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Nasrullah A, Virk S, Javed A, Shah A, Ramanujam D, Sharma A, Gutierrez L, Nauer K, Maggio M, Yin Y, Bajwa Y, Cheema T, Disilvio B. Effects of pulmonary rehabilitation on functional and psychological parameters in post-acute sequelae of SARS-CoV-2 infection (PASC) patients. BMC Pulm Med 2024; 24:231. [PMID: 38745298 PMCID: PMC11092229 DOI: 10.1186/s12890-024-03047-0] [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: 12/08/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND COVID-19 survivors may develop long-term symptoms of fatigue, dyspnea, mental health issues, and functional limitations: a condition termed post-acute sequelae of COVID-19 (PASC). Pulmonary rehabilitation (PR) is a recommended treatment for PASC; however, there is a lack of data regarding PR's effect on multiple health indices and the factors that influence patient outcomes. The aim of our study is to evaluate the impact of pulmonary rehabilitation on functional and psychological parameters in patients diagnosed with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), thereby offering insights into the efficacy of such interventions in improving the quality of life and clinical outcomes for these individuals. METHODS We extracted patient demographic, comorbidity, and outcome data from Allegheny Health Network's electronic medical records. Functionality test results were compared before and after PR, including 6-minute walk test (6MWT), chair rise repetitions (CR reps), timed up and go test (TUG), gait speed (Rehab gait), modified medical research council scale (MMRC), shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS) and chronic obstructive pulmonary disease assessment test (CAT) scores. Multiple regression analysis was done to evaluate the effect of comorbidities and patient factors on patient responses to PR. RESULTS The 55 patients included in this study had a mean time of 4 months between the initial COVID-19 diagnosis and the subsequent PASC diagnosis. Following pulmonary rehabilitation (PR), significant improvements were observed across various metrics. The distance covered in the 6-minute walk test (6MWT) increased markedly from a pre-rehabilitation average of 895 feet (SD 290) to 1,300 feet (SD 335) post-rehabilitation, with a mean change of 405 feet (95% CI [333, 477]). Chair rise repetitions (CR reps) saw an increase from 9 (SD 3) reps to 13 (SD 3) reps, with a change of 4 reps (95% CI [3.7, 4.9]). The timed up and go test (TUG) time decreased significantly from 13 s (SD 5) to 10 s (SD 2), reflecting a mean reduction of 3 s (95% CI [-4.5, -2.5]). Rehabilitation gait speed improved from 1.0 m/s to 1.3 m/s, changing by 0.3 m/s (95% CI [0.2, 0.3]). The Modified Medical Research Council (MMRC) dyspnea scale showed a notable decrease from a mean of 2 (SD 1) to 1 (SD 1), a change of -1 (95% CI [-1.5, -1]). The Shortness of Breath Questionnaire (SOBQ) scores reduced significantly from 51 (SD 21) to 22 (SD 18), with a change of -29 (95% CI [-34, -23]). The Hospital Anxiety and Depression Scale (HADS) scores decreased from 11 (SD 7) to 8 (SD 7), a reduction of -4 (95% CI [-5, -2]). Lastly, the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) scores significantly dropped from 18 (SD 7) to 9 (SD 7), changing by -10 (95% CI [-11, -8]). However, the presence of hypertension, diabetes, chronic lung diseases, outpatient status, and receipt of specific pharmacologic treatments (decadron, decadron + remdesivir, and decadron + remdesivir + tocilizumab) were identified as factors associated with a poor response to PR. CONCLUSION Our study supports PR as an integrated model of care for PASC patients to improve several physical and mental health indices. The long-term effects of PR on patients' functional status should be investigated in the future.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Shiza Virk
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Anam Javed
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Aaisha Shah
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Deeksha Ramanujam
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Alisha Sharma
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laura Gutierrez
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kevin Nauer
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Yue Yin
- Allegheny-Singer Research Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Tariq Cheema
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | - Briana Disilvio
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
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Nicholas DB, Katz SL, Ciesielski J, Zulla RT. Psychosocial and Service Delivery Impacts of the COVID-19 Pandemic on Children With Respiratory Conditions, Their Parents and Their Health Care Providers. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241246338. [PMID: 38602062 PMCID: PMC11008339 DOI: 10.1177/00469580241246338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024]
Abstract
The COVID-19 pandemic imposed widespread impacts on the health and well-being of children with respiratory challenges and their families, as well as on the health care system that supports them. An exploratory qualitative study was undertaken to examine how the pandemic impacted families' and health care providers' daily lives and experiences of care. Four youth, 12 parents and 7 health care providers participated in interviews via telephone or online technology. Content analysis of transcribed interviews revealed participant experiences, including initial responses to the pandemic, adjustment to pandemic shifts, and anticipation of the future. While deleterious physical health impacts were minimal for children with pre-existing respiratory conditions, their mental health was negatively impacted by the pandemic and related health protocols. Families and health care providers experienced strain, yet demonstrated resilience. Pandemic-related shifts profoundly impacted daily life at home, school, and work. Pediatric pandemic planning in clinical care is recommended to better address the needs of children with respiratory conditions and their families as well as pediatric health care providers.
