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Bes-Berlandier H, Coiffard B, Bermudez J, Demazes-Dufeu N, Coltey B, Boschi C, Colson P, Hraiech S, Reynaud-Gaubert M, Cassir N. Management of immunosuppression in lung transplant recipients and COVID-19 outcomes: an observational retrospective cohort-study. BMC Infect Dis 2024; 24:536. [PMID: 38807049 PMCID: PMC11134755 DOI: 10.1186/s12879-024-09269-1] [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: 01/28/2024] [Accepted: 03/28/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of immunosuppression management on coronavirus disease 2019 (COVID-19) outcomes. METHODS We performed a single-center retrospective study in a cohort of 358 lung transplant recipients (LTx) over the period from March 2020 to April 2022. All included symptomatic patients had at least one positive SARS-CoV-2 rt-PCR. We used a composite primary outcome for COVID-19 including increased need for oxygen since the hospital admission, ICU transfer, and in-hospital mortality. We assessed by univariate and multivariate analyses the risk factors for poor outcomes. RESULTS Overall, we included 91 LTx who contracted COVID-19. The COVID-19 in-hospital mortality rate reached 4.4%. By hierarchical clustering, we found a strong and independent association between the composite poor outcome and the discontinuation of at least one immunosuppressive molecule among tacrolimus, cyclosporine, mycophenolate mofetil, and everolimus. Obesity (OR = 16, 95%CI (1.96; 167), p = 0.01) and chronic renal failure (OR = 4.6, 95%CI (1.4; 18), p = 0.01) were also independently associated with the composite poor outcome. Conversely, full vaccination was protective (OR = 0.23, 95%CI (0.046; 0.89), p = 0.047). CONCLUSION The administration of immunosuppressive drugs such as tacrolimus, cyclocporine or everolimus can have a protective effect in LTx with COVID-19, probably related to their intrinsic antiviral capacity.
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Affiliation(s)
- Hugo Bes-Berlandier
- Department of Infectious Diseases, University Hospital Institute -Méditerranée Infection (IHU), Marseille, France
| | - Benjamin Coiffard
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Julien Bermudez
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Nadine Demazes-Dufeu
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Bérengère Coltey
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
| | - Céline Boschi
- Department of Infectious Diseases, University Hospital Institute -Méditerranée Infection (IHU), Marseille, France
- Microbes, Evolution, Phylogeny and Infection (MEΦI), Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Institut de Recherche Pour le Développement IRD, Assistance Publique, Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, Cedex 05 13385, France
| | - Philippe Colson
- Department of Infectious Diseases, University Hospital Institute -Méditerranée Infection (IHU), Marseille, France
- Microbes, Evolution, Phylogeny and Infection (MEΦI), Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Institut de Recherche Pour le Développement IRD, Assistance Publique, Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, Cedex 05 13385, France
| | - Sami Hraiech
- Service de Médecine Intensive - Réanimation, AP-HM, Hôpital Nord, Marseille, France
- Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, Marseille, 13005, France
| | - Martine Reynaud-Gaubert
- Department of Respiratory Medicine and Lung Transplantation, Aix Marseille Univ, APHM, Hôpital Nord, Marseille, France
- Microbes, Evolution, Phylogeny and Infection (MEΦI), Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Institut de Recherche Pour le Développement IRD, Assistance Publique, Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, Cedex 05 13385, France
| | - Nadim Cassir
- Department of Infectious Diseases, University Hospital Institute -Méditerranée Infection (IHU), Marseille, France.
- Microbes, Evolution, Phylogeny and Infection (MEΦI), Hôpitaux de Marseille (AP-HM), Aix-Marseille Université, Institut de Recherche Pour le Développement IRD, Assistance Publique, Institut Hospitalo-Universitaire (IHU), Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille, Cedex 05 13385, France.
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Singla A, Harun N, Dilling DF, Merchant K, McMahan S, Ingledue R, French A, Corral JA, Korbee L, Kopras EJ, Gupta N. Safety and efficacy of sirolimus in hospitalised patients with COVID-19 pneumonia. Respir Investig 2024; 62:216-222. [PMID: 38211546 DOI: 10.1016/j.resinv.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There is a critical need to develop novel therapies for COVID-19. METHODS We conducted a phase 2, multicentre, placebo-controlled, double-blind, randomised trial; hospitalised patients with hypoxemic respiratory failure due to COVID-19 and at least one poor prognostic biomarker, were given sirolimus (6 mg on Day 1 followed by 2 mg daily for 14 days or hospital discharge, whichever happens first) or placebo, in a 2:1 randomization scheme favouring sirolimus. Primary outcome was the proportion of patients alive and free from advanced respiratory support measures at Day 28. RESULTS Between April 2020 and April 2021, 32 patients underwent randomization and 28 received either sirolimus (n = 18) or placebo (n = 10). Mean age was 57 years and 75 % of the subjects were men. Twenty-two subjects had at least one co-existing condition (Diabetes, hypertension, obesity, CHF, or asthma/COPD) associated with worse prognosis. Mean FiO2 requirement was 0.35. There was no difference in the proportion of patients who were alive and free from advanced respiratory support measures in the sirolimus group (n = 15, 83 %) compared with the placebo group (n = 8, 80 %). Although patients in the sirolimus group demonstrated faster improvement in oxygenation and spent less time in the hospital, these differences were not statistically significant. There was no between-group difference in the rate of change in serum biomarkers such as LDH, ferritin, d-dimer or lymphocyte count. There was a decreased risk of thromboembolic complications in patients on sirolimus compared with placebo. CONCLUSIONS Larger studies are warranted to evaluate the role sirolimus in COVID-19 infection.
