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Sai Priya T, Ramalingam V, Suresh Babu K. Natural products: A potential immunomodulators against inflammatory-related diseases. Inflammopharmacology 2024:10.1007/s10787-024-01562-4. [PMID: 39196458 DOI: 10.1007/s10787-024-01562-4] [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: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
The incidence and prevalence of inflammatory-related diseases (IRDs) are increasing worldwide. Current approved treatments for IRDs in the clinic are combat against inhibiting the pro-inflammatory cytokines. Though significant development in the treatment in the IRDs has been achieved, the severe side effects and inefficiency of currently practicing treatments are endless challenge. Drug discovery from natural sources is efficacious over a resurgence and also natural products are leading than the synthetic molecules in both clinical trials and market. The use of natural products against IRDs is a conventional therapeutic approach since it is a reservoir of unique structural chemistry, accessibility and bioactivities with reduced side effects and low toxicity. In this review, we discuss the cause of IRDs, treatment of options for IRDs and the impact and adverse effects of currently practicing clinical drugs. As well, the significant role of natural products against various IRDs, the limitations in the clinical development of natural products and thus pave the way for development of natural products as immunomodulators against IRDs are also discussed.
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Affiliation(s)
- Telukuntla Sai Priya
- Department of Natural Products & Medicinal Chemistry, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vaikundamoorthy Ramalingam
- Department of Natural Products & Medicinal Chemistry, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Katragadda Suresh Babu
- Department of Natural Products & Medicinal Chemistry, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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Gao Y, Zhao K, Liu J, Zhang X, Gong L, Zhou X, Chen G. Prediction of Clinical Severity of COVID-19 Using a Combination of Heparin-Binding Protein, Interleukin-6, and C-Reactive Protein: A Retrospective Study. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e70003. [PMID: 39187469 PMCID: PMC11347126 DOI: 10.1111/crj.70003] [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: 02/23/2024] [Revised: 06/16/2024] [Accepted: 08/05/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Systemic inflammation stands as a pivotal factor tightly interwoven with the progression of COVID-19. This study endeavors to elucidate the significance of three key inflammatory molecules, that is, heparin-binding protein (HBP), interleukin-6 (IL-6), and C-reactive protein (CRP), in assessing the severity and prognostic implications of COVID-19. METHODS The demographic, clinical, and laboratory data were retrospectively collected from a cohort of 214 adult patients diagnosed with COVID-19. Patients were divided into two groups: nonsevere (n = 93; 43.5%) and severe (n = 121; 56.5%). Additionally, based on their organ function, patients were categorized into nonorgan failure (n = 137) and organ failure (n = 77) groups. The levels of inflammation-related cytokines were then compared among these defined groups. RESULTS The severe group was characterized by a higher proportion of males, older age, and longer hospital stays compared to nonsevere cases. Additionally, severe cases exhibited a higher prevalence of underlying diseases and organ failure. Statistical analysis revealed significantly elevated levels of HBP, IL-6, and CRP in the severe group. HBP, IL-6, and CRP were identified as independent risk factors for severe COVID-19. Furthermore, a combined assessment of these biomarkers demonstrated superior diagnostic sensitivity (85.10%) and specificity (95.70%) for predicting COVID-19 severity. A positive relationship between elevated HBP, IL-6, and CRP levels and impaired organ function was also observed. The predictive efficiency significantly increased (hazard ratio = 3.631, log-rank p = 0.003) when two or more of them were combinedly used. Notably, elevated levels of HBP, IL-6, and CRP were associated with an increased risk of mortality. CONCLUSIONS In conclusion, the combined assessment of HBP, IL-6, and CRP offers enhanced accuracy and specificity in predicting the severity, organ failure, and mortality risk associated with COVID-19.
