS had an AUC of 0.82 for the primary outcome and 0.93 for mortality, outperforming other scores (CURB-65, qCSI, qSOFA, NEWS) and CXR. In 474 (91%) patients with 4CMS≤8, the mortality rate was 0.2% and the hospital admission rate was 6.8%, versus 12.8% and 36.2% for 4CMS≥9 (P<0.001). CXR did not provide additional discrimination. CONCLUSIONS COVID-19 outpatients with 4CMS≤8 have mild outcomes and can be safely discharged from the ED. [NCT0462918].
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Affiliation(s)
- Fulvio Morello
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy - .,Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Paolo Bima
- School of Emergency Medicine, University of Turin, Turin, Italy.,MeCAU Unit, Maria Vittoria Hospital, Turin, Italy
| | - Jacopo D Giamello
- School of Emergency Medicine, University of Turin, Turin, Italy.,Emergency Medicine Unit, A.O. S. Croce e Carle, Cuneo, Italy
| | - Denise Baricocchi
- School of Emergency Medicine, University of Turin, Turin, Italy.,Emergency Medicine Unit, A.O. Parini, Aosta, Italy
| | - Francesca Risi
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,School of Emergency Medicine, University of Turin, Turin, Italy
| | - Matteo Vesan
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,School of Emergency Medicine, University of Turin, Turin, Italy
| | - Emanuele E Pivetta
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Michela Chiarlo
- Emergency Medicine Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Simona Veglia
- Unit of Radiology2, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulia Schivazappa
- Unit of Radiology2, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulio Mengozzi
- Baldi e Riberi Laboratory, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Lauria
- Emergency Medicine Unit, A.O. S. Croce e Carle, Cuneo, Italy
| | | | | | - Franco Aprà
- Emergency Medicine Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | - Enrico Lupia
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
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9
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Sonaglioni A, Lombardo M, Albini A, Noonan DM, Re M, Cassandro R, Elia D, Caminati A, Nicolosi GL, Harari S. Charlson comorbidity index, neutrophil-to-lymphocyte ratio and undertreatment with renin-angiotensin-aldosterone system inhibitors predict in-hospital mortality of hospitalized COVID-19 patients during the omicron dominant period. Front Immunol 2022; 13:958418. [PMID: 36090992 PMCID: PMC9453812 DOI: 10.3389/fimmu.2022.958418] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the clinical predictors of in-hospital mortality in hospitalized patients with Coronavirus disease 2019 (COVID-19) infection during the Omicron period. Methods All consecutive hospitalized laboratory‐confirmed COVID-19 patients between January and May 2022 were retrospectively analyzed. All patients underwent accurate physical, laboratory, radiographic and echocardiographic examination. Primary endpoint was in-hospital mortality. Results 74 consecutive COVID-19 patients (80.0 ± 12.6 yrs, 45.9% males) were included. Patients who died during hospitalization (27%) and those who were discharged alive (73%) were separately analyzed. Compared to patients discharged alive, those who died were significantly older, with higher comorbidity burden and greater prevalence of laboratory, radiographic and echographic signs of pulmonary and systemic congestion. Charlson comorbidity index (CCI) (OR 1.76, 95%CI 1.07-2.92), neutrophil-to-lymphocyte ratio (NLR) (OR 1.24, 95%CI 1.10-1.39) and absence of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs) therapy (OR 0.01, 95%CI 0.00-0.22) independently predicted the primary endpoint. CCI ≥7 and NLR ≥9 were the best cut-off values for predicting mortality. The mortality risk for patients with CCI ≥7, NLR ≥9 and not in ACEI/ARBs therapy was high (86%); for patients with CCI <7, NLR ≥9, with (16.6%) or without (25%) ACEI/ARBs therapy was intermediate; for patients with CCI <7, NLR <9 and in ACEI/ARBs therapy was of 0%. Conclusions High comorbidity burden, high levels of NLR and the undertreatment with ACEI/ARBs were the main prognostic indicators of in-hospital mortality. The risk stratification of COVID-19 patients at hospital admission would help the clinicians to take care of the high-risk patients and reduce the mortality.