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Affiliation(s)
- Abhishek Singla
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0564, Cincinnati, OH, 45267, USA
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Centre, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Daniel F Dilling
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Centre, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Karim Merchant
- Division of Pulmonary and Critical Care Medicine, Keck Hospital of University of Southern California, IRD Building 7th Floor, 2020 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Susan McMahan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0564, Cincinnati, OH, 45267, USA
| | - Rebecca Ingledue
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0564, Cincinnati, OH, 45267, USA
| | - Alexandria French
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0564, Cincinnati, OH, 45267, USA
| | - Josefina A Corral
- Clinical Research Office, Loyola University Chicago, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Leslie Korbee
- Academic Regulatory & Monitoring Services LLC, 7806 Gapstow Bridge, Cincinnati, OH, 45231, USA
| | - Elizabeth J Kopras
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0564, Cincinnati, OH, 45267, USA
| | - Nishant Gupta
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0564, Cincinnati, OH, 45267, USA.
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Stoler S, van Hal SJ, Chadban S, Le T, Torzillo P, Scarlato RM, Wyburn K, Perkins GB, Marinelli T. Protracted COVID-19 pneumonitis early post-ABO incompatible kidney transplantation: Management considerations and the role of whole genome sequencing. Nephrology (Carlton) 2023; 28:639-643. [PMID: 37635271 DOI: 10.1111/nep.14235] [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: 07/17/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
We present the case of a recent ABO incompatible kidney transplant recipient with persistent SARS-CoV-2 infection and pneumonitis. Serial whole genome sequencing confirmed intra-host viral evolution, which was used as a surrogate to confirm active viral replication and support re-treatment with antivirals, late in the course of infection. A prolonged course of remdesivir combined with immunosuppression modulation resulted in successful clearance of virus and clinical improvement. The diagnostic process undertaken in this case provides a useful guide for other clinicians when approaching similar patients.
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Affiliation(s)
- Sara Stoler
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sebastiaan J van Hal
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Steve Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Le
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred, Sydney, New South Wales, Australia
| | - Paul Torzillo
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rose-Marie Scarlato
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate Wyburn
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Griffith B Perkins
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Immunology Directorate, SA Pathology, Adelaide, South Australia, Australia
| | - Tina Marinelli
- Department of Infectious Diseases and Microbiology, Royal Prince Alfred, Sydney, New South Wales, Australia
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Beltrami S, Rizzo S, Caccuri F, Rizzo R, Bortolotti D, Schiuma G. SARS-CoV-2 Systemic Effects: New Clues. Microorganisms 2023; 11:1209. [PMID: 37317183 DOI: 10.3390/microorganisms11051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/07/2023] [Indexed: 06/16/2023] Open
Abstract
To date, much discussion has been had on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lung infection associated with COVID-19 onset, of which the major manifestation is characterized by a "cytokine storm" [...].
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Affiliation(s)
- Silvia Beltrami
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Sabrina Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Francesca Caccuri
- Department of Microbiology and Virology, "Spedali Civili", 25126 Brescia, Italy
| | - Roberta Rizzo
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Daria Bortolotti
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanna Schiuma
- Department of Chemical, Pharmaceutical and Agricultural Science, University of Ferrara, 44121 Ferrara, Italy
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Pinchera B, Buonomo AR, Trucillo E, Susini S, D'Agostino A, Di Filippo I, Tanzillo A, Villari R, Carrano R, Troisi RI, Gentile I. COVID-19 in solid organ transplant recipients after 2 years of pandemic: Outcome and impact of antiviral treatments in a single-center study. FRONTIERS IN TRANSPLANTATION 2023; 2:1095225. [PMID: 38993895 PMCID: PMC11235278 DOI: 10.3389/frtra.2023.1095225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/31/2023] [Indexed: 07/13/2024]
Abstract
More than 2 years after the pandemic, the availability of vaccination and the use of monoclonal antibodies and direct antivirals have changed the fate of COVID-19, allowing for a better management of the disease, reducing hospitalization rates, and improving survival. This study aims to describe the outcome of COVID-19 in a cohort of solid organ transplant recipients and the impact of novel antivirals against SARS-CoV-2. We conducted an observational retrospective cohort study. We enrolled solid organ transplant recipients with COVID-19 attending the A.O.U. Federico II of Naples and followed up from January 2022 to July 2022. We enrolled 40 SOTs with COVID-19. Our experience highlights the favorable impact of therapies with antivirals and monoclonal antibodies in the early stages of COVID-19. Interesting data concern the impact of immunosuppressive therapy on COVID-19, in particular the role of Mycophenolate (associated with deterioration to severe COVID-19) and Everolimus (protective for progression to severe disease) needs to be investigated. Our experience also confirms the fundamental role of vaccination and in particular the importance of the booster dose.