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Affiliation(s)
- David B. Nicholas
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada
| | - Sherri Lynne Katz
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jill Ciesielski
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada
| | - Rosslynn T. Zulla
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, AB, Canada
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Giacconi R, D'Aquila P, Cardelli M, Piacenza F, Pierpaoli E, Sena G, Di Rosa M, Bonfigli AR, Galeazzi R, Cherubini A, Fedecostante M, Sarzani R, Di Pentima C, Giordano P, Antonicelli R, Lattanzio F, Passarino G, Provinciali M, Bellizzi D. Blood circulating bacterial DNA in hospitalized old COVID-19 patients. Immun Ageing 2023; 20:76. [PMID: 38111002 PMCID: PMC10726536 DOI: 10.1186/s12979-023-00401-4] [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: 07/21/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Coronavirus disease COVID-19 is a heterogeneous condition caused by SARS-CoV-2 infection. Generally, it is characterized by interstitial pneumonia that can lead to impaired gas-exchange, acute respiratory failure, and death, although a complex disorder of multi-organ dysfunction has also been described. The pathogenesis is complex, and a variable combination of factors has been described in critically ill patients. COVID-19 is a particular risk for older persons, particularly those with frailty and comorbidities. Blood bacterial DNA has been reported in both physiological and pathological conditions and has been associated with some haematological and laboratory parameters but, to date, no study has characterized it in hospitalized old COVID-19 patients The present study aimed to establish an association between blood bacterial DNA (BB-DNA) and clinical severity in old COVID-19 patients. RESULTS BB-DNA levels were determined, by quantitative real-time PCRs targeting the 16S rRNA gene, in 149 hospitalized older patients (age range 65-99 years) with COVID-19. Clinical data, including symptoms and signs of infection, frailty status, and comorbidities, were assessed. BB-DNA was increased in deceased patients compared to discharged ones, and Cox regression analysis confirmed an association between BB-DNA and in-hospital mortality. Furthermore, BB-DNA was positively associated with the neutrophil count and negatively associated with plasma IFN-alpha. Additionally, BB-DNA was associated with diabetes. CONCLUSIONS The association of BB-DNA with mortality, immune-inflammatory parameters and diabetes in hospitalized COVID-19 patients suggests its potential role as a biomarker of unfavourable outcomes of the disease, thus it could be proposed as a novel prognostic marker in the assessment of acute COVID-19 disease.
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Affiliation(s)
- Robertina Giacconi
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | - Patrizia D'Aquila
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036, Rende, Italy
| | - Maurizio Cardelli
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | - Francesco Piacenza
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | - Elisa Pierpaoli
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | - Giada Sena
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036, Rende, Italy
| | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona, Italy
| | | | - Roberta Galeazzi
- Clinical Laboratory and Molecular Diagnostic, Italian National Research Center On Aging, IRCCS INRCA, Ancona, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Massimiliano Fedecostante
- Geriatria, Accettazione Geriatrica e Centro Di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy, Internal Medicine and Geriatrics, Italian National Research Centre On Aging, Hospital "U. Sestilli", IRCCS INRCA, Ancona, Italy
| | - Chiara Di Pentima
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy, Internal Medicine and Geriatrics, Italian National Research Centre On Aging, Hospital "U. Sestilli", IRCCS INRCA, Ancona, Italy
| | - Piero Giordano
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy, Internal Medicine and Geriatrics, Italian National Research Centre On Aging, Hospital "U. Sestilli", IRCCS INRCA, Ancona, Italy
| | | | | | - Giuseppe Passarino
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036, Rende, Italy
| | - Mauro Provinciali
- Advanced Technology Center for Aging Research, IRCCS INRCA, Ancona, Italy
| | - Dina Bellizzi
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036, Rende, Italy.
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Dokic D, Cibrev D, Danilovski D, Chamurovski N, Karajovanov ID, Karanfilovski V, Stefanovski G, Klenkoski S, Arnautovska B, Barbov I, Zeynel S, Stardelova KG, Rambabova-Bushljetik I, Nikolovska S, Netkovski J, Duma H. Comorbid Conditions in a Cohort of Inpatients with SARS-CoV-2 and their Association with In-Hospital Mortality During the Early Phases of the Pandemic. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:27-39. [PMID: 38109453 DOI: 10.2478/prilozi-2023-0044] [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] [Indexed: 12/20/2023]
Abstract
Introduction: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample. Materials and Methods: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed. Results: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample. Conclusion: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities.