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Affiliation(s)
- Andrea Sonaglioni
- Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Michele Lombardo
- Division of Cardiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Adriana Albini
- European Institute of Oncology (IEO) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- *Correspondence: Adriana Albini,
| | - Douglas M. Noonan
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Unit of Molecular Pathology, Immunology and Biochemistry, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Margherita Re
- Division of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Roberto Cassandro
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Davide Elia
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | - Antonella Caminati
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
| | | | - Sergio Harari
- Division of Pneumology, Semi Intensive Care Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Di Milano, Milan, Italy
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10
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Ranucci M, Parati G, Di Dedda U, Bussotti M, Agricola E, Menicanti L, Bombace S, De Martino F, Giovinazzo S, Zambon A, Menè R, La Rovere MT. When Outcomes Diverge: Age and Cardiovascular Risk as Determinants of Mortality and ICU Admission in COVID-19. J Clin Med 2022; 11:jcm11144099. [PMID: 35887864 PMCID: PMC9316345 DOI: 10.3390/jcm11144099] [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: 06/17/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of disease severity in COVID-19 patients. Cardiovascular co-morbidities are one of the main determinants of negative outcomes. In this study we investigated the impact of cardiovascular co-morbidities on mortality and admission to the ICU in first-wave COVID-19 patients. Methods: A multicenter, retrospective, cohort study. A total of 1077 patients were analyzed for mortality and ICU admission. Cardiovascular risk factors were explored as determinants of the outcomes after correction for other confounders. Results: In the multivariable model, after correction for age, only a history of heart failure remained independently associated (p = 0.0013) with mortality (hazard ratio 2.22, 95% confidence interval 1.37 to 3.62). Age showed a mortality risk increase of 8% per year (hazard ratio 1.08, 95% confidence interval 1.05 to 1.10, p = 0.001). The transition from ward to the ICU had, as a single determinant, the age, but in a reversed fashion (hazard ratio 0.96, 95% confidence interval 0.94 to 0.98, p = 0.0002). Conclusions: Once adjusted for the main determinant of mortality (age) heart failure only remained independently associated with mortality. Admission to the ICU was less likely for elderly patients. This may reflect the catastrophic impact of the first wave of COVID-19 pandemic in terms of ICU bed availability in Lombardy, leading to a selection process for ICU admission.
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Affiliation(s)
- Marco Ranucci
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
- Correspondence: ; Tel.: +39-02-52774754
| | - Gianfranco Parati
- Department of Cardiovascular Neural and Metabolic Sciences, Department of Medicine and Surgery, IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Umberto Di Dedda
- Department of Cardiovascular Anesthesia and ICU, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Maurizio Bussotti
- Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, 20138 Milan, Italy;
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Vita-Salute University, IRCCS San Raffaele Hospital, 20132 Milan, Italy;
| | - Lorenzo Menicanti
- Scientific Directorate, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy;
| | - Sara Bombace
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Fabiana De Martino
- Heart Failure Unit, Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico, 20138 Milan, Italy;
| | - Stefano Giovinazzo
- Cardiovascular Disease Unit, Cardiac, Thoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Antonella Zambon
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, 20126 Milan, Italy;
- Department of Statistics and Quantitative Methods, Università di Milano-Bicocca, 20126 Milan, Italy
| | - Roberto Menè
- Department of Cardiology, IRCCS Istituto Auxologico Italiano, Università di Milano-Bicocca, 20126 Milan, Italy;
| | - Maria Teresa La Rovere
- Department of Cardiac Rehabilitation, IRCCS Istituti Clinici Scientifici Maugeri, 28843 Montescano, Italy;
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11
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Cosentini R, Groff P, Brambilla AM, Camajori Todeschini R, Gangitano G, Ingrassia S, Marino R, Nori F, Pagnozzi F, Panero F, Ferrari R. SIMEU position paper on non-invasive respiratory support in COVID-19 pneumonia. Intern Emerg Med 2022; 17:1175-1189. [PMID: 35103926 PMCID: PMC8803573 DOI: 10.1007/s11739-021-02906-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
The rapid worldwide spread of the Coronavirus disease (COVID-19) crisis has put health systems under pressure to a level never experienced before, putting intensive care units in a position to fail to meet an exponentially growing demand. The main clinical feature of the disease is a progressive arterial hypoxemia which rapidly leads to ARDS which makes the use of intensive care and mechanical ventilation almost inevitable. The difficulty of health systems to guarantee a corresponding supply of resources in intensive care, together with the uncertain results reported in the literature with respect to patients who undergo early conventional ventilation, make the search for alternative methods of oxygenation and ventilation and potentially preventive of the need for tracheal intubation, such as non-invasive respiratory support techniques particularly valuable. In this context, the Emergency Department, located between the area outside the hospital and hospital ward and ICU, assumes the role of a crucial junction, due to the possibility of applying these techniques at a sufficiently early stage and being able to rapidly evaluate their effectiveness. This position paper describes the indications for the use of non-invasive respiratory support techniques in respiratory failure secondary to COVID-19-related pneumonia, formulated by the Non-invasive Ventilation Faculty of the Italian Society of Emergency Medicine (SIMEU) on the base of what is available in the literature and on the authors' direct experience. Rationale, literature, tips & tricks, resources, risks and expected results, and patient interaction will be discussed for each one of the escalating non-invasive respiratory techniques: standard oxygen, HFNCO, CPAP, NIPPV, and awake self-repositioning. The final chapter describes our suggested approach to the failing patient.