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Affiliation(s)
- Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Emilia Trucillo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Stefano Susini
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Alessia D'Agostino
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Isabella Di Filippo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Anastasia Tanzillo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Riccardo Villari
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Rosa Carrano
- Section of Nephrology, Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Roberto Ivan Troisi
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive, Robotic and Transplant Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Pérez-Flores I, Juarez I, Aiffil Meneses AS, Lopez-Gomez A, Romero NC, Rodriguez-Cubillo B, Moreno de la Higuera MA, Peix-Jiménez B, Gonzalez-Garcia R, Baos-Muñoz E, Vilela AA, Gómez Del Moral M, Martínez-Naves E, Sanchez-Fructuoso AI. Role of mTOR inhibitor in the cellular and humoral immune response to a booster dose of SARS-CoV-2 mRNA-1273 vaccine in kidney transplant recipients. Front Immunol 2023; 14:1111569. [PMID: 36817489 PMCID: PMC9931894 DOI: 10.3389/fimmu.2023.1111569] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Background Immunocompromised patients have an increased risk of developing severe COVID disease, as well as a tendency to suboptimal responses to vaccines. The objective of this study was to evaluate the specific cellular and humoral adaptive immune responses of a cohort of kidney transplant recipients (KTR) after 3 doses of mRNA-1273 vaccine and to determinate the main factors involved. Methods Prospective observational study in 221 KTR (149 non infected), 55 healthy volunteers (HV) and 23 dialysis patients (DP). We evaluated anti-spike (by quantitative chemiluminescence immunoassay) and anti-nucleocapsid IgG (ELISA), percentage of TCD4+ and TCD8+ lymphocytes producing IFNγ against S-protein by intracellular flow cytometry after Spike-specific 15-mer peptide stimulation and serum neutralizing activity (competitive ELISA) at baseline and after vaccination. Results Among COVID-19 naïve KTR, 54.2% developed cellular and humoral response after the third dose (vs 100% in DP and 91.7% in HV), 18% only showed cell-mediated response, 22.2% exclusively antibody response and 5.6% none. A correlation of neutralizing activity with both the IgG titer (r=0.485, p<0.001) and the percentage of S-protein-specific IFNγ-producing CD8-T cells (r=0.198, p=0.049) was observed. Factors related to the humoral response in naïve KTR were: lymphocytes count pre-vaccination >1000/mm3 [4.68 (1.72-12.73, p=0.003], eGFR>30 mL/min [7.34(2.72-19.84), p<0.001], mTOR inhibitors [6.40 (1.37-29.86), p=0.018]. Infected KTR developed a stronger serologic response than naïve patients (96.8 vs 75.2%, p<0.001). Conclusions KTR presented poor cellular and humoral immune responses following vaccination with mRNA-1273. The immunosuppression degree and kidney function of these patients play an important role, but the only modifiable factor with a high impact on humoral immunogenicity after a booster dose was an immunosuppressive therapy including a mTOR inhibitor. Clinical trials are required to confirm these results.
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Affiliation(s)
- Isabel Pérez-Flores
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ignacio Juarez
- Immunology Department, Complutense University School of Medicine, Madrid, Spain,*Correspondence: Ignacio Juarez,
| | - Arianne S. Aiffil Meneses
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ana Lopez-Gomez
- Immunology Department, Complutense University School of Medicine, Madrid, Spain
| | - Natividad Calvo Romero
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | - Beatriz Rodriguez-Cubillo
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | - María Angeles Moreno de la Higuera
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | - Belen Peix-Jiménez
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | | | - Elvira Baos-Muñoz
- Microbiology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | - Ana Arribi Vilela
- Microbiology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
| | | | | | - Ana Isabel Sanchez-Fructuoso
- Nephrology Department, Institute San Carlos for Medical Research (Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), San Carlos Clinical University Hospital, Madrid, Spain
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Pinchera B, Schiano Moriello N, Buonomo AR, Di Filippo I, Tanzillo A, Buzzo G, Villari R, Gentile I. Diabetes and SARS-CoV-2 Infection: The Potential Role of Antidiabetic Therapy in the Evolution of COVID-19. Microorganisms 2023; 11:microorganisms11010145. [PMID: 36677437 PMCID: PMC9865860 DOI: 10.3390/microorganisms11010145] [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: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Diabetes mellitus represents one of the most frequent comorbidities among patients with COVID-19, constituting a risk factor for a more severe prognosis than that of non-diabetic patients. However, the pathophysiological mechanism underlying this unfavorable outcome is still not completely clear. The goal of our study was to evaluate the potential role of antidiabetic therapy in the evolution of COVID-19.
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