1
|
Schmidt W, Pawlak-Buś K, Jóźwiak B, Leszczyński P. Identification of Clinical Response Predictors of Tocilizumab Treatment in Patients with Severe COVID-19 Based on Single-Center Experience. J Clin Med 2023; 12:jcm12062429. [PMID: 36983429 PMCID: PMC10051490 DOI: 10.3390/jcm12062429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Hyperinflammation in COVID-19 plays a crucial role in pathogenesis and severity; thus, many immunomodulatory agents are applied in its treatment. We aimed to identify good clinical response predictors of tocilizumab (TCZ) treatment in severe COVID-19, among clinical, laboratory, and radiological variables. We conducted a prospective, observational study with 120 patients with severe COVID-19 not improving despite dexamethasone (DEX) treatment. We used parametric and non-parametric statistics, univariate logistic regression, receiver operating characteristic (ROC) curves, and nonlinear factors tertile analysis. In total, 86 (71.7%) patients achieved the primary outcome of a good clinical response to TCZ. We identified forty-nine predictive factors with potential utility in patient selection and treatment monitoring. The strongest included time from symptom onset between 9 and 12 days, less than 70% of estimated radiological lung involvement, and lower activity of lactate dehydrogenase. Additional predictors were associated with respiratory function, vitamin D concentration, comorbidities, and inflammatory/organ damage biomarkers. Adverse events analysis proved the safety of such a regimen. Our study confirmed that using TCZ early in the hyperinflammatory phase, before severe respiratory failure development, is most beneficial. Considering the described predictive factors, employing simple and widely available laboratory, radiological, and clinical tools can optimize patient selection for immunomodulatory treatment with TCZ.
Collapse
Affiliation(s)
- Wiktor Schmidt
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
- Doctoral School, Poznan University of Medical Sciences, 60-812 Poznan, Poland
| | - Katarzyna Pawlak-Buś
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Barbara Jóźwiak
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
| | - Piotr Leszczyński
- Department of Rheumatology, Systemic Connective Tissue Diseases and Immunotherapy of Rheumatic Diseases, J. Strus Municipal Hospital, 61-285 Poznan, Poland
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| |
Collapse
|
2
|
Sebbar EH, Choukri M. Cardiovascular markers and COVID-19. MATERIALS TODAY. PROCEEDINGS 2023; 72:3356-3359. [PMID: 35937953 PMCID: PMC9343768 DOI: 10.1016/j.matpr.2022.07.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
COVID-19 is an emerging viral disease with incompletely elucidated pathogenesis, a heterogeneous clinical profile, and significant interindividual variability. The major cardiovascular complications of COVID-19 include acute cardiac injury, acute myocardial infarction (AMI), myocarditis, arrhythmia, heart failure, and venous thromboembolism (VTE)/pulmonary embolism (PE). Elevated BNP /NT-proBNP, troponin and d-dimer levels has been found in a significant proportion of patients since the first data analysis, suggesting that myocardial damage is a likely pathogenic mechanism contributing to severe disease and mortality. The level of these markers is now associated with a risk of adverse outcome, namely mortality. The aim of our study is to highlight the importance of these biomarkers for the prediction of cardiovascular complications and their potential role in the evolution of COVID-19.