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Affiliation(s)
| | - Paolo Groff
- Pronto Soccorso e Osservazione Breve, Perugia, AO, Italy
| | | | | | | | - Stella Ingrassia
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST FBF Sacco, Milan, Italy
| | - Roberta Marino
- Emergency Medicine, Sant'Andrea Hospital, Vercelli, Italy
| | - Francesca Nori
- Emergency Room, Emergency Care Unit, Santa Maria Della Scaletta Hospital, Imola, Italy
| | | | - Francesco Panero
- MECAU 2, Pronto Soccorso e Area Critica, ASL Città di Torino, Turin, Italy
| | - Rodolfo Ferrari
- Emergency Room, Emergency Care Unit, Santa Maria Della Scaletta Hospital, Imola, Italy
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12
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Plasma Levels and Renal Handling of Amino Acids Contribute to Determination of Risk of Mortality or Feed of Ventilation in Patients with COVID-19. Metabolites 2022; 12:metabo12060486. [PMID: 35736419 PMCID: PMC9228241 DOI: 10.3390/metabo12060486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022] Open
Abstract
COVID-19 infection may lead to serious complications, e.g., need for mechanical ventilation or death in some cases. A retrospective analysis of patients referred to our COVID Emergency Department, indiscriminately, was performed. A routine lab analysis measured amino acids in plasma and urine of patients. Data of surviving and deceased patients and those requiring or not requiring mechanical ventilation were compared, and logistic regression analyses have been performed. Deceased patients were older, had higher blood glucose, potassium, AST, LDH, troponin, d-dimer, hsCRP, procalcitonin, interleukin-6 levels (p < 0.05 for all). They had lower plasma serine, glycine, threonine, tryptophan levels (p < 0.01), higher tyrosine and phenylalanine levels (p < 0.05), and higher fractional excretion of arginine, methionine, and proline (p < 0.05) than survivors. In a regression model, age, severity score of COVID-pneumonia, plasma levels of threonine and phenylalanine were predictors of in-hospital mortality. There was a difference in ventilated vs. non-ventilated patients in CT-scores, glucose, and renal function (p < 0.001). Using logistic regression, CT-score, troponin, plasma level, and fractional excretion of glycine were predictors of ventilation. Plasma levels and renal excretion of certain amino acids are associated with the outcome of COVID-19 infection beside other parameters such as the CT-score or age.
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13
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Giannitrapani L, Augello G, Mirarchi L, Amodeo S, Veronese N, Sasso BL, Giglio RV, Licata A, Barbagallo M, Ciaccio M, Cervello M, Soresi M. Outcome predictors in SARS-CoV-2 disease (COVID-19): The prominent role of IL-6 levels and an IL-6 gene polymorphism in a western Sicilian population. J Infect 2022; 85:174-211. [PMID: 35490738 PMCID: PMC9050196 DOI: 10.1016/j.jinf.2022.04.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Lydia Giannitrapani
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy; Institute for Biomedical Research and Innovation, National Research Council, Via Ugo La Malfa 153, Palermo 90146, Italy
| | - Giuseppa Augello
- Institute for Biomedical Research and Innovation, National Research Council, Via Ugo La Malfa 153, Palermo 90146, Italy
| | - Luigi Mirarchi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Simona Amodeo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Bruna Lo Sasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Rosaria Vincenza Giglio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Anna Licata
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Melchiorre Cervello
- Institute for Biomedical Research and Innovation, National Research Council, Via Ugo La Malfa 153, Palermo 90146, Italy.