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Affiliation(s)
- Dejan Dokic
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 2PHI University Clinic for Pulmonology and Allergology, Skopje, RN Macedonia
| | - Dragan Cibrev
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 3PHI University Clinic for Neurology, Skopje, RN Macedonia
| | - Dragan Danilovski
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 4Institute for Epidemiology, Biostatistics and Medical informatics, Skopje, RN Macedonia
| | - Nikola Chamurovski
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 5Institute for Tuberculosis and Respiratory Diseases, Skopje, RN Macedonia
| | - Ivana Dohcheva Karajovanov
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 6PHI University Clinic for Dermatology, Skopje, RN Macedonia
| | - Vlatko Karanfilovski
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 7PHI University Clinic for Nephrology, Skopje, RN Macedonia
| | - Goran Stefanovski
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 8PHI University Clinic for Gastroenterohepatology, Skopje, RN Macedonia
| | - Suzana Klenkoski
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 9PHI University Clinic for Eye Diseases, Skopje, RN Macedonia
| | - Bogdanka Arnautovska
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 10PHI University Clinic for ORL, Skopje, RN Macedonia
| | - Ivan Barbov
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 3PHI University Clinic for Neurology, Skopje, RN Macedonia
| | - Sead Zeynel
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 5Institute for Tuberculosis and Respiratory Diseases, Skopje, RN Macedonia
| | - Kalina Grivcheva Stardelova
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 8PHI University Clinic for Gastroenterohepatology, Skopje, RN Macedonia
| | - Irena Rambabova-Bushljetik
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 7PHI University Clinic for Nephrology, Skopje, RN Macedonia
| | - Suzana Nikolovska
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 6PHI University Clinic for Dermatology, Skopje, RN Macedonia
| | - Jane Netkovski
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 10PHI University Clinic for ORL, Skopje, RN Macedonia
| | - Hristijan Duma
- 1Medical Faculty, Saints Cyril and Methodius University in Skopje, Skopje, RN Macedonia
- 9PHI University Clinic for Eye Diseases, Skopje, RN Macedonia
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Candel FJ, Barreiro P, Salavert M, Cabello A, Fernández-Ruiz M, Pérez-Segura P, San Román J, Berenguer J, Córdoba R, Delgado R, España PP, Gómez-Centurión IA, González Del Castillo JM, Heili SB, Martínez-Peromingo FJ, Menéndez R, Moreno S, Pablos JL, Pasquau J, Piñana JL, On Behalf Of The Modus Investigators Adenda. Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2. Viruses 2023; 15:1449. [PMID: 37515137 PMCID: PMC10383267 DOI: 10.3390/v15071449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Pablo Barreiro
- Regional Public Health Laboratory, Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, 28055 Madrid, Spain
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases, Internal Medicine, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Alfonso Cabello
- Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28041 Madrid, Spain
| | - Pedro Pérez-Segura
- Medical Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Jesús San Román
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Juan Berenguer
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28007 Madrid, Spain
| | - Raúl Córdoba
- Haematology and Haemotherapy, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Rafael Delgado
- Clinical Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Pedro Pablo España
- Pneumology, Hospital Universitario de Galdakao-Usansolo, 48960 Vizcaya, Spain
| | | | | | - Sarah Béatrice Heili
- Intermediate Respiratory Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Francisco Javier Martínez-Peromingo
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Geriatrics, Hospital Universitario Rey Juan Carlos, 28933 Madrid, Spain
| | - Rosario Menéndez
- Pneumology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Santiago Moreno
- Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - José Luís Pablos
- Rheumatology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Juan Pasquau
- Infectious Diseases, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - José Luis Piñana
- Haematology and Haemotherapy, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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7
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Xu N, Zhong K, Yu H, Shu Z, Chang K, Zheng Q, Tian H, Zhou L, Wang W, Qu Y, Liu B, Zhou X, Chan KW, Li J. Add-on Chinese medicine for hospitalized chronic obstructive pulmonary disease (CHOP): A cohort study of hospital registry. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 109:154586. [PMID: 36610116 DOI: 10.1016/j.phymed.2022.154586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The effect of Chinese medicine (CM) on mortality during acute exacerbation of COPD is unclear. We evaluated the real-world effectiveness of add-on personalized CM in hospitalized COPD patients with acute exacerbation. METHODS This is a retrospective cohort study with new-user design. All electronic medical records of hospitalized adult COPD patients (n = 4781) between July 2011 and November 2019 were extracted. Personalized CM exposure was defined as receiving CM that were prescribed, and not in a fixed form and dose at baseline. A 1:1 matching control cohort was generated from the same source and matched by propensity score. Primary endpoint was mortality. Multivariable Cox regression models were used to estimate the hazard ratio (HR) adjusting the same set of covariates (most prevalent with significant inter-group difference) used in propensity score calculation. Secondary endpoints included the change