Collapse
|
3
|
Özdemir E, Karagöz U, Emren SV, Altay S, Eren NK, Özdemir S, Tokaç M. Strain Echocardiographic Evaluation of Myocardial Involvement in Patients with Continuing Chest Pain after COVID-19 Infection. Arq Bras Cardiol 2022; 120:e20220287. [PMID: 36629604 PMCID: PMC9833213 DOI: 10.36660/abc.20220287] [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: 01/22/2022] [Accepted: 09/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND A new clinical manifestation called post or long coronavirus disease (p/l COVID) has walked into our lives after the acute COVID-19 phase. P/l COVID may lead to myocardial injury with subsequent cardiac problems. Diagnosing these patients quickly and simply has become more important due to the increasing number of patients with p/l COVID. OBJECTIVES We compared strain echocardiography (SE) parameters of patients who suffered from atypical chest pain and had sequel myocarditis findings on cardiac magnetic resonance (CMR). We aimed to investigate the value of SE for detection of myocardial involvement in patients with p/l COVID. METHODS A total of 42 patients were enrolled. Our population was separated into two groups. The CMR(-) group (n = 21) had no myocardial sequelae on CMR, whereas the CMR(+) group had myocardial sequelae on CMR (n = 21). The predictive value of SE for myocarditis was also evaluated by age-adjusted multivariate analysis. P values < 0.05 were considered statistically significant. RESULTS When compared with left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and global circumferential strain (GCS) had a stronger relationship (LVEF, p = 0.05; GLS, p < 0.001; GCS, p < 0.001) with p/l COVID associated myocardial involvement. GLS < 20.35 had 85.7% sensitivity and 81% specificity; GCS < 21.35 had 81% sensitivity and 81% specificity as diagnostic values for myocardial sequelae detected with CMR. While there was no difference between the groups in terms of inflammatory markers (C-reactive protein, p = 0.31), a difference was observed between biochemical markers, which are indicators of cardiac involvement (brain natriuretic peptide, p < 0.001). CONCLUSION SE is more useful than traditional echocardiography for making diagnosis quickly and accurately in order not to delay treatment in the presence of myocardial involvement.
Collapse
Affiliation(s)
- Emre Özdemir
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| | - Uğur Karagöz
- Departamento da CardiologiaTorbalı Goverment HospitalIzmirTurquiaDepartamento da Cardiologia, Torbalı Goverment Hospital, Izmir – Turquia
| | - Sadık Volkan Emren
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| | - Sedat Altay
- Departamento da RadiologiaAtatürk Research and Training HospitalIzmirTurquiaDepartamento da Radiologia, Atatürk Research and Training Hospital, Izmir – Turquia
| | - Nihan Kahya Eren
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| | - Selin Özdemir
- Departamento de Doenças InfecciosasBozyaka Research and Training HospitalIzmirTurquiaDepartamento de Doenças Infecciosas, Bozyaka Research and Training Hospital, Izmir – Turquia
| | - Mehmet Tokaç
- Faculdade de MedicinaAtatürk Research and Training HospitalKatip Çelebi UniversityIzmirTurquiaDepartamento da Cardiologia, Faculdade de Medicina, Atatürk Research and Training Hospital, Katip Çelebi University, Izmir – Turquia
| |
Collapse
|
4
|
Semiz S. COVID19 biomarkers: What did we learn from systematic reviews? Front Cell Infect Microbiol 2022; 12:1038908. [PMID: 36583110 PMCID: PMC9792992 DOI: 10.3389/fcimb.2022.1038908] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID19) pandemic continues to represent a substantial public health concern. It can rapidly progress to severe disease, with poor prognosis and a high mortality risk. An early diagnosis and specific prognostic tools can help healthcare providers to start interventions promptly, understand the likely prognosis and to identify and treat timely individuals likely to develop severe disease with enhanced mortality risk. Here we focused on an impressive set of systematic reviews and meta-analyses that were performed since the start of the COVID19 pandemic and summarized their results related to the levels of hematologic, inflammatory, immunologic biomarkers as well as markers of cardiac, respiratory, hepatic, gastrointestinal and renal systems and their association with the disease progression, severity and mortality. The evidence outlines the significance of specific biomarkers, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, interleukin-6), hematological (lymphocytes count, neutrophil-to-lymphocyte ratio, D-dimer, ferritin, red blood cell distribution width), cardiac (troponin, CK-MB, myoglobin), liver (AST, ALT, total bilirubin, albumin) and lung injury (Krebs von den Lungen-6) that can be used as prognostic biomarkers to aid the identification of high-risk patients and the prediction of serious outcomes, including mortality, in COVID19. Thus, these parameters should be used as essential tools for an early risk stratification and adequate intervention in improving disease outcomes in COVID19 patients.