| | - Maurizio Soresi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
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14
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Risk of Seven-Day Worsening and Death: A New Clinically Derived COVID-19 Score. Viruses 2022; 14:v14030642. [PMID: 35337049 PMCID: PMC8951891 DOI: 10.3390/v14030642] [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: 02/14/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 01/28/2023] Open
Abstract
This monocentric, retrospective, two-stage observational study aimed to recognize the risk factors for a poor outcome in patients hospitalized with SARS-CoV-2 infection, and to develop and validate a risk score that identifies subjects at risk of worsening, death, or both. The data of patients with SARS-CoV-2 infection during the first wave of the pandemic were collected and analyzed as a derivation cohort. Variables with predictive properties were used to construct a prognostic score, which was tried out on a validation cohort enrolled during the second wave. The derivation cohort included 494 patients; the median age was 62 and the overall fatality rate was 22.3%. In a multivariable analysis, age, oxygen saturation, neutrophil-to-lymphocyte ratio, C-reactive protein and lactate dehydrogenase were independent predictors of death and composed the score. A cutoff value of 3 demonstrated a sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of 93.5%, 68.5%, 47.4% and 97.2% for death, and 84.9%, 84.5%, 79.6% and 87.9% for worsening, respectively. The validation cohort included 415 subjects. The score application showed a Se, Sp, PPV and NPV of 93.4%, 61.6%, 29.5% and 98.1% for death, and 81%, 76.3%, 72.1% and 84.1% for worsening, respectively. We propose a new clinical, easy and reliable score to predict the outcome in hospitalized SARS-CoV-2 patients.
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15
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Preti C, Biza R, Novelli L, Ghirardi A, Conti C, Galimberti C, Della Bella L, Memaj I, Di Marco F, Cosentini R. Usefulness of CURB-65, pneumonia severity index and MULBSTA in predicting COVID-19 mortality. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/14/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of our study is to evaluate the accuracy of CURB-65 and Pneumonia Severity Index (PSI), the most widely used scores for community acquired pneumonia, and MuLBSTA, a viral pneumonia score, in predicting 28-day mortality in Coronavirus Disease 2019 (COVID-19) pneumonia.We retrospectively collected clinical data of consecutive patients with laboratory-confirmed COVID-19 pneumonia admitted at Papa Giovanni XXIII Hospital from February 23rd to March 14th, 2020. We calculated at Emergency Department (ED) presentation CURB-65, PSI and MuLBSTA and we compared their performances in discriminating between survivors and non-survivors at 28 days. Among 431 hospitalized patients, the majority presented with hypoxic respiratory failure: median (interquartile range, IQR) PaO2/FiO2 ratio at admission was 228.6 (142.0-278.1). In the first 24 hours, 111 (27%) patients were administered low-flow oxygen cannula, 50 (12%) Venturi Mask, 95 (23%) non-rebreather mask, 106 (26%) non-invasive ventilation, 12 (3%) mechanical ventilation and 41 (9%) were not administered oxygen therapy. Mortality rate at 28-day was 35% (150/431). Between survivors and non-survivors, median (IQR) scores were, respectively, 1.0 (1.0-2.0) and 2.0 (2.0-3.0) for CURB-65 (p<0.001); 90.5 (76.0-105.5) and 115.0 (100.0-129.0) for PSI (p<0.001); 7.0 (5.0-10.0) and 11.0 (9.0-13.0) for MuLBSTA (p<0.001). Areas under the receiver operating characteristic curve (AUCs) for each score were, respectively, 0.725 (0.662-0.787), 0.776 (0.693-0.859) and 0.743 (0.680-0.806) (p>0,05). PSI and MuLBSTA did not show a better performance when compared to CURB-65. Although CURB-65, PSI and MuLBSTA scores are useful tools to discriminate between survivors and non-survivors in COVID-19 pneumonia, their diagnostic accuracy in discriminating 28-day mortality in COVID-19 pneumonia is moderate, as confirmed by AUCs <0.80, and there is a potential underestimation of disease severity in the low-risk classes. For this reason, they should not be recommended in ED to decide between inpatient and outpatient management in patients affected by COVID-19 pneumonia.
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16
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Yao L, Li M, Wan JY, Howard SC, Bailey JE, Graff JC. Democracy and case fatality rate of COVID-19 at early stage of pandemic: a multicountry study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:8694-8704. [PMID: 34490579 PMCID: PMC8421237 DOI: 10.1007/s11356-021-16250-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/26/2021] [Indexed: 05/14/2023]
Abstract
Many studies have evaluated factors that influence the course of the COVID-19 pandemic in different countries. This multicountry study assessed the influence of democracy and other factors on the case fatality rate of COVID-19 during the early stage of the pandemic. We accessed the World Health Organization, World Bank, and the Democracy Index 2019 databases for data from the 148 countries. Multiple analyses were conducted to examine the association between the Democracy Index and case fatality rate of COVID-19. Within 148 countries, the percentage of the population aged 65 years and above (p = 0.0193), and health expenditure as a percentage of GDP (p = 0.0237) were positively associated with countries' case fatality rates. By contrast, hospital beds per capita helped to reduce the case fatality rates. In particular, the Democracy Index was positively associated with case fatality rates in a subgroup of 47 high-income countries. This study suggests that enhancing the health system with increased hospital beds and healthcare workforce per capita should reduce case fatality rate. The findings suggest that a higher Democracy Index is associated with more deaths from COVID-19 at the early stage of the pandemic, possibly due to the decreased ability of the government.