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Affiliation(s)
- Yidan Gao
- Department of HepatologyThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouZhejiangChina
| | - Ke Zhao
- Department of Immunology and Pathogen Biology, School of Basic Medical SciencesHangzhou Normal UniversityHangzhouZhejiangChina
| | - Jing Liu
- Department of HepatologyThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouZhejiangChina
| | - Xiangbo Zhang
- Department of HepatologyThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouZhejiangChina
| | - Ling Gong
- Department of HepatologyThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouZhejiangChina
| | - Xiang Zhou
- Department of HepatologyThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouZhejiangChina
| | - Gongying Chen
- Department of HepatologyThe Affiliated Hospital of Hangzhou Normal UniversityHangzhouZhejiangChina
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Patange AP, Desai JV, Pujari B, Marwah A, Dey A. Dynamic Assessment of Hematological Parameters as Predictive Biomarkers for Disease Severity and Prognosis in COVID-19 Patients: A Longitudinal Study. Cureus 2024; 16:e63593. [PMID: 39087175 PMCID: PMC11290381 DOI: 10.7759/cureus.63593] [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: 06/02/2024] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to substantial morbidity and mortality worldwide. Hematological abnormalities are common in COVID-19 patients and play a significant role in disease pathogenesis and prognosis. OBJECTIVE This study aimed to longitudinally monitor hematological parameters in COVID-19 patients and investigate their predictive value for disease severity and prognosis. METHODS A prospective longitudinal design was employed to enroll 121 adult patients diagnosed with COVID-19 based on positive SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR) test results. Baseline demographic and clinical data were collected, and hematological parameters, including complete blood count (CBC) indices, inflammatory markers, and coagulation profiles, were measured at predefined time points during hospitalization or outpatient visits. Follow-up assessments were conducted longitudinally to monitor the disease progression and clinical outcomes. RESULTS This study revealed dynamic changes in hematological parameters over the course of COVID-19. Hemoglobin levels showed a decrease from baseline (mean ± SD: 12.5 ± 1.8 g/dL) to the peak of illness (10.2 ± 2.0 g/dL), indicating the development of anemia during the acute phase of infection. White blood cell counts demonstrated an initial increase (8.9 ± 3.2 × 10^9/L) followed by a decline (5.4 ± 1.9 × 10^9/L) as the disease progressed, suggesting an early inflammatory response followed by immune suppression. The platelet counts fluctuated, with a decrease observed during the acute phase (190 ± 50 × 10^9/L) and subsequent recovery during convalescence (240 ± 60 × 10^9/L). Inflammatory markers, such as C-reactive protein and interleukin-6, were elevated, peaking at 120 and 150 pg/mL, respectively, indicating systemic inflammation. Coagulation profiles showed abnormalities suggestive of COVID-19-associated coagulopathy, including elevated D-dimer levels (mean ± SD: 3.5 ± 1.2 µg/mL) and prolonged prothrombin time (15.8 ± 2.5 seconds). Longitudinal analysis of hematological parameters revealed associations between disease severity and clinical outcomes, with certain abnormalities correlating with an increased risk of complications and a poor prognosis. CONCLUSION This study highlights the importance of monitoring hematological parameters in COVID-19 patients for risk stratification, prognostication, and guiding therapeutic interventions.
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Affiliation(s)
- Aparna P Patange
- Department of Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Jabbar V Desai
- Department of Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Bhupal Pujari
- Department of Medicine, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Aparna Marwah
- Department of Management Studies, Bharati Vidyapeeth (Deemed to be University) Institute of Management and Research, New Delhi, IND
| | - Animesh Dey
- Department of Allied Health Sciences, Brainware University, Kolkota, IND
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Biasetti L, Zervogiannis N, Shaw K, Trewhitt H, Serpell L, Bailey D, Wright E, Hall CN. Risk factors for severe COVID-19 disease increase SARS-CoV-2 infectivity of endothelial cells and pericytes. Open Biol 2024; 14:230349. [PMID: 38862017 DOI: 10.1098/rsob.230349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/15/2024] [Indexed: 06/13/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) was initially considered a primarily respiratory disease but is now known to affect other organs including the heart and brain. A major route by which COVID-19 impacts different organs is via the vascular system. We studied the impact of apolipoprotein E (APOE) genotype and inflammation on vascular infectivity by pseudo-typed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses in mouse and human cultured endothelial cells and pericytes. Possessing the APOE4 allele or having existing systemic inflammation is known to enhance the severity of COVID-19. Using targeted replacement human APOE3 and APOE4 mice and inflammation induced by bacterial lipopolysaccharide (LPS), we investigated infection by SARS-CoV-2. Here, we show that infectivity was higher in murine cerebrovascular pericytes compared to endothelial cells and higher in cultures expressing APOE4. Furthermore, increasing the inflammatory state of the cells by prior incubation with LPS increased infectivity into human and mouse pericytes and human endothelial cells. Our findings provide insights into the mechanisms underlying severe COVID-19 infection, highlighting how risk factors such as APOE4 genotype and prior inflammation may exacerbate disease severity by augmenting the virus's ability to infect vascular cells.