in hematology and biochemistry, and the association between the use of difference CMs and treatment effect. The prescription pattern was also assessed and the putative targets of the CMs on COPD was analyzed with network pharmacology approach. RESULTS 4325 (90.5%) patients were included in the analysis. The mean total hospital stay was 16.7 ± 11.8 days. In the matched cohort, the absolute risk reduction by add-on personalized CM was 5.2% (3.9% vs 9.1%). The adjusted HR of mortality was 0.13 (95% CI: 0.03 to 0.60, p = 0.008). The result remained robust in the sensitivity analyses. The change in hematology and biochemistry were comparable between groups. Among the top 10 most used CMs, Poria (Fu-ling), Citri Reticulatae Pericarpium (Chen-pi) and Glycyrrhizae Radix Et Rhizoma (Gan-cao) were associated with significant hazard reduction in mortality. The putative targets of the CM used in this cohort on COPD were related to Jak-STAT, Toll-like receptor, and TNF signaling pathway which shares similar mechanism with a range of immunological disorders and infectious diseases. CONCLUSION Our results suggest that add-on personalized Chinese medicine was associated with significant mortality reduction in hospitalized COPD patients with acute exacerbation in real-world setting with minimal adverse effect on liver and renal function. Further randomized trials are warranted.
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Affiliation(s)
- Ning Xu
- The First Affiliated Hospital, Henan University of Chinese Medicine, Renmin Road, Zhengzhou, Henan, 450000, China; National Data Center of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Kunyu Zhong
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Haibin Yu
- The First Affiliated Hospital, Henan University of Chinese Medicine, Renmin Road, Zhengzhou, Henan, 450000, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Zixin Shu
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Kai Chang
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Qiguang Zheng
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Haoyu Tian
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China
| | - Ling Zhou
- The First Affiliated Hospital, Henan University of Chinese Medicine, Renmin Road, Zhengzhou, Henan, 450000, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Wei Wang
- The First Affiliated Hospital, Henan University of Chinese Medicine, Renmin Road, Zhengzhou, Henan, 450000, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Yunyan Qu
- The First Affiliated Hospital, Henan University of Chinese Medicine, Renmin Road, Zhengzhou, Henan, 450000, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Baoyan Liu
- National Data Center of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Xuezhong Zhou
- Institute of Medical Intelligence, School of Computer and Information Technology, Beijing Jiaotong University, Beijing, 100044, China.
| | - Kam Wa Chan
- Department of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Jiansheng Li
- The First Affiliated Hospital, Henan University of Chinese Medicine, Renmin Road, Zhengzhou, Henan, 450000, China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan province & Education Ministry of P.R. China, Henan University of Chinese Medicine, Jinshui East Road, Zhengzhou, Henan, 450046, China.
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8
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Toppen W, Yan P, Markovic D, Shover CM, Buhr RG, Fulcher JA, Tashkin DP, Barjaktarevic I. Chronic Obstructive Pulmonary Disease is Not Associated with In-Hospital Mortality in COVID-19: An Observational Cohort Analysis. Int J Chron Obstruct Pulmon Dis 2022; 17:3111-3121. [PMID: 36570857 PMCID: PMC9788836 DOI: 10.2147/copd.s386463] [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: 08/19/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with worsened outcomes in COVID-19 (coronavirus disease 2019). However, data remain fraught with heterogeneity and bias from comorbid conditions. Additionally, data on the impact of COPD-specific factors, such as pre-hospital medications and pulmonologist involvement, remain sparse. Objective We report a single-center analysis of COPD patients hospitalized with COVID-19 compared to those without COPD. Primary outcomes include ICU admission, mechanical ventilation, and in-hospital mortality. Methods We evaluated all patients ≥40 years admitted with PCR-confirmed COVID-19 between February 2020 and February 2021. COPD was defined by documented ICD-10 diagnosis of COPD, confirmed smoking history, and active bronchodilator use. We compared outcomes between COPD patients and the remainder of the COVID-19 cohort. Multivariable analyses were adjusted for age, sex, smoking status, and comorbid conditions. Results Of 1537 hospitalized COVID-19 patients, 122 (7.9%) carried a diagnosis of COPD. The COPD cohort was older (74 ± 13 vs 66 ± 15 years, P < 0.001) and more often former smokers (P < 0.001). Comorbid conditions including diabetes, cardiovascular disease, and kidney disease were more prevalent in the COPD group (P < 0.001). After adjusting for comorbid conditions, the COPD cohort had higher severity scores and trended towards fewer hospital-free days. Among patients with COPD, pre-hospital use of aspirin was associated with decreased ICU admissions (aHR 0.56, P = 0.049) and mechanical ventilation (aHR 0.25, P = 0.008), while LAMAs (long-acting muscarinic antagonists) were associated with decreased in-hospital mortality (aHR 0.34, P = 0.047). Involvement of pulmonology in pre-hospital management of COPD was not found to significantly affect outcomes. Conclusion When corrected for comorbid illnesses, COPD was associated with more severe disease but not with increased ICU admission, mechanical ventilation, or in-hospital mortality rates. Among COPD patients, prehospital treatment with aspirin and COPD-directed therapies were associated with improved outcomes.