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Affiliation(s)
- Lan Yao
- Health Outcomes and Policy Research, College of Graduate Health Sciences, University of Tennessee Health Science Center, 750 Adams Ave #1001, Memphis, TN 38163 USA
| | - Minghui Li
- Minghui Li, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Jim Y. Wan
- Jim Y. Wan, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Scott C. Howard
- Scott C. Howard, College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - James E. Bailey
- James E. Bailey, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Joyce Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, 874 Union Avenue, Memphis, TN 38163 USA
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17
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Clinical outcomes of immunomodulatory therapies in the management of COVID-19: A tertiary-care experience from Pakistan. PLoS One 2022; 17:e0262608. [PMID: 35085312 PMCID: PMC8794194 DOI: 10.1371/journal.pone.0262608] [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: 08/13/2021] [Accepted: 12/29/2021] [Indexed: 12/15/2022] Open
Abstract
The pharmacological management of COVID-19 has evolved significantly and various immunomodulatory agents have been repurposed. However, the clinical efficacy has been variable and a search for cure for COVID-19 continues. A retrospective cohort study was conducted on 916 patients hospitalized with polymerase chain reaction (PCR)-confirmed COVID-19 between February 2020 and October 2020 at a tertiary care academic medical center in Karachi, Pakistan. The median age was 57 years (interquartile range (IQR) 46–66 years). The most common medications administered were Methylprednisolone (65.83%), Azithromycin (50.66%), and Dexamethasone (46.6%). Majority of the patients (70%) had at least two or more medications used in combination and the most frequent combination was methylprednisolone with azithromycin. Overall in-hospital mortality was 13.65% of patients. Mortality was found to be independently associated with age greater than or equal to 60 years (OR = 4.98; 95%CI: 2.78–8.91), critical illness on admission (OR = 13.75; 95%CI: 7.27–25.99), use of hydrocortisone (OR = 12.56; 95%CI: 6.93–22.7), Ferritin> = 1500(OR = 2.07; 95%CI: 1.18–3.62), Creatinine(OR = 2.33; 95%CI: 1.31–4.14) and D-Dimer> = 1.5 (OR = 2.27; 95%CI: 1.26–4.07). None of the medications whether used as monotherapy or in combination were found to have a mortality benefit. Our study highlights the desperate need for an effective drug for the management of critical COVID-19 which necessitates usage of multiple drug combinations in patients particularly Azithromycin which has long term implications for antibiotic resistance particularly in low-middle income countries.
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18
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Patrucco F, Zeppegno P, Baricich A, Gramaglia CM, Balbo PE, Falaschi Z, Carriero A, Cuneo D, Pirisi M, Bellan M. Long-lasting consequences of Coronavirus disease 19 pneumonia: a systematic review. Minerva Med 2021; 113:158-171. [PMID: 34856780 DOI: 10.23736/s0026-4806.21.07594-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Coronavirus Disease 19 (Covid-19) is an infectious disease caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have plenty of data about the clinical features of the disease's acute phase, while little is known about the long-term consequences on survivors. EVIDENCE ACQUISITION We aimed to review systematically emerging evidence about clinical and functional consequences of Covid-19 pneumonia months after hospital discharge. EVIDENCE SYNTHESIS Current evidence supports the idea that a high proportion of Covid-19 survivors complain of symptoms months after the acute illness phase, being fatigue and reduced tolerance to physical effort the most frequently reported symptom. The strongest association for these symptoms is with the female gender, while disease severity seems less relevant. Respiratory symptoms are associated with a decline in respiratory function and, conversely, seem to be more frequent in those who experienced a more severe acute pneumonia. Current evidence highlighted a persistent motor impairment which is, again, more prevalent among those survivors who experienced a more severe acute phase of the disease. Additionally, the persistence of symptoms is a primary determinant of mental health outcome, with anxiety, depression, sleep disturbances, and post-traumatic stress symptoms being commonly reported in Covid-19 survivors. CONCLUSIONS Current literature highlights the importance of a multidisciplinary approach to Coronavirus Disease 19 since the sequelae appear to involve different organs and systems. Given the pandemic outbreak's size, this is a critical public health issue: a better insight on this topic should inform clinical decisions about the modalities of follow-up for Covid-19 survivors.
