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Hamilton JL, Baccile R, Best TJ, Desai P, Landay A, Rojas JC, Wimmer MA, Balk RA. Association between Dexmedetomidine Use and Mortality in Patients with COVID-19 Receiving Invasive Mechanical Ventilation: A U.S. National COVID Cohort Collaborative (N3C) Study. J Clin Med 2024; 13:3429. [PMID: 38929961 PMCID: PMC11204330 DOI: 10.3390/jcm13123429] [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: 04/16/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
(1) Background/Objectives: Dexmedetomidine is a sedative for patients receiving invasive mechanical ventilation (IMV) that previous single-site studies have found to be associated with improved survival in patients with COVID-19. The reported clinical benefits include dampened inflammatory response, reduced respiratory depression, reduced agitation and delirium, improved preservation of responsiveness and arousability, and improved hypoxic pulmonary vasoconstriction and ventilation-perfusion ratio. Whether improved mortality is evident in large, multi-site COVID-19 data is understudied. (2) Methods: The association between dexmedetomidine use and mortality in patients with COVID-19 receiving IMV was assessed. This retrospective multi-center cohort study utilized patient data in the United States from health systems participating in the National COVID Cohort Collaborative (N3C) from 1 January 2020 to 3 November 2022. The primary outcome was 28-day mortality rate from the initiation of IMV. Propensity score matching adjusted for differences between the group with and without dexmedetomidine use. Adjusted hazard ratios (aHRs) for 28-day mortality were calculated using multivariable Cox proportional hazards models with dexmedetomidine use as a time-varying covariate. (3) Results: Among the 16,357,749 patients screened, 3806 patients across 17 health systems met the study criteria. Mortality was lower with dexmedetomidine use (aHR, 0.81; 95% CI, 0.73-0.90; p < 0.001). On subgroup analysis, mortality was lower with earlier dexmedetomidine use-initiated within the median of 3.5 days from the start of IMV-(aHR, 0.67; 95% CI, 0.60-0.76; p < 0.001) as well as use prior to standard, widespread use of dexamethasone for patients on respiratory support (prior to 30 July 2020) (aHR, 0.54; 95% CI, 0.42-0.69; p < 0.001). In a secondary model that was restricted to 576 patients across six health system sites with available PaO2/FiO2 data, mortality was not lower with dexmedetomidine use (aHR 0.95, 95% CI, 0.72-1.25; p = 0.73); however, on subgroup analysis, mortality was lower with dexmedetomidine use initiated earlier than the median dexmedetomidine start time after IMV (aHR, 0.72; 95% CI, 0.53-0.98; p = 0.04) and use prior to 30 July 2020 (aHR, 0.22; 95% CI, 0.06-0.78; p = 0.02). (4) Conclusions: Dexmedetomidine use was associated with reduced mortality in patients with COVID-19 receiving IMV, particularly when initiated earlier, rather than later, during the course of IMV as well as use prior to the standard, widespread usage of dexamethasone during respiratory support. These particular findings might suggest that the associated mortality benefit with dexmedetomidine use is tied to immunomodulation. However, further research including a large randomized controlled trial is warranted to evaluate the potential mortality benefit of DEX use in COVID-19 and evaluate the physiologic changes influenced by DEX that may enhance survival.
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Affiliation(s)
- John L. Hamilton
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; (P.D.); (A.L.); (J.C.R.); (M.A.W.)
| | - Rachel Baccile
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL 60637, USA; (R.B.); (T.J.B.)
| | - Thomas J. Best
- Center for Health and the Social Sciences, University of Chicago, Chicago, IL 60637, USA; (R.B.); (T.J.B.)
| | - Pankaja Desai
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; (P.D.); (A.L.); (J.C.R.); (M.A.W.)
| | - Alan Landay
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; (P.D.); (A.L.); (J.C.R.); (M.A.W.)
| | - Juan C. Rojas
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; (P.D.); (A.L.); (J.C.R.); (M.A.W.)
| | - Markus A. Wimmer
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; (P.D.); (A.L.); (J.C.R.); (M.A.W.)
| | - Robert A. Balk
- Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA; (P.D.); (A.L.); (J.C.R.); (M.A.W.)