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Affiliation(s)
- Luca Biasetti
- Sussex Neuroscience, School of Psychology, University of Sussex , East Sussex BN1 9QG, UK
| | - Nikos Zervogiannis
- Sussex Neuroscience, School of Psychology, University of Sussex , East Sussex BN1 9QG, UK
| | - Kira Shaw
- Sussex Neuroscience, School of Psychology, University of Sussex , East Sussex BN1 9QG, UK
| | - Harry Trewhitt
- Sussex Neuroscience, School of Psychology, University of Sussex , East Sussex BN1 9QG, UK
| | - Louise Serpell
- Sussex Neuroscience, School of Life Sciences, University of Sussex , East Sussex BN1 9QG, UK
| | | | - Edward Wright
- Viral Pseudotype Unit, School of Life Sciences, University of Sussex , , East Sussex BN1 9QG, UK
| | - Catherine N Hall
- Sussex Neuroscience, School of Psychology, University of Sussex , East Sussex BN1 9QG, UK
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Mussbacher M, Basílio J, Belakova B, Pirabe A, Ableitner E, Campos-Medina M, Schmid JA. Effects of Chronic Inflammatory Activation of Murine and Human Arterial Endothelial Cells at Normal Lipoprotein and Cholesterol Levels In Vivo and In Vitro. Cells 2024; 13:773. [PMID: 38727309 PMCID: PMC11083315 DOI: 10.3390/cells13090773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
The activation of endothelial cells is crucial for immune defense mechanisms but also plays a role in the development of atherosclerosis. We have previously shown that inflammatory stimulation of endothelial cells on top of elevated lipoprotein/cholesterol levels accelerates atherogenesis. The aim of the current study was to investigate how chronic endothelial inflammation changes the aortic transcriptome of mice at normal lipoprotein levels and to compare this to the inflammatory response of isolated endothelial cells in vitro. We applied a mouse model expressing constitutive active IκB kinase 2 (caIKK2)-the key activator of the inflammatory NF-κB pathway-specifically in arterial endothelial cells and analyzed transcriptomic changes in whole aortas, followed by pathway and network analyses. We found an upregulation of cell death and mitochondrial beta-oxidation pathways with a predicted increase in endothelial apoptosis and necrosis and a simultaneous reduction in protein synthesis genes. The highest upregulated gene was ACE2, the SARS-CoV-2 receptor, which is also an important regulator of blood pressure. Analysis of isolated human arterial and venous endothelial cells supported these findings and also revealed a reduction in DNA replication, as well as repair mechanisms, in line with the notion that chronic inflammation contributes to endothelial dysfunction.
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Affiliation(s)
- Marion Mussbacher
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (J.B.); (B.B.); (A.P.); (M.C.-M.)
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria;
| | - José Basílio
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (J.B.); (B.B.); (A.P.); (M.C.-M.)
- INESC ID, Instituto Superior Técnico, Universidade de Lisboa, 1000-029 Lisboa, Portugal
- Institute of Pathophysiology and Allergy Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Barbora Belakova
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (J.B.); (B.B.); (A.P.); (M.C.-M.)
| | - Anita Pirabe
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (J.B.); (B.B.); (A.P.); (M.C.-M.)
| | - Elisabeth Ableitner
- Department of Pharmacology and Toxicology, Institute of Pharmaceutical Sciences, University of Graz, 8010 Graz, Austria;
| | - Manuel Campos-Medina
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (J.B.); (B.B.); (A.P.); (M.C.-M.)
| | - Johannes A. Schmid
- Department of Vascular Biology and Thrombosis Research, Centre for Physiology and Pharmacology, Medical University of Vienna, 1090 Vienna, Austria; (M.M.); (J.B.); (B.B.); (A.P.); (M.C.-M.)
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Mwala NN, Borkent JW, van der Meij BS, de van der Schueren MAE. Challenges in identifying malnutrition in obesity; An overview of the state of the art and directions for future research. Nutr Res Rev 2024:1-10. [PMID: 38576127 DOI: 10.1017/s095442242400012x] [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] [Indexed: 04/06/2024]
Abstract
(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.