Collapse
|
5
|
Cardiac Biomarkers and Risk Scores in Relation with History of Atherosclerotic Cardiovascular Disease in Patients Admitted with COVID-19: The Experience of an Eastern European Center. J Clin Med 2022; 11:jcm11195671. [PMID: 36233539 PMCID: PMC9571947 DOI: 10.3390/jcm11195671] [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: 08/28/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Data regarding the combined prognostic role of biomarkers and risk scores in relation with the history of atherosclerotic cardiovascular disease (ASCVD) in COVID-19 patients are lacking. Methods: The aim of this observational cohort study was to evaluate the combined prognostic value of N-terminal pro B-type natriuretic peptide (NT-pro BNP), troponin and risk scores in relation with ASCVD history in hospitalized COVID-19 patients. The primary composite endpoint was Intensive Care Unit (ICU) admission and death. Results: From April 2020 to June 2022, 1066 consecutive COVID-19 patients with available biomarkers upon admission were included. During a median follow-up period of 12 days, 176 patients (16.5%) died. Independent predictors of ICU admission and death in patients with ASCVD were NT-pro BNP (HR 2.63; 95% CI, 1.65–4.18) and troponin (HR 1.51; 95% CI, 1.13–2.03). In patients without ASCVD, only NT-pro BNP was predictive for the primary endpoint (HR 1.66; 95% CI, 1.10–2.53). This remained significant after adjustment for other relevant covariates (HR 3.54; 95% CI, 1.98–6.33) in patients with ASCVD and in patients without ASCVD (HR 1.82; 95% CI, 1.02–3.26). Conclusions: These data showed the combined prognostic accuracy of NT-pro BNP and troponin in relation with ASCVD history for ICU admission and death in COVID-19 patients.
Collapse
|
6
|
Palazzuoli A, Metra M, Collins SP, Adamo M, Ambrosy AP, Antohi LE, Ben Gal T, Farmakis D, Gustafsson F, Hill L, Lopatin Y, Tramonte F, Lyon A, Masip J, Miro O, Moura B, Mullens W, Radu RI, Abdelhamid M, Anker S, Chioncel O. Heart failure during the COVID-19 pandemic: clinical, diagnostic, management, and organizational dilemmas. ESC Heart Fail 2022; 9:3713-3736. [PMID: 36111511 PMCID: PMC9773739 DOI: 10.1002/ehf2.14118] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
The coronavirus 2019 (COVID-19) infection pandemic has affected the care of patients with heart failure (HF). Several consensus documents describe the appropriate diagnostic algorithm and treatment approach for patients with HF and associated COVID-19 infection. However, few questions about the mechanisms by which COVID can exacerbate HF in patients with high-risk (Stage B) or symptomatic HF (Stage C) remain unanswered. Therefore, the type of HF occurring during infection is poorly investigated. The diagnostic differentiation and management should be focused on the identification of the HF phenotype, underlying causes, and subsequent tailored therapy. In this framework, the relationship existing between COVID and onset of acute decompensated HF, isolated right HF, and cardiogenic shock is questioned, and the specific management is mainly based on local hospital organization rather than a standardized model. Similarly, some specific populations such as advanced HF, heart transplant, patients with left ventricular assist device (LVAD), or valve disease remain under investigated. In this systematic review, we examine recent advances regarding the relationships between HF and COVID-19 pandemic with respect to epidemiology, pathogenetic mechanisms, and differential diagnosis. Also, according to the recent HF guidelines definition, we highlight different clinical profile identification, pointing out the main concerns in understudied HF populations.