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Schlosser T, Krasselt M, Elsing L, Hecker M, Holler B, Hoffmeister A. Symptoms and Severity of COVID-19 in Patients with Immune-Mediated Inflammatory Diseases: Experience of a University Medical Center. Autoimmune Dis 2024; 2024:6627035. [PMID: 38571561 PMCID: PMC10990649 DOI: 10.1155/2024/6627035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 04/05/2024] Open
Abstract
Background The pandemic situation of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) and its associated disease (coronavirus disease 2019 (COVID-19)) represents a challenging condition with a plethora of aspects. The course of COVID-19 in patients with immune-mediated inflammatory diseases (IMID) such as inflammatory bowel disease (IBD) and rheumatic diseases (RD) is not well known. Our study is one step toward closing this gap by collecting data on vaccination rates, infection-free survival, and individual symptom severity. Methods We conducted a prospective questionnaire-based study between April 2022 and October 2022 at our university hospital. Outward patients over the age of 18 years were screened for participation and reported about their infection/infection-free survival since the start of the pandemic. Results Finally, 156 patients were included in the study, 117 (75.0%) of which had inflammatory bowel disease and 39 (25.0%) patients with rheumatic disease. Altogether, 143 (91.7%) persons had received at least one vaccination against SARS-CoV-2. A total of 153 patients provided information regarding their COVID-19 history: 81 patients (52.0%) self-reported about their SARS-CoV-2 infection. In general, courses of infection were mild: only two patients (2.5% of patients with reported COVID-19) were hospitalized due to COVID-19 with one (1.2%) of the two needing intensive care. Asymptomatic COVID-19 had been described by 7 persons (8.6% of patients with reported COVID-19). Acute COVID-19 was accompanied by fatigue/tiredness in 58 persons (71.6% of patients with history of COVID-19) as the most frequent symptom. Other complaints were common cold (55 patients = 67.9%), cough (51 patients = 63.0%), headache (44 patients = 54.3%), and fever (35 patients = 43.2%). Stratified by vaccination status (unvaccinated vs. at least once vaccinated), the time to infection differed significantly (logrank test: p = 0.04, Chi2 4.1). At least once vaccinated people had a median COVID-19-free survival of 28.5 months (confidence interval (CI): 23.6 months-not reached). Without any vaccination, the estimated time to infection was 25.1 months (CI: 23.6 months-not reached). Conclusion Our IMID patients have a high rate of vaccination against SARS-CoV-2. Data show a significantly longer infection-free survival in vaccinated IMID patients as compared to unvaccinated patients. Discrimination between symptoms of COVID-19 and a concomitant inflammatory disease is difficult as complaints might be overlapping. This trial is registered with DRKS00028880.
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Affiliation(s)
- Tobias Schlosser
- Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Division of Gastroenterology, University Medical Center, Leipzig, Germany
| | - Marco Krasselt
- Department of Endocrinology, Nephrology and Rheumatology, Division of Rheumatology, University Medical Center, Leipzig, Germany
| | - Louis Elsing
- Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Division of Gastroenterology, University Medical Center, Leipzig, Germany
| | - Martin Hecker
- Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Division of Gastroenterology, University Medical Center, Leipzig, Germany
| | - Babett Holler
- Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Division of Gastroenterology, University Medical Center, Leipzig, Germany
| | - Albrecht Hoffmeister
- Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Division of Gastroenterology, University Medical Center, Leipzig, Germany
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Kapusta J, Babicki M, Pieniawska-Śmiech K, Kałuzińska-Kołat Ż, Kołat D, Jankowski P, Kasprzak JD, Wejner-Mik P, Bianek-Bodzak A, Chudzik M. Clinical and electrocardiographic correlates of myocardial dysfunction after COVID-19 in nonhospitalised patients in long-term follow-up. Data from the polish long-covid cardiovascular study. J Med Virol 2023; 95:e29331. [PMID: 38112151 DOI: 10.1002/jmv.29331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
Clinical evidence indicates that COVID-19 is a multiorgan disease that significantly impacts the cardiovascular system. However, little is known about the predictors of myocardial dysfunction after SARS-CoV-2 infection. Therefore, this research aimed to evaluate the clinical and electrocardiographic correlates of myocardial dysfunction after SARS-CoV-2 infection in nonhospitalised patients without previously diagnosed cardiovascular disease. This observational study included 448 patients selected from the database of 4142 patients in the Polish Long-Covid Cardiovascular study. All patients underwent a 12-lead electrocardiogram (ECG); 24-h Holter ECG monitoring, 24/7 ambulatory blood pressure monitoring, echocardiography, and cardiac magnetic resonance imaging. According to the results of diagnostic tests, patients were divided into two groups depending on the occurrence of myocardial dysfunction after COVID-19. Group 1-without myocardial dysfunction after COVID-19-consisted of 419 patients, with a mean age of 48.82 (SD ± 11.91), and Group 2 (29 patients)-with myocardial dysfunction after COVID-19, with a mean age of 51.45 (SD ± 12.92). When comparing the analysed groups, there were significantly more men in Group 2 (p = 0.006). QRS (corresponds to the time of ventricular contraction in an electrocardiographic examination) fragmentation (p = 0.031), arrhythmias (atrial fibrillation, supraventricular extrasystole, ventricular extrasystole) (p = 0.008), and male gender (p = 0.007) were independently associated with myocardial dysfunction after COVID-19. The study showed that myocardial damage after COVID-19 affects men more often and is independent of typical clinical factors and the severity of the disease course. The QRS fragmentation and arrhythmias observed in the ECG indicate the possibility of myocardial dysfunction in patients after COVID-19, which may be a valuable marker for physicians.
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Affiliation(s)
- Joanna Kapusta
- Department of Internal Diseases, Rehabilitation, and Physical Medicine, Medical University of Lodz, Lodz, Poland
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karolina Pieniawska-Śmiech
- Department of Immunology and Pediatrics, The J. Gromkowski Provincial Specialist Hospital, Wroclaw, Poland
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Damian Kołat
- Department of Biomedicine and Experimental Surgery, Medical University of Lodz, Lodz, Poland
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Jarosław D Kasprzak
- I Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Paulina Wejner-Mik
- I Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Michał Chudzik
- Department of Internal Medicine and Geriatric Cardiology, Medical Centre for Postgraduate Education, Warsaw, Poland
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Lodz, Poland
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