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Affiliation(s)
- William Toppen
- Section of Hospital Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter Yan
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Daniela Markovic
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carolyn M Shover
- Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA,Offsite Care, Santa Rosa, CA, USA
| | - Russell G Buhr
- Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA,Department of Medicine, Greater Los Angeles Veterans Affairs Health Care System, Los Angeles, CA, USA
| | - Jennifer A Fulcher
- Department of Medicine, Greater Los Angeles Veterans Affairs Health Care System, Los Angeles, CA, USA,Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Donald P Tashkin
- Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Igor Barjaktarevic
- Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA,Correspondence: Igor Barjaktarevic, 10833 Le Conte Avenue, 43118 CHS, Los Angeles, CA, 90095, Email
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9
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Fedeli U, Barbiellini Amidei C, Marcon A, Casotto V, Grippo F, Grande E, Gaisl T, Barco S. Mortality Related to Chronic Obstructive Pulmonary Disease during the COVID-19 Pandemic: An Analysis of Multiple Causes of Death through Different Epidemic Waves in Veneto, Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912844. [PMID: 36232144 PMCID: PMC9565127 DOI: 10.3390/ijerph191912844] [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: 09/01/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/12/2023]
Abstract
Mortality related to chronic obstructive pulmonary disease (COPD) during the COVID-19 pandemic is possibly underestimated by sparse available data. The study aimed to assess the impact of the pandemic on COPD-related mortality by means of time series analyses of causes of death data. We analyzed the death certificates of residents in Veneto (Italy) aged ≥40 years from 2008 to 2020. The age-standardized rates were computed for COPD as the underlying cause of death (UCOD) and as any mention in death certificates (multiple cause of death-MCOD). The annual percent change (APC) in the rates was estimated for the pre-pandemic period. Excess COPD-related mortality in 2020 was estimated by means of Seasonal Autoregressive Integrated Moving Average models. Overall, COPD was mentioned in 7.2% (43,780) of all deaths. From 2008 to 2019, the APC for COPD-related mortality was -4.9% (95% CI -5.5%, -4.2%) in men and -3.1% in women (95% CI -3.8%, -2.5%). In 2020 compared to the 2018-2019 average, the number of deaths from COPD (UCOD) declined by 8%, while COPD-related deaths (MCOD) increased by 14% (95% CI 10-18%), with peaks corresponding to the COVID-19 epidemic waves. Time series analyses confirmed that in 2020, COPD-related mortality increased by 16%. Patients with COPD experienced significant excess mortality during the first year of the pandemic. The decline in COPD mortality as the UCOD is explained by COVID-19 acting as a competing cause, highlighting how an MCOD approach is needed.