Collapse
Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, S. Maria alle Scotte HospitalUniversity of Siena53100SienaItaly
| | - Marco Metra
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Sean P. Collins
- Department of Emergency MedicineVanderbilt University Medical CentreNashvilleTNUSA
| | - Marianna Adamo
- Cardiology, Cardio‐Thoracic Department, Civil Hospitals, Brescia, Italy; Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
| | - Andrew P. Ambrosy
- Department of CardiologyKaiser Permanente San Francisco Medical CenterSan FranciscoCAUSA,Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Laura E. Antohi
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu” BucharestBucharestRomania
| | - Tuvia Ben Gal
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dimitrios Farmakis
- Cardio‐Oncology Clinic, Heart Failure Unit, “Attikon” University HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece,University of Cyprus Medical SchoolNicosiaCyprus
| | | | - Loreena Hill
- School of Nursing and MidwiferyQueen's UniversityBelfastUK
| | - Yuri Lopatin
- Volgograd Medical UniversityCardiology CentreVolgogradRussia
| | - Francesco Tramonte
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department, S. Maria alle Scotte HospitalUniversity of Siena53100SienaItaly
| | - Alexander Lyon
- Cardio‐Oncology ServiceRoyal Brompton Hospital and Imperial College LondonLondonUK
| | - Josep Masip
- Intensive Care Department, Consorci Sanitari IntegralUniversity of BarcelonaBarcelonaSpain,Department of CardiologyHospital Sanitas CIMABarcelonaSpain
| | - Oscar Miro
- Emergency Department, Hospital Clínic de BarcelonaUniversity of BarcelonaBarcelonaSpain
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of MedicineUniversity of PortoPortoPortugal
| | - Wilfried Mullens
- Cardiovascular PhysiologyHasselt University, Belgium, & Heart Failure and Cardiac Rehabilitation Specialist, Ziekenhuis Oost‐LimburgGenkBelgium
| | - Razvan I. Radu
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C.Iliescu” BucharestBucharestRomania
| | - Magdy Abdelhamid
- Cardiology Department, Kasr Alainy School of MedicineCairo UniversityNew Cairo, 5th settlementCairo11865Egypt
| | - Stefan Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu” Bucharest; University for Medicine and Pharmacy “Carol Davila” BucharestBucharestRomania
| |
Collapse
|
7
|
Network analysis for elucidating the mechanisms of Shenfu injection in preventing and treating COVID-19 combined with heart failure. Comput Biol Med 2022; 148:105845. [PMID: 35849948 PMCID: PMC9279168 DOI: 10.1016/j.compbiomed.2022.105845] [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: 12/20/2021] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022]
Abstract
Background The emergence of the novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to millions of infections and is exerting an unprecedented impact on society and economies worldwide. The evidence showed that heart failure (HF) is a clinical syndrome that could be encountered at different stages during the progression of COVID-19. Shenfu injection (SFI), a traditional Chinese medicine (TCM) formula has been widely used for heart failure therapy in China and was suggested to treat critical COVID-19 cases based on the guideline for diagnosis and treatment of COVID-19 (the 7th version) issued by National Health Commission of the People's Republic of China. However, the active components, potential targets, related pathways, and underlying pharmacology mechanism of SFI against COVID-19 combined with HF remain vague. Objective To investigate the effectiveness and possible pharmacological mechanism of SFI for the prevention and treatment of COVID-19 combined with HF. Methods In the current study, a network analysis approach integrating active compound screening (drug-likeness, lipophilicity, and aqueous solubility models), target fishing (Traditional Chinese Medicine Systems Pharmacology, fingerprint-based Similarity Ensemble Approach, and PharmMapper databases), compound-target-disease network construction (Cytoscape software), protein-protein interaction network construction (STRING and Cytoscape software), biological process analysis (STRING and Cytoscape plug-in Clue GO) and pathway analysis (Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis) was developed to decipher the active ingredients, potential targets, relevant pathways, and the therapeutic mechanisms of SFI for preventing and treating COVID-19 combined with HF. Results Finally, 20 active compounds (DL ≥ 0.18, 1≤Alog P ≤ 5, and −5≤LogS ≤ −1) and 164 relevant targets of SFI were identified related to the development of COVID-19 combined with HF, which were mainly involved in three biological processes including metabolic, hemostasis, and cytokine signaling in immune system. The C-T-D network and reactome pathway analysis indicated that SFI probably regulated the pathological processes of heart failure, respiratory failure, lung injury, and inflammatory response in patients with COVID-19 combined with HF through acting on several targets and pathways. Moreover, the venn diagram was used to identify 54 overlapped targets of SFI, COVID-19, and HF. KEGG pathway enrichment analysis showed that 54 overlapped targets were highly enriched to several COVID-19 and HF related pathways, such as IL-17 signaling pathway, Th17 cell differentiation, and NF-kappa B signaling pathway. Conclusions A comprehensive network analysis approach framework was developed to systematically elucidate the potential pharmacological mechanism of SFI for the prevention and treatment of SFI against COVID-19 combined with HF. The current study may not only provide in-depth understanding of the pharmacological mechanisms of SFI, but also a scientific basis for the application of SFI against COVID-19 combined with HF.