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Affiliation(s)
- Natasha Nalucha Mwala
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Jos W Borkent
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Barbara S van der Meij
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, Australia
| | - Marian A E de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
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Radwan E, Abdelaziz A, Mandour MAM, Meki ARMA, El-Kholy MM, Mohamed MN. MBOAT7 expression is associated with disease progression in COVID-19 patients. Mol Biol Rep 2024; 51:79. [PMID: 38183501 PMCID: PMC10771377 DOI: 10.1007/s11033-023-09009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/09/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND AIM The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 caused a pandemic of acute respiratory disease, named coronavirus disease 2019 (COVID-19). COVID-19 became one of the most challenging health emergencies, hence the necessity to find different prognostic factors for disease progression, and severity. Membrane bound O-acyltransferase domain containing 7 (MBOAT7) demonstrates anti-inflammatory effects through acting as a fine-tune regulator of the amount of cellular free arachidonic acid. We aimed in this study to evaluate MBOAT7 expression in COVID-19 patients and to correlate it with disease severity and outcomes. METHODS This case-control study included 56 patients with confirmed SARS-CoV-2 diagnosis and 28 control subjects. Patients were further classified into moderate (n = 28) and severe (n = 28) cases. MBOAT7, tumor necrosis factor-α (TNF-α), and interleukin-1ß (IL-1ß) mRNA levels were evaluated in peripheral blood mononuclear cells (PBMC) samples isolated from patients and control subjects by real time quantitative polymerase chain reaction (RT-qPCR). In addition, circulating MBOAT7 protein levels were assayed by enzyme-linked immunosorbent assay (ELISA). RESULTS Significant lower levels of circulating MBOAT7 mRNA and protein were observed in COVID-19 patients compared to control subjects with severe COVID-19 cases showing significant lower levels compared to moderate cases. Moreover, severe cases showed a significant upregulation of TNF-α and IL-1ß mRNA. MBOAT7 mRNA and protein levels were significantly correlated with inflammatory markers (TNF-α, IL-1ß, C-reactive protein (CRP), and ferritin), liver enzymes, severity, and oxygen saturation levels. CONCLUSION COVID-19 is associated with downregulation of MBAOT7, which correlates with disease severity.
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Affiliation(s)
- Eman Radwan
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt.
- Department of Biochemistry, Sphinx University, New Assiut City, Assiut 10, Egypt.
| | - Ahmed Abdelaziz
- Department of Biochemistry, Faculty of Pharmacy, Assiut University, Assiut, 71515, Egypt
| | - Manal A M Mandour
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Abdel-Raheim M A Meki
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
- Department of Biochemistry, Sphinx University, New Assiut City, Assiut 10, Egypt
| | - Maha M El-Kholy
- Department of Chest diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Marwan N Mohamed
- Department of Chest diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt
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Kounis NG, Gogos C, de Gregorio C, Hung MY, Kounis SN, Tsounis EP, Assimakopoulos SF, Pourmasumi S, Mplani V, Servos G, Dousdampanis P, Plotas P, Michalaki MA, Tsigkas G, Grammatikopoulos G, Velissaris D, Koniar I. "When," "Where," and "How" of SARS-CoV-2 Infection Affects the Human Cardiovascular System: A Narrative Review. Balkan Med J 2024; 41:7-22. [PMID: 38173173 PMCID: PMC10767774 DOI: 10.4274/balkanmedj.galenos.2023.2023-10-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the novel severe acute respiratory coronavirus-2 (SARS-CoV-2). Several explanations for the development of cardiovascular complications during and after acute COVID-19 infection have been hypothesized. The COVID-19 pandemic, caused by SARS-CoV-2, has emerged as one of the deadliest pandemics in modern history. The myocardial injury in COVID-19 patients has been associated with coronary spasm, microthrombi formation, plaque rupture, hypoxic injury, or cytokine storm, which have the same pathophysiology as the three clinical variants of Kounis syndrome. The angiotensin-converting enzyme 2 (ACE2), reninaldosterone system (RAAS), and kinin-kallikrein system are the main proposed mechanisms contributing to cardiovascular complications with the COVID-19 infection. ACE receptors can be found in the heart, blood vessels, endothelium, lungs, intestines, testes, neurons, and other human body parts. SARS-CoV-2 directly invades the endothelial cells with ACE2 receptors and constitutes the main pathway through which the virus enters the endothelial cells. This causes angiotensin II accumulation downregulation of the ACE2 receptors, resulting in prothrombotic effects, such as hemostatic imbalance via activation of the coagulation cascade, impaired fibrinolysis, thrombin generation, vasoconstriction, endothelial and platelet activation, and pro-inflammatory cytokine release. The KKS system typically causes vasodilation and regulates tissue repair, inflammation, cell proliferation, and platelet aggregation, but SARS-CoV-2 infection impairs such counterbalancing effects. This cascade results in cardiac arrhythmias, cardiac arrest, cardiomyopathy, cytokine storm, heart failure, ischemic myocardial injuries, microvascular disease, Kounis syndrome, prolonged COVID, myocardial fibrosis, myocarditis, new-onset hypertension, pericarditis, postural orthostatic tachycardia syndrome, pulmonary hypertension, stroke, Takotsubo syndrome, venous thromboembolism, and thrombocytopenia. In this narrative review, we describe and elucidate when, where, and how COVID-19 affects the human cardiovascular system in various parts of the human body that are vulnerable in every patient category, including children and athletes.