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Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | | | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Veronica Casotto
- Epidemiological Department, Azienda Zero, Veneto Region, 35131 Padova, Italy
| | - Francesco Grippo
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Roma, Italy
| | - Enrico Grande
- Integrated System for Health, Social Assistance and Welfare, Italian National Institute of Statistics, 00184 Roma, Italy
| | - Thomas Gaisl
- Department of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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10
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Alsaad S, Addweesh A, Beyari M, Alkhateb M, Alswat A, Alshabnan A, Alsaad A, AlSaif H. Comorbidities associated with risk of ICU admission in elderly patients with COVID-19: Data from academic hospital in Saudi Arabia. Medicine (Baltimore) 2022; 101:e30799. [PMID: 36181092 PMCID: PMC9524535 DOI: 10.1097/md.0000000000030799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, of which 5% required intensive care, especially mechanical ventilation. The prognosis depends on several factors including comorbidities. This study was conducted to identify the comorbidities associated with the intensive care unit (ICU) admission in elderly with COVID-19 admitted to a tertiary academic hospital. A retrospective cross-sectional study was conducted at KSUMC including all hospitalized patients (age ≥ 65 years) with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection admitted between March 2020 and August 2021. Data collection included sociodemographic characteristics, underlying comorbidities, and the Charlson comorbidity index. Comorbidities were compared between the elderly patients with COVID-19 admitted to the ICU and those not admitted to the ICU. The odds ratios were calculated and a P value of < .05 and 95% confidence intervals were used to report the statistical significance A total of 444 patients (ICU = 147, non-ICU = 297) were included in the study. The study revealed that elderly patients with COVID-19 admitted to ICU had a higher rate of mortality (n = 64, 67.4%; P < .0001) and a higher proportion of them had shortness of breath (n = 97, 38.3%; P = .007) compared to the elderly patients not admitted to ICU. The mean length of stay (P < .0001), and weight (P = .02) among ICU patients were higher than the values for the non-ICU group, while the mean oxygen saturation (SpO2; P = .006) was lower among the ICU group. The comorbidities that demonstrated a statistically significant association with ICU admission were heart failure (P = .004, odd ratio (OR) = 2.02, 95% confidence intervals (CI) [1.263, 3540]), chronic obstructive pulmonary disease (COPD; P = .027, OR = 3.361, 95% CI [1.080, 10.464]), and chronic kidney disease (P = .021, OR = 1.807, 95% CI [1.087, 3.006]). The current study identified that the comorbidities such as COPD, heart failure, and factors like SpO2 and length of stay are associated with an increased risk of ICU admission in elderly patients with COVID-19. These findings highlight the clinical implications of comorbidity among geriatric population.
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Affiliation(s)
- Saad Alsaad
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Saad Alsaad, Department of Family and Community Medicine, College of Medicine, King Saud University, 11461 Riyadh, Saudi Arabia (e-mail: )
| | | | - Mohammed Beyari
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Munib Alkhateb
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Abdulrahman Alshabnan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulaziz Alsaad
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Haytham AlSaif
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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11
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Halpin DMG, Rabe AP, Loke WJ, Grieve S, Daniele P, Hwang S, Forsythe A. Epidemiology, Healthcare Resource Utilization, and Mortality of Asthma and COPD in COVID-19: A Systematic Literature Review and Meta-Analyses. J Asthma Allergy 2022; 15:811-825. [PMID: 35747745 PMCID: PMC9211747 DOI: 10.2147/jaa.s360985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/01/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose There has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden of illness of asthma and COPD, and the use of baseline medicines among COVID-19 populations. Patients and Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE® and Cochrane were searched (January 2019–August 2021). The prevalence of asthma or COPD among COVID-19 populations was compared to the country-specific populations. Odds ratios (ORs) were estimated to compare healthcare resource utilization (HCRU) rates, and meta-analyses of outcomes were estimated from age-adjusted ORs (aORs) or hazard ratios (aHRs). Meta-analyses of COVID-19 outcomes were conducted using random effects models for binary outcomes. Results Given the number and heterogeneity of studies, only 183 high-quality studies were analyzed, which reported hospitalization, intensive care unit (ICU) admissions, ventilation/intubation, or mortality. Asthma patients were not at increased risk for COVID-19–related hospitalization (OR = 1.05, 95% CI: 0.92 to 1.20), ICU admission (OR = 1.21, 95% CI: 0.99 to 1.1.48), ventilation/intubation (OR = 1.24, 95% CI: 0.95 to 1.62), or mortality (OR = 0.85, 95% CI: 0.75 to 0.96). Accounting for confounding variables, COPD patients were at higher risk of hospitalization (aOR = 1.45, 95% CI: 1.30 to 1.61), ICU admission (aOR = 1.28, 95% CI: 1.08 to 1.51), and mortality (aOR = 1.41, 95% CI: 1.37 to 1.65). Sixty-five studies reported outcomes associated with ICS or biologic use. There was limited evidence that ICS or biologics significantly impacted the risk of SARS-CoV-2 infection, HCRU, or mortality in asthma or COPD patients. Conclusion In high-quality studies included, patients with asthma were not at significantly higher odds for adverse COVID-19–related outcomes, while patients with COPD were at higher odds. There was no clear evidence that baseline medication affected outcomes. Registration PROSPERO (CRD42021233963).