Collapse
|
8
|
Holland DJ, Blazak PL, Martin J, Broom J, Poulter RS, Stanton T. Myocarditis and Cardiac Complications Associated With COVID-19 and mRNA Vaccination: A Pragmatic Narrative Review to Guide Clinical Practice. Heart Lung Circ 2022; 31:924-933. [PMID: 35398005 PMCID: PMC8984702 DOI: 10.1016/j.hlc.2022.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
Abstract
Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus is likely to remain endemic globally despite widespread vaccination. There is increasing concern for myocardial involvement and ensuing cardiac complications due to COVID-19, however, the available evidence suggests these risks are low. Pandemic publishing has resulted in rapid manuscript availability though pre-print servers. Subsequent article retractions, a lack of standardised definitions, over-reliance on isolated troponin elevation and the heterogeneity of studied patient groups (i.e. severe vs. symptomatic vs all infections) resulted in early concern for high rates of myocarditis in patients with and recovering from COVID-19. The estimated incidence of myocarditis in COVID-19 infection is 11 cases per 100,000 infections compared with an estimated 2.7 cases per 100,000 persons following mRNA vaccination. For substantiated cases, the clinical course of myocarditis related to COVID-19 or mRNA vaccination appears mild and self-limiting, with reports of severe/fulminant myocarditis being rare. There is limited data available on the management of myocarditis in these settings. Clinical guidance for appropriate use of cardiac investigations and monitoring in COVID-19 is needed for effective risk stratification and efficient use of cardiac resources in Australia. An amalgamation of national and international position statements and guidelines is helpful for guiding clinical practice. This paper reviews the current available evidence and guidelines and provides a summary of the risks and potential use of cardiac investigations and monitoring for patients with COVID-19.
Collapse
Affiliation(s)
- David J Holland
- Cardiology Department, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia; School of Medicine, Griffith University, Sunshine Coast, Qld, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Penni L Blazak
- Cardiology Department, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Joshua Martin
- Cardiology Department, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Jennifer Broom
- School of Medicine, The University of Queensland, Brisbane, Qld, Australia; Infectious Diseases Service, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Rohan S Poulter
- Cardiology Department, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Tony Stanton
- Cardiology Department, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia; School of Medicine, Griffith University, Sunshine Coast, Qld, Australia; School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, Qld, Australia
| |
Collapse
|
9
|
Allwood BW, Koegelenberg CF, Ngah VD, Sigwadhi LN, Irusen EM, Lalla U, Yalew A, Tamuzi JL, McAllister M, Zemlin AE, Jalavu TP, Erasmus R, Chapanduka ZC, Matsha TE, Fwemba I, Zumla A, Nyasulu PS. Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa. IJID REGIONS 2022; 3:242-247. [PMID: 35720137 PMCID: PMC8971059 DOI: 10.1016/j.ijregi.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/07/2023]
Abstract
Background The second wave of coronavirus disease 2019 (COVID-19) in South Africa was caused by the Beta variant of severe acute respiratory syndrome coronavirurus-2. This study aimed to explore clinical and biochemical parameters that could predict outcome in patients with COVID-19. Methods A prospective study was conducted between 5 November 2020 and 30 April 2021 among patients with confirmed COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital. The Cox proportional hazards model in Stata 16 was used to assess risk factors associated with survival or death. Factors with P<0.05 were considered significant. Results Patients who died were found to have significantly lower median pH (P<0.001), higher median arterial partial pressure of carbon dioxide (P<0.001), higher D-dimer levels (P=0.001), higher troponin T levels (P=0.001), higher N-terminal-prohormone B-type natriuretic peptide levels (P=0.007) and higher C-reactive protein levels (P=0.010) compared with patients who survived. Increased standard bicarbonate (HCO3std) was associated with lower risk of death (hazard ratio 0.96, 95% confidence interval 0.93-0.99). Conclusions The mortality of patients with COVID-19 admitted to the ICU was associated with elevated D-dimer and a low HCO3std level. Large studies are warranted to increase the identification of patients at risk of poor prognosis, and to improve the clinical approach.