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Affiliation(s)
- Filippo Patrucco
- Pneumology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Alessio Baricich
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy - .,Physical and Rehabilitation Medicine, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Carla M Gramaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Piero E Balbo
- Pneumology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Zeno Falaschi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Radiology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Alessandro Carriero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Radiology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Daria Cuneo
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.,Physical and Rehabilitation Medicine, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Internal Medicine Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Internal Medicine Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
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19
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Funakoshi K, Morita T, Kumanogoh A. Longer Prehospitalization and Preintubation Periods in Intubated Non-survivors and ECMO Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:727101. [PMID: 34722567 PMCID: PMC8554002 DOI: 10.3389/fmed.2021.727101] [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: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose: There is no clear consensus on the clinical course of critical COVID-19 patients. We examined the clinical course among intubated survivors, non-survivors, and extracorporeal membrane oxygenation (ECMO) patients to reveal the standard clinical course and the difference among critical COVID-19 patients. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, and Scopus for original studies published until December 11, 2020, including case accumulation and clinical course reporting. Pregnant patients and children were excluded. We followed PRISMA guidelines and registered them with PROSPERO (CRD42021235534). Results: Of the 11,716 studies identified, 94 met the selection criteria, and 2,549 cases were included in this meta-analysis. The times from intubation to extubation and death were 12.07 days (95% confidence interval 9.80–14.33 days) and 10.14 days (8.18–12.10 days), respectively, and the ECMO duration was 14.72 days (10.57–18.87 days). The time from symptom onset to hospitalization (prehospitalization period) of intubated survivors, non-survivors, and ECMO patients was 6.15 (4.61–7.69 days), 6.45 (4.55–8.34 days), and 7.15 days (6.48–7.81 days), and that from symptom onset to intubation (preintubation period) was 8.58 (7.36–9.80 days), 9.14 (7.26–11.01 days), and 10.54 days (9.18–11.90 days), respectively. Sensitivity analysis showed that the time from intubation to extubation and death was longer in the US and Europe than in East Asia. Conclusion: For COVID-19, we hypothesize that prehospitalization and preintubation periods are longer in intubated non-survivors and ECMO patients than in intubated survivors. These periods may serve as a predictor of disease severity or death and support therapeutic strategy determination.
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Affiliation(s)
- Kenji Funakoshi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan.,Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Japan
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20
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Gandolfo C, Bonfiglio M, Spinetto G, Ferraioli G, Barlascini C, Nicolini A, Solidoro P. Pneumomediastinum associated with severe pneumonia related to COVID-19: diagnosis and management. Minerva Med 2021; 112:779-785. [PMID: 34142771 DOI: 10.23736/s0026-4806.21.07585-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pneumomediastinum (PNM) can develop as a severe complication of severe COVID 19 and may be correlated with greater morbidity and mortality. PNM is a rarely reported complication in COVID-19 patients and usually associated with endotracheal intubation. METHODS Our aim is to describe the characteristics of patients with PNM in twenty-one patients with COVID-19 related pneumonia and acute respiratory failure in a retrospective case series. RESULTS Twenty-one patients were diagnosed, two were treated with high flow nasal cannula, five with non invasive ventilation and four with invasive mechanical ventilation. In four cases PNM was massive PNM was often associated to subcuatneous emphysema; more rarely associated also with pneumothorax. Conservative management was the most used therapeutic strategy. CONCLUSIONS PNM should is s serious but not extremely rare complication of severe forms of pulmonary involvement of COVID 19. The clinician should consider this rare complication; moreover, we advise careful attention when clinicians start mechanical ventilation.