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Affiliation(s)
- David M G Halpin
- Respiratory Medicine, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK
| | - Adrian Paul Rabe
- Primary Care and Public Health, Imperial College London, London, UK.,Global Medical Affairs, AstraZeneca, Cambridge, UK
| | - Wei Jie Loke
- Lister Hospital, Stevenage, East and North Hertfordshire NHS Trust, Stevenage, UK.,Ways Group, London, UK
| | - Stacy Grieve
- North America Real World Advanced Analytics, Cytel, Inc., Waltham, MA, USA
| | - Patrick Daniele
- North America Real World Advanced Analytics, Cytel, Inc., Waltham, MA, USA
| | - Sanghee Hwang
- North America Real World Advanced Analytics, Cytel, Inc., Waltham, MA, USA
| | - Anna Forsythe
- North America Real World Advanced Analytics, Cytel, Inc., Waltham, MA, USA.,Value and Access, Cytel, Inc., Waltham, MA, USA
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12
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Aggarwal AN, Prasad KT, Muthu V. Obstructive lung diseases burden and COVID-19 in developing countries: a perspective. Curr Opin Pulm Med 2022; 28:84-92. [PMID: 34652297 PMCID: PMC8815642 DOI: 10.1097/mcp.0000000000000836] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Asthma and chronic obstructive pulmonary disease (COPD) are widely prevalent disorders, and important contributors to morbidity and mortality, in both developing and developed countries. It is conjectured that these obstructive lung diseases may have had more deleterious effects in developing nations during the 2019 coronavirus disease (COVID-19) pandemic. We provide an evidence-based perspective on the relationship between asthma/COPD prevalence and COVID-19 burden, and the impact of comorbid asthma/COPD on selected COVID-19 outcomes and healthcare utilization, with special reference to developing countries. RECENT FINDINGS Developing countries with higher COPD (but not asthma) prevalence appear to have higher COVID-19 related mortality. Patients with asthma (but not COPD) in developing countries may be less likely to acquire COVID-19. Published literature suggests that the overall impact of comorbid asthma or COPD on adverse COVID-19 outcomes may be broadly similar between developed and developing nations. SUMMARY There is paucity of information on interaction between asthma/COPD and COVID-19 in developing countries. Limited data suggest minor differences between developed and developing nations. In view of inadequacies in healthcare preparedness and delivery in several developing countries, there is a need to generate quality evidence to assess impact of obstructive lung diseases and COVID-19 on each other.
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Affiliation(s)
- Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Hasenpusch C, Matterne U, Tischer C, Hrudey I, Apfelbacher C. Development and Content Validation of a Comprehensive Health Literacy Survey Instrument for Use in Individuals with Asthma during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041923. [PMID: 35206109 PMCID: PMC8871813 DOI: 10.3390/ijerph19041923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.
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Affiliation(s)
- Claudia Hasenpusch
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto Von Guericke University, 39120 Magdeburg, Germany; (U.M.); (I.H.); (C.A.)
- Correspondence:
| | - Uwe Matterne
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto Von Guericke University, 39120 Magdeburg, Germany; (U.M.); (I.H.); (C.A.)
| | - Christina Tischer
- Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, 97080 Wuerzburg, Germany;
- State Institute of Health, Bavarian Health and Food Safety Authority, 91058 Erlangen, Germany
| | - Ilona Hrudey
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto Von Guericke University, 39120 Magdeburg, Germany; (U.M.); (I.H.); (C.A.)
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto Von Guericke University, 39120 Magdeburg, Germany; (U.M.); (I.H.); (C.A.)
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14
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Nazir A, Ampadu HK. Interpretable deep learning for the prediction of ICU admission likelihood and mortality of COVID-19 patients. PeerJ Comput Sci 2022; 8:e889. [PMID: 35494832 PMCID: PMC9044277 DOI: 10.7717/peerj-cs.889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/24/2022] [Indexed: 05/09/2023]
Abstract
The global healthcare system is being overburdened by an increasing number of COVID-19 patients. Physicians are having difficulty allocating resources and focusing their attention on high-risk patients, partly due to the difficulty in identifying high-risk patients early. COVID-19 hospitalizations require specialized treatment capabilities and can cause a burden on healthcare resources. Estimating future hospitalization of COVID-19 patients is, therefore, crucial to saving lives. In this paper, an interpretable deep learning model is developed to predict intensive care unit (ICU) admission and mortality of COVID-19 patients. The study comprised of patients from the Stony Brook University Hospital, with patient information such as demographics, comorbidities, symptoms, vital signs, and laboratory tests recorded. The top three predictors of ICU admission were ferritin, diarrhoea, and alamine aminotransferase, and the top predictors for mortality were COPD, ferritin, and myalgia. The proposed model predicted ICU admission with an AUC score of 88.3% and predicted mortality with an AUC score of 96.3%. The proposed model was evaluated against existing model in the literature which achieved an AUC of 72.8% in predicting ICU admission and achieved an AUC of 84.4% in predicting mortality. It can clearly be seen that the model proposed in this paper shows superiority over existing models. The proposed model has the potential to provide tools to frontline doctors to help classify patients in time-bound and resource-limited scenarios.