Collapse
Affiliation(s)
- Brian W. Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Coenraad F. Koegelenberg
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Veranyuy D. Ngah
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lovemore N. Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elvis M. Irusen
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Usha Lalla
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Anteneh Yalew
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Jacques L. Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marli McAllister
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise E. Zemlin
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Thumeka P. Jalavu
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Rajiv Erasmus
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Zivanai C. Chapanduka
- Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Tandi E. Matsha
- Faculty of Health and Wellness Sciences, Peninsula University of Technology, Bellville Campus, Cape Town
| | - Isaac Fwemba
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Alimuddin Zumla
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London Royal Free Campus, London, UK
- NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Peter S. Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - COVID-19 Research Response Collaboration
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
- Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa
- Faculty of Health and Wellness Sciences, Peninsula University of Technology, Bellville Campus, Cape Town
- School of Public Health, University of Zambia, Lusaka, Zambia
- Division of Infection and Immunity, Centre for Clinical Microbiology, University College London Royal Free Campus, London, UK
- NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
10
|
Fraser M, Agdamag ACC, Maharaj VR, Mutschler M, Charpentier V, Chowdhury M, Alexy T. COVID-19-Associated Myocarditis: An Evolving Concern in Cardiology and Beyond. BIOLOGY 2022; 11:biology11040520. [PMID: 35453718 PMCID: PMC9025425 DOI: 10.3390/biology11040520] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 01/08/2023]
Abstract
Simple Summary Coronavirus disease-2019 (COVID-19) affects many organs in the body, including the heart. One complication of particular concern is inflammation of the heart muscle, called myocarditis. This paper presents updated research data on COVID-19-associated myocarditis. Specifically, we review the incidence, potential mechanisms, blood and imaging tests that can be used to detect the disease. We emphasize that, in contrast with early reports, recent data suggest that myocarditis in the setting of COVID-19 is relatively uncommon, yet infected individuals are at a substantially increased risk for poor outcomes. It is important to continue research in this area. Abstract The direct and indirect adverse effects of SARS-CoV-2 infection on the cardiovascular system, including myocarditis, are of paramount importance. These not only affect the disease course but also determine clinical outcomes and recovery. In this review, the authors aimed at providing an update on the incidence of Coronavirus disease-2019 (COVID-19)-associated myocarditis. Our knowledge and experience relevant to this area continues to evolve rapidly since the beginning of the pandemic. It is crucial for the scientific and medical community to stay abreast of current information. Contrasting early reports, recent data suggest that the overall incidence of SARS-CoV-2-associated myocarditis is relatively low, yet infected individuals are at a substantially increased risk. Therefore, understanding the pathophysiology and diagnostic evaluation, including the use of serum biomarkers and imaging modalities, remain important. This review aims to summarize the most recent data in these areas as they relate to COVID-19-associated myocarditis. Given its increasing relevance, a brief update is included on the proposed mechanisms of myocarditis in COVID-19 vaccine recipients.
Collapse
Affiliation(s)
- Meg Fraser
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Arianne Clare C. Agdamag
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Valmiki R. Maharaj
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | - Melinda Mutschler
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
| | | | | | - Tamas Alexy
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA; (M.F.); (A.C.C.A.); (V.R.M.); (M.M.)
- Correspondence: ; Tel.: +1-612-625-9100
| |
Collapse
|
11
|
Kamińska D, Augustyniak-Bartosik H, Kościelska-Kasprzak K, Żabińska M, Bartoszek D, Poznański P, Kuriata-Kordek M, Kusztal M, Mazanowska O, Krajewska M. Comparing Humoral and Cellular Adaptive Immunity during Convalescent Phase of COVID-19 in Hemodialysis Patients and Kidney Transplant Recipients. J Clin Med 2021; 10:jcm10214833. [PMID: 34768356 PMCID: PMC8585082 DOI: 10.3390/jcm10214833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background. It is still unclear whether COVID-19 convalescent kidney transplant recipients (KTR) and hemodialysis (HD) patients can develop anti-SARS-CoV-2 adaptive immunity. The aim was to characterize and compare the immune response to the virus in HD patients and KTR. Methods. The study included 26 HD patients and 54 KTR—both convalescent (14 HD, 25 KTR) and unexposed. The immune response was assessed by determining the anti-SARS-CoV-2 antibodies in serum and specific T cell response via the interferon-gamma release assay (IGRA). Moreover, blood-morphology-derived parameters, immune cell phenotypes, and acute phase reactants were evaluated. Results. KRT and HD convalescents presented similar serum levels of anti-SARS-CoV-2 IgG and IgA. A negative correlation occurred between IgG and time after the infection was observed. There was a strong relationship between the prevalence of anti-SARS-CoV-2 cellular and humoral responses in both groups. Convalescent IGRA response was significantly higher in HD patients compared to KTR. Conclusions. HD patients and KTR develop humoral and cellular responses after COVID-19. The antibodies levels are similar in both groups of patients. SARS-CoV-2-reactive T cell response is stronger in HD patients compared to KTR. The SARS-CoV-2-specific IgG level decreases with time while IgA and a cellular response are maintained. IGRA proved to be a valuable test for the assessment of specific cellular immunity in immunocompromised HD patients and KTR.