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Affiliation(s)
- Corinna Gandolfo
- COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy
| | - Monica Bonfiglio
- COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy
| | - Giulia Spinetto
- COVID 19 Intensive Care Unit, General Hospital Unit, Sestri Levante, Genova, Italy
| | | | | | - Antonello Nicolini
- Respiratory Diseases Unit, General Hospital, Sestri Levante, Genova, Italy -
| | - Paolo Solidoro
- Medical Sciences Department, University of Torino, Turin, Italy.,Division of Respiratory Diseases, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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21
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Radovanovic D, Santus P, Coppola S, Saad M, Pini S, Giuliani F, Mondoni M, Chiumello DA. Characteristics, outcomes and global trends of respiratory support in patients hospitalized with COVID-19 pneumonia: a scoping review. Minerva Anestesiol 2021; 87:915-926. [PMID: 34036769 DOI: 10.23736/s0375-9393.21.15486-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To date, a shared international consensus on treatment of Coronavirus Disease 2019 (COVID-19) with invasive or non-invasive respiratory support is lacking. Patients' management and outcomes, especially in severe and critical cases, can vary depending on regional standard operating procedures and local guidance. EVIDENCE ACQUISITION Rapid review methodology was applied to include all the studies published on PubMed and Embase between December 15th 2019 and February 28th 2021, reporting in-hospital and respiratory support-related mortality in adult patients hospitalized with COVID-19 that underwent either continuous positive airway pressure (CPAP), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV). Only English language studies with ≥100 patients and reporting data on respiratory failure were included. Data on comorbidities, ventilatory parameters and hospital-related complications were registered. EVIDENCE SYNTHESIS Fifty-two studies (287359 patients - 57.5% males, mean age 64 years (range 24-98)) from 17 different countries were included in the final analysis. 33.3% of patients were hospitalized in intensive care units. 44.2% had hypertension, 26.1% had diabetes, and 7.1% a chronic respiratory disease. 55% of patients underwent respiratory support (36% IMV, 62% NIV and 2% CPAP). Without considering a study with the highest number of patients treated with NIV (n=96729), prevalence of NIV and CPAP use was 12.5% and 13.5% respectively. Globally, invasive and non-invasive approaches were heterogeneously applied. In-hospital mortality was 33.7%, and IMV-related mortality was 72.6% (range: 4.3%-99%). Specific mortality in patients treated with CPAP or NIV was available for 53% of studies, and was 29% (range: 7.2%-100%). The median length of hospital stay was 13 days (range: 6-63). The most frequent hospital-related complication was acute kidney injury being reported in up to 55.7% of enrolled patients. CONCLUSIONS Global employment of respiratory supports and related outcomes are very heterogeneous. The most frequent respiratory support in patients with COVID-19 pneumonia is IMV, while NIV and CPAP are less frequently and equally applied, the latter especially in Europe, while data on NIV/CPAP-related mortality is often under-reported. Integrated and comprehensive reporting is desirable and needed to construct evidence-based recommendations.
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Affiliation(s)
- Dejan Radovanovic
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Pierachille Santus
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Silvia Coppola
- SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy
| | - Marina Saad
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Stefano Pini
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy.,Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milano, Italy
| | - Fabio Giuliani
- Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy
| | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy.,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Davide A Chiumello
- SC Anestesia e Rianimazione, Ospedale San Paolo-Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy - .,Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.,Centro Ricerca Coordinata di Insufficienza Respiratoria, Università degli Studi di Milano, Milano, Italy
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22
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Raimondi F, Novelli L, Marchesi G, Fabretti F, Grazioli L, Riva I, Allegri C, Biza R, Galimberti C, Lorini FL, Di Marco F. Worsening of gas exchange parameters at high FiO 2 in COVID-19: misleading or informative? Multidiscip Respir Med 2021; 16:759. [PMID: 34123380 PMCID: PMC8168493 DOI: 10.4081/mrm.2021.759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Background In COVID-19, higher than expected level of intrapulmonary shunt has been described, in association with a discrepancy between the initial relatively preserved lung mechanics and the hypoxia severity. This study aim was to measure the shunt fraction and variations of PaO2/FiO2 ratio and oxygen alveolar-arterial gradient (A-a O2) at different FiO2. Methods Shunt was measured by a non-invasive system during spontaneous breathing in 12 patients hospitalized at COVID-19 Semi-Intensive Care Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, between October 22 and November 23, 2020. Results Nine patients were men, mean age (±SD) 62±15 years, mean BMI 27.5±4.8 Kg/m2. Systemic hypertension, diabetes type 2 and previous myocardial infarction were referred in 33%, 17%, and 7%, respectively. Mean PaO2/FiO2 ratio was 234±66 and 11 patients presented a bilateral chest X-ray involvement. Mean shunt was 21±6%. Mainly in patients with a more severe respiratory failure, we found a progressive decrease of PaO2/FiO2 ratio with higher FiO2. Considering (A-a O2), we found a uniform tendency to increase with FiO2 increasing. Even in this case, the more severe were the patients, the higher was the slope, suggesting FiO2 insensitiveness due to a shunt effect, as strengthened by our measurements. Conclusion Relying on a single evaluation of PaO2/FiO2 ratio, especially at high FiO2, could be misleading in COVID-19. We propose a two steps evaluation, the first at low SpO2 value (e.g., 92-94%) and the second one at high FiO2 (i.e., >0.7), allowing to characterize both the amendable (ventilation/perfusion mismatch), and the fixed (shunt) contribution quote of respiratory impairment, respectively.