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Affiliation(s)
- Amril Nazir
- Department of Information Systems and Technology Management, College of Technological Innovation Zayed University, Abu Dhabi, United Arab Emirates
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15
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COVID-19 in complex common variable immunodeficiency patients affected by lung diseases. Curr Opin Allergy Clin Immunol 2021; 21:535-544. [PMID: 34580250 DOI: 10.1097/aci.0000000000000789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In the general population, the risk of severe COVID-19 is associated with old age, male sex, hypertension, obesity and chronic diseases. Chronic lung diseases are listed as additional risk factors for hospitalization and ICU admission. The purpose of this review is to define whether chronic lung diseases, such as bronchiectasis and interstitial diseases, represent a risk for a severe SARS-CoV-2 infection in patients affected by common variable immunodeficiency (CVID), the most common symptomatic primary antibody defect. RECENT FINDINGS CVID patients with SARS-CoV-2 infection have been reported since the beginning of the pandemic with a wide range of clinical presentations ranging from asymptomatic to mild/moderate and severe COVID-19. The meta-analysis of 88 CVID cases described in large cohorts and case reports demonstrated that CVID patients with chronic lung involvement have an increased risk for severe COVID-19 in comparison to CVID without lung diseases (50 vs. 28%, relative risk 1.75, 95% confidence interval 1.04--2.92, P = 0.043). Differently from the general population, age and metabolic comorbidities did not represent a risk factor for severe course in this patient's population. SUMMARY Underlying chronic lung diseases but not age represent a risk factor for severe COVID-19 in CVID. Prompt therapeutic intervention should be adopted in SARS-CoV-2 positive CVID patients with chronic lung diseases independently of their age.
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16
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Jung Y, Wee JH, Kim JH, Choi HG. The Effects of Previous Asthma and COPD on the Susceptibility to and Severity of COVID-19: A Nationwide Cohort Study in South Korea. J Clin Med 2021; 10:jcm10204626. [PMID: 34682749 PMCID: PMC8541474 DOI: 10.3390/jcm10204626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background: There is controversial evidence of the associations of asthma and chronic obstructive pulmonary disease (COPD) with the risk and outcomes of Coronavirus Disease 2019 (COVID-19). We aimed to evaluate the effects of asthma and COPD on the susceptibility to and severity of COVID-19. Methods: Data from a nationwide COVID-19 cohort database by the Korea National Health Insurance Corporation were utilized. A total of 4066 COVID-19 patients (1 January 2020 through 4 June 2020) were 1:4 matched with 16,264 controls with regard to age, sex, and income. Asthma and COPD were defined as diagnostic codes (ICD-10) and medication claim codes. Conditional and unconditional multivariate logistic regression were applied to analyze the susceptibility to and severity of COVID-19 associated with asthma and COPD. Results: The prevalence of mild and severe asthma/COPD did not differ between the COVID-19 and control patients in the multivariate analyses. Among the total 4066 COVID-19 patients, 343 (8.4%) had severe COVID-19, of whom 132 (3.2% of the total COVID-19 patients) died. Regarding the outcomes of COVID-19, neither mild nor severe asthma were associated with the severity or mortality of COVID-19 after adjusting for other variables. However, severe COPD was a significant risk factor for severe COVID-19 (odds ratio (OR) = 2.23, 95% confidence intervals (CI): 1.08–4.60, p = 0.030) and the mortality of COVID-19 in the multivariate analyses (OR = 3.06, 95% CI: 1.14–8.2, p = 0.026). Conclusions: In a Korean nationwide cohort, neither asthma nor COPD were associated with COVID-19, but severe COPD was associated with the severity and mortality of COVID-19.
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Affiliation(s)
- Younghee Jung
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Korea;
| | - Jee Hye Wee
- Department of Otorhinolaryngology, College of Medicine, Hallym University, Anyang 14068, Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy and Critical Care Medicine Department of Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang 14068, Korea;
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Hallym University, Anyang 14068, Korea
- Hallym Data Science Laboratory, College of Medicine, Hallym University, Anyang 14068, Korea
- Correspondence:
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17
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Steuder R, Pott H, Maxheim M, Schmeck B. Pneumonie und COVID-19 bei COPD-Patienten. PNEUMO NEWS 2021; 13:30-35. [PMID: 34691274 PMCID: PMC8526095 DOI: 10.1007/s15033-021-2749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Regina Steuder
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
| | - Hendrik Pott
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
| | - Michael Maxheim
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
| | - Bernd Schmeck
- Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Universitätsklinikum Marburg, Hans-Meerwein-Str. 2, 35043 Marburg, Germany
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