Collapse
|
12
|
Lippi G, Sanchis-Gomar F, Henry BM, Lavie CJ. Cardiac Biomarkers in COVID-19: A Narrative Review. EJIFCC 2021; 32:337-346. [PMID: 34819823 PMCID: PMC8592630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The diagnosis and risk stratification of coronavirus disease 2019 (COVID-19) is primarily based on discretionary use of laboratory resources. Several lines of evidence now attest that cardiovascular disease not only is a frequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but its pre-existence may increase the risk of morbidity, disability, and death in patients with COVID-19. To this end, routine assessment of biomarkers of cardiac injury (i.e., cardiac troponin I or T) and dysfunction (e.g., natriuretic peptides) has emerged as an almost essential practice in patients with moderate, severe, and critical COVID-19 illness. Therefore, this narrative review aims to provide an overview of cardiac involvement in patients with SARS-CoV-2 infection as well as the clinical background for including cardiac biomarkers within specific panels of laboratory tests for managing COVID-19 patients.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy,Corresponding author: Prof. Giuseppe Lippi Section of Clinical Biochemistry University Hospital of Verona Piazzale L.A. Scuro, 10 37134 Verona Italy Phone: 0039-045-8122970 Fax: 0039-045-8124308
| | - Fabian Sanchis-Gomar
- University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain
| | - Brandon Michael Henry
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A.
| | - Carl J. Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, Louisiana, U.S.A.
| |
Collapse
|
13
|
Arévalos V, Ortega-Paz L, Rodríguez-Arias JJ, Calvo López M, Castrillo-Golvano L, Salazar-Rodríguez A, Sabaté-Tormos M, Spione F, Sabaté M, Brugaletta S. Acute and Chronic Effects of COVID-19 on the Cardiovascular System. J Cardiovasc Dev Dis 2021; 8:jcdd8100128. [PMID: 34677197 PMCID: PMC8541609 DOI: 10.3390/jcdd8100128] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/24/2021] [Accepted: 09/29/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has shown significant morbidity with the involvement of multiple systems, including the cardiovascular system. Cardiovascular manifestations in the acute phase can include myocardial injury itself, myocardial infarction, venous thromboembolic events, myocarditis, Takotsubo syndrome, and different arrhythmic events. Myocardial injury defined by the rise of cardiac biomarkers in blood has been found in multiple studies with a prevalence of about 20%. Its presence is related to worse clinical outcomes and in-hospital mortality. The mechanisms of myocardial injury have been the subject of intense research but still need to be clarified. The characterization of the cardiac affectation with echocardiography and cardiac magnetic resonance has found mixed results in different studies, with a striking incidence of imaging criteria for myocarditis. Regarding post-acute and chronic follow-up results, the persistence of symptoms and imaging changes in recovered COVID-19 patients has raised concerns about the duration and the possible significance of these findings. Even though the knowledge about this disease has increased incredibly in the last year, many aspects are still unclear and warrant further research.
Collapse
Affiliation(s)
- Victor Arévalos
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Luis Ortega-Paz
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Juan José Rodríguez-Arias
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Margarita Calvo López
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Leticia Castrillo-Golvano
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Anthony Salazar-Rodríguez
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Marta Sabaté-Tormos
- Department of Medicine, Medical School, Universitat de Barcelona, 08036 Barcelona, Spain;
| | - Francesco Spione
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
| | - Manel Sabaté
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| | - Salvatore Brugaletta
- Department of Cardiology, Clinic Cardiovascular Institute, Hospital Clinic, 08036 Barcelona, Spain; (V.A.); (L.O.-P.); (J.J.R.-A.); (M.C.L.); (L.C.-G.); (A.S.-R.); (F.S.); (M.S.)
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-227-9305
| |
Collapse
|