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Affiliation(s)
- Nicholas G. Kounis
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | - Christos Gogos
- Clinic of Cardiology, COVID-19 Unit, Papageorgiou General Hospital, Pavlos Melas, Greece
| | - Cesare de Gregorio
- Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
| | - Ming-Yow Hung
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Efthymios P. Tsounis
- Division of Gastroenterology, Department of Internal Medicine, Medical School, University Hospital of Patras, Rio, Greece
| | - Stelios F. Assimakopoulos
- Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, Rio, Greece
| | - Soheila Pourmasumi
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Virginia Mplani
- Intensive Care Unit, Patras University Hospital, Rio, Greece
| | - George Servos
- Pediatric Cardiology Unit, “P. & A. Kyriakou” Children’s Hospital, Athina, Greece
| | | | - Panagiotis Plotas
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | - Marina A. Michalaki
- Department of Internal Medicine, Division of Endocrinology, University of Patras, School of Health Sciences, Rio, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Rio, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras Medical School, Rio, Greece
| | - Ioanna Koniar
- Electrophysiology and Device Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
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Burnett FN, Coucha M, Bolduc DR, Hermanns VC, Heath SP, Abdelghani M, Macias-Moriarity LZ, Abdelsaid M. SARS-CoV-2 Spike Protein Intensifies Cerebrovascular Complications in Diabetic hACE2 Mice through RAAS and TLR Signaling Activation. Int J Mol Sci 2023; 24:16394. [PMID: 38003584 PMCID: PMC10671133 DOI: 10.3390/ijms242216394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/03/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
Diabetics are more vulnerable to SARS-CoV-2 neurological manifestations. The molecular mechanisms of SARS-CoV-2-induced cerebrovascular dysfunction in diabetes are unclear. We hypothesize that SARS-CoV-2 exacerbates diabetes-induced cerebrovascular oxidative stress and inflammation via activation of the destructive arm of the renin-angiotensin-aldosterone system (RAAS) and Toll-like receptor (TLR) signaling. SARS-CoV-2 spike protein was injected in humanized ACE2 transgenic knock-in mice. Cognitive functions, cerebral blood flow, cerebrovascular architecture, RAAS, and TLR signaling were used to determine the effect of SARS-CoV-2 spike protein in diabetes. Studies were mirrored in vitro using human brain microvascular endothelial cells treated with high glucose-conditioned media to mimic diabetic conditions. Spike protein exacerbated diabetes-induced cerebrovascular oxidative stress, inflammation, and endothelial cell death resulting in an increase in vascular rarefaction and diminished cerebral blood flow. SARS-CoV-2 spike protein worsened cognitive dysfunction in diabetes compared to control mice. Spike protein enhanced the destructive RAAS arm at the expense of the RAAS protective arm. In parallel, spike protein significantly exacerbated TLR signaling in diabetes, aggravating inflammation and cellular apoptosis vicious circle. Our study illustrated that SAR-CoV-2 spike protein intensified RAAS and TLR signaling in diabetes, increasing cerebrovascular damage and cognitive dysfunction.