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Affiliation(s)
- Federico Raimondi
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo.,Department of Medical Sciences, University of Milan
| | - Luca Novelli
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo
| | | | - Fabrizio Fabretti
- Anesthesiology Intensive Care Unit 3, ASST Papa Giovanni XXIII, Bergamo
| | - Lorenzo Grazioli
- Anesthesiology Intensive Care Unit 2, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Ivano Riva
- Anesthesiology Intensive Care Unit 3, ASST Papa Giovanni XXIII, Bergamo
| | - Chiara Allegri
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo.,Department of Medical Sciences, University of Milan
| | - Roberta Biza
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo.,Department of Medical Sciences, University of Milan
| | | | | | - Fabiano Di Marco
- Pulmonary Medicine Unit, ASST Papa Giovanni XXIII, Bergamo.,Department of Medical Sciences, University of Milan
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23
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Versaci F, Gaspardone A, Danesi A, Ferranti F, Mancone M, Mariano E, Rotolo FL, Musto C, Proietti I, Berni A, Trani C, Sergi SC, Speciale G, Tanzilli G, Tomai F, Di Giosa A, Marchegiani G, Romagnoli E, Cavarretta E, Carnevale R, Frati G, Biondi-Zoccai G. Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020. Int J Cardiol 2021; 329:251-259. [PMID: 33387558 PMCID: PMC7833791 DOI: 10.1016/j.ijcard.2020.12.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area. METHODS AND RESULTS Italy was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI cases. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all p<0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (p<0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (p<0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (p<0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both p<0.001). CONCLUSIONS Reductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.
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Affiliation(s)
- Francesco Versaci
- UOC UTIC, Emodinamica e Cardiologia, Ospedale S. Maria Goretti, Latina, Italy
| | | | | | - Fabio Ferranti
- Division of Cardiology, G. B. Grassi Hospital, Lido di Ostia, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Francesco L Rotolo
- Interventional Cardiology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Carmine Musto
- Interventional Cardiology Unit, San Camillo Hospital, Rome, Italy
| | - Igino Proietti
- Division of Cardiology, M. G. Vannini Hospital, Rome, Italy
| | - Andrea Berni
- Department of Cardiovascular Diseases, Sant'Andrea Hospital, Rome, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | - Gaetano Tanzilli
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Enrico Romagnoli
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Roberto Carnevale
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; IRCCS NEUROMED, Pozzilli, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
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24
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Ylescupidez A, Rips A, Bahnson HT, Speake C, Verma P, Hocking AM, Buckner JH, Malhotra U. Early Prognostic Indicators of Subsequent Hospitalization in Patients with Mild COVID-19. J Clin Med 2021; 10:jcm10081562. [PMID: 33917702 PMCID: PMC8068070 DOI: 10.3390/jcm10081562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 12/30/2022] Open
Abstract
Comprehensive data on early prognostic indicators in patients with mild COVID-19 remains sparse. In this single center case series, we characterized the initial clinical presentation in 180 patients with mild COVID-19 and defined the earliest predictors of subsequent deterioration and need for hospitalization. Three broad patient phenotypes and four symptom clusters were characterized, differentiated by varying risk for adverse outcomes. Among 14 symptoms assessed, subjective shortness of breath (SOB) most strongly associated with adverse outcomes (odds ratio (OR) 21.3, 95% confidence interval (CI): 2.7–166.4; p < 0.0001). In combination, SOB and number of comorbidities were highly predictive of subsequent hospitalization (area under the curve (AUC) 92%). Additionally, initial lymphopenia (OR 21.0, 95% CI: 2.1–210.1; p = 0.002) and male sex (OR 3.5, 95% CI: 0.9–13.0; p = 0.05) were associated with increased risk of poor outcomes. Patients with known comorbidities, especially multiple, and those presenting with subjective SOB or lymphopenia should receive close monitoring and consideration for preemptive treatment, even when presenting with mild symptoms.
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Affiliation(s)
- Alyssa Ylescupidez
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA; (A.Y.); (A.R.); (H.T.B.); (C.S.)
| | - Aaron Rips
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA; (A.Y.); (A.R.); (H.T.B.); (C.S.)
| | - Henry T. Bahnson
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA; (A.Y.); (A.R.); (H.T.B.); (C.S.)
| | - Cate Speake
- Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA; (A.Y.); (A.R.); (H.T.B.); (C.S.)
| | - Punam Verma
- Department of Microbiology, Virginia Mason Medical Center, Seattle, WA 98101, USA;
| | - Anne M. Hocking
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA; (A.M.H.); (J.H.B.)
| | - Jane H. Buckner
- Center for Translational Immunology, Benaroya Research Institute at Virginia Mason, Seattle, WA 98101, USA; (A.M.H.); (J.H.B.)
| | - Uma Malhotra
- Department of Infectious Disease, Virginia Mason Medical Center, Seattle, WA 98101, USA
- Department of Medicine, Section of Infectious Diseases, University of Washington, Seattle, WA 98101, USA
- Correspondence:
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