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Affiliation(s)
- Faith N. Burnett
- Department of Biomedical Sciences, School of Medicine, Mercer University, Savannah, GA 31404, USA; (F.N.B.); (V.C.H.); (S.P.H.); (M.A.)
| | - Maha Coucha
- Department of Pharmaceutical Sciences, School of Pharmacy, South University, Savannah, GA 31406, USA; (M.C.); (L.Z.M.-M.)
| | - Deanna R. Bolduc
- Department of Biomedical Sciences, School of Medicine, Mercer University, Savannah, GA 31404, USA; (F.N.B.); (V.C.H.); (S.P.H.); (M.A.)
| | - Veronica C. Hermanns
- Department of Biomedical Sciences, School of Medicine, Mercer University, Savannah, GA 31404, USA; (F.N.B.); (V.C.H.); (S.P.H.); (M.A.)
| | - Stan P. Heath
- Department of Biomedical Sciences, School of Medicine, Mercer University, Savannah, GA 31404, USA; (F.N.B.); (V.C.H.); (S.P.H.); (M.A.)
| | - Maryam Abdelghani
- Department of Biomedical Sciences, School of Medicine, Mercer University, Savannah, GA 31404, USA; (F.N.B.); (V.C.H.); (S.P.H.); (M.A.)
| | - Lilia Z. Macias-Moriarity
- Department of Pharmaceutical Sciences, School of Pharmacy, South University, Savannah, GA 31406, USA; (M.C.); (L.Z.M.-M.)
| | - Mohammed Abdelsaid
- Department of Biomedical Sciences, School of Medicine, Mercer University, Savannah, GA 31404, USA; (F.N.B.); (V.C.H.); (S.P.H.); (M.A.)
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Supák D, Mészáros B, Turi B, Herold Z, Kukor Z, Valent S. Predicting Potentially Fatal COVID-19 Disease in Pregnant Patients Using the Neutrophil-to-Lymphocyte Ratio (NLR). J Clin Med 2023; 12:6896. [PMID: 37959361 PMCID: PMC10649139 DOI: 10.3390/jcm12216896] [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: 09/23/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To evaluate the neutrophil-to-lymphocyte ratio (NLR) values' possible predictive role in fatal and severe cases of COVID-19 disease in pregnant women. Design and data collection: A case-control study was conducted with the inclusion of 45 pregnant COVID-19 patients. All the data were obtained from the hospital information system of Semmelweis University by two of the authors. RESULTS Statistical analyses showed that NLR values were significantly higher in patients with fatal COVID-19 compared to those who survived the disease, with or without mechanical ventilation. The study also assessed whether NLR values measured on the first day of hospitalization or at their peak provided better markers of disease severity. While both the first-day and peak NLR values were evaluated in patients who did not survive the disease, only the peak NLR values had predictive value regarding patient death. CONCLUSION Based on our results, the peak NLR values appear to be useful markers of COVID-19 severity, with a cut-off value of 18.05. However, the authors suggest and hope that larger sample size studies will be conducted to further validate the findings of their research.
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Affiliation(s)
- Dorina Supák
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
| | - Balázs Mészáros
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
| | - Balázs Turi
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
| | - Zoltán Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, 1082 Budapest, Hungary;
| | - Zoltán Kukor
- Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, 1094 Budapest, Hungary
| | - Sándor Valent
- Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary; (D.S.); (B.M.); (B.T.); (S.V.)
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11
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Mrakic-Sposta S, Vezzoli A, Garetto G, Paganini M, Camporesi E, Giacon TA, Dellanoce C, Agrimi J, Bosco G. Hyperbaric Oxygen Therapy Counters Oxidative Stress/Inflammation-Driven Symptoms in Long COVID-19 Patients: Preliminary Outcomes. Metabolites 2023; 13:1032. [PMID: 37887357 PMCID: PMC10608857 DOI: 10.3390/metabo13101032] [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: 08/24/2023] [Revised: 09/15/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Long COVID-19 patients show systemic inflammation and persistent symptoms such as fatigue and malaise, profoundly affecting their quality of life. Since improving oxygenation can oppose inflammation at multiple tissue levels, we hypothesized that hyperbaric oxygen therapy (HBOT) could arrest inflammation progression and thus relieve symptoms of COVID-19. We evaluated oxy-inflammation biomarkers in long COVID-19 subjects treated with HBOT and monitored with non-invasive methods. Five subjects (two athletes and three patients with other comorbidities) were assigned to receive HBOT: 100% inspired O2 at 2.4 ATA in a multiplace hyperbaric chamber for 90 min (three athletes: 15 HBOT × 5 days/wk for 3 weeks; two patients affected by Idiopathic Sudden Sensorineural Hearing Loss: 30 HBOT × 5 days/wk for 6 weeks; and one patient with osteomyelitis: 30 HBOT × 5 days/wk for week for 6 weeks and, after a 30-day break, followed by a second cycle of 20 HBOT). Using saliva and/or urine samples, reactive oxygen species (ROS), antioxidant capacity, cytokines, lipids peroxidation, DNA damage, and renal status were assessed at T1_pre (basal level) and at T2_pre (basal level after treatment), and the results showed attenuated ROS production, lipid peroxidation, DNA damage, NO metabolites, and inflammation biomarker levels, especially in the athletes post-treatment. Thus, HBOT may represent an alternative non-invasive method for treating long COVID-19-induced long-lasting manifestations of oxy-inflammation.
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Affiliation(s)
- Simona Mrakic-Sposta
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20162 Milan, Italy;
| | - Alessandra Vezzoli
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20162 Milan, Italy;
| | | | - Matteo Paganini
- Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (M.P.); (E.C.); (T.A.G.); (J.A.); (G.B.)
| | - Enrico Camporesi
- Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (M.P.); (E.C.); (T.A.G.); (J.A.); (G.B.)
| | - Tommaso Antonio Giacon
- Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (M.P.); (E.C.); (T.A.G.); (J.A.); (G.B.)
| | - Cinzia Dellanoce
- Institute of Clinical Physiology, National Research Council (IFC-CNR), 20162 Milan, Italy;
| | - Jacopo Agrimi
- Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (M.P.); (E.C.); (T.A.G.); (J.A.); (G.B.)
| | - Gerardo Bosco
- Department of Biomedical Sciences, University of Padova, 35122 Padova, Italy; (M.P.); (E.C.); (T.A.G.); (J.A.); (G.B.)
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12
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Stepanova N, Driianska V, Korol L, Snisar L, Savchenko S. Pre-existing serum indoxyl sulfate and COVID-19 outcomes in patients undergoing hemodialysis: A retrospective cohort study. UKRAINIAN JOURNAL OF NEPHROLOGY AND DIALYSIS 2023:61-68. [DOI: 10.31450/ukrjnd.2(78).2023.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Patients undergoing hemodialysis (HD) are at increased risk of severe complications from COVID-19 due to compromised immune function and comorbidities. This retrospective study aimed to investigate the association between pre-existing serum indoxyl sulfate (IS) concentrations and COVID-19 outcomes in HD patients.
Methods. Data on pre-existing IS and proinflammatory cytokines, such as interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and tumor necrosis factor-alpha (TNF-α) were extracted from an existing patient database. The patients were followed up for 1.5 years and compared according to median serum IS concentration: low-IS (< 22.2 μg/mL) and high-IS (≥22.2 μg/mL) groups. The primary outcomes focused on assessing the risk and severity of COVID-19 infection.
Results. A total of 56 patients aged 62 (56-67) years with a dialysis vintage of 37.5 (30-168) months were included in the analysis. Serum levels of IS were significantly correlated with Kt/V values (p = 0.043), arterial hypertension (p = 0.001), IL-6 (p = 0.023), MCP-1 (p = 0.023), and TNF-α (p = 0.033) concentrations. Elevated serum IS levels were significantly associated with an increased risk of COVID-19 infection (p < 0.0001) and a higher likelihood of hospitalization (p = 0.03). Patients with higher IS levels exhibited more severe lung involvement (p < 0.0001) and a greater need for respiratory support (p = 0.004). A serum IS concentration of 21.5 μg/mL was the optimal threshold for predicting COVID-19 infection in HD patients (sensitivity of 83.4% and specificity of 92.3%, p < 0.0001).
Conclusion: Our study highlights the detrimental impact of serum IS on COVID-19 infection and its clinical outcomes in patients undergoing HD. Further research is warranted to elucidate the underlying mechanisms and explore potential therapeutic strategies targeting IS in this population.
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13
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Russell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity and COVID-19. Nat Med 2023; 29:334-343. [PMID: 36797482 DOI: 10.1038/s41591-022-02156-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/25/2022] [Indexed: 02/18/2023]
Abstract
The influence of comorbidities on COVID-19 outcomes has been recognized since the earliest days of the pandemic. But establishing causality and determining underlying mechanisms and clinical implications has been challenging-owing to the multitude of confounding factors and patient variability. Several distinct pathological mechanisms, not active in every patient, determine health outcomes in the three different phases of COVID-19-from the initial viral replication phase to inflammatory lung injury and post-acute sequelae. Specific comorbidities (and overall multimorbidity) can either exacerbate these pathological mechanisms or reduce the patient's tolerance to organ injury. In this Review, we consider the impact of specific comorbidities, and overall multimorbidity, on the three mechanistically distinct phases of COVID-19, and we discuss the utility of host genetics as a route to causal inference by eliminating many sources of confounding. Continued research into the mechanisms of disease-state interactions will be crucial to inform stratification of therapeutic approaches and improve outcomes for patients.
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Affiliation(s)
- Clark D Russell
- Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK.
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
| | - J Kenneth Baillie
- Intensive Care Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
- Baillie Gifford Pandemic Science Hub, Centre for Inflammation Research, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK.
- Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK.
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14
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Choi KJ, Jung SK, Kim KC, Kim EJ. Methylprednisolone pulse therapy for critically ill patients with COVID-19: a cohort study. Acute Crit Care 2023; 38:57-67. [PMID: 36935535 PMCID: PMC10030243 DOI: 10.4266/acc.2022.00941] [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: 07/27/2022] [Accepted: 11/15/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The guidelines recommend the use of dexamethasone 6 mg or an equivalent dose in patients with coronavirus disease 2019 (COVID-19) who require supplemental oxygen. Given that the severity of COVID-19 varies, we investigated the effect of a pulse dose of corticosteroids on the clinical course of critically ill patients with COVID-19. METHODS This single-center, retrospective cohort study was conducted between September and December 2021, which was when the Delta variant of the COVID-19 virus was predominant. We evaluated the mortality and oxygenation of severe to critical COVID-19 cases between groups that received dexamethasone 6 mg for 10 days (control group) and methylprednisolone 250 mg/day for 3 days (pulse group). RESULTS Among 44 patients, 14 and 30 patients were treated with control steroids and pulse steroids, respectively. There was no difference in disease severity, time from COVID-19 diagnosis to steroid administration, or use of remdesivir or antibacterial agents between the two groups. The pulse steroid group showed a significant improvement in oxygenation before and after steroid treatment (P<0.001) compared with the control steroid group (P=0.196). There was no difference in in-hospital mortality (P=0.186); however, the pulse steroid group had a lower mortality rate (23.3%) than the control steroid group (42.9%). There was a significant difference in the length of hospital stay between both two groups (P=0.039). CONCLUSIONS Pulse steroids showed no mortality benefit but were associated with oxygenation improvement and shorter hospital stay than control steroids. Hyperglycemia should be carefully monitored with pulse steroids.
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Affiliation(s)
- Keum-Ju Choi
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Soo Kyun Jung
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Eun Jin Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
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15
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Adiponectin, Leptin, and Resistin Are Dysregulated in Patients Infected by SARS-CoV-2. Int J Mol Sci 2023; 24:ijms24021131. [PMID: 36674646 PMCID: PMC9861572 DOI: 10.3390/ijms24021131] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
Obesity, through adipose tissue (AT) inflammation and dysregulation, represents a critical factor for COVID-19; here, we investigated whether serum levels of adiponectin, HMW oligomers, leptin, and resistin are modulated and/or correlated with clinical and biochemical parameters of severe COVID-19 patients. This study included 62 severe COVID-19 patients; 62 age and sex-matched healthy subjects were recruited as a control group. Anthropometric and biochemical parameters were obtained and compared. Adiponectin, HMW oligomers, leptin, and resistin were analyzed by ELISA. The adiponectin oligomerization state was visualized by Western blotting. When compared to healthy subjects, total adiponectin levels were statistically lower in severe COVID-19 while, in contrast, the levels of leptin and resistin were statistically higher. Interestingly, HMW adiponectin oligomers negatively correlated with leptin and were positively associated with LUS scores. Resistin showed a positive association with IL-6, IL-2R, and KL-6. Our data strongly support that adipose tissue might play a functional role in COVID-19. Although it needs to be confirmed in larger cohorts, adiponectin HMW oligomers might represent a laboratory resource to predict patient seriousness. Whether adipokines can be integrated as a potential additional tool in the evolving landscape of biomarkers for the COVID-19 disease is still a matter of debate. Other studies are needed to understand the molecular mechanisms behind adipokine's involvement in COVID-19.
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16
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The metabolic control and laboratory evaluation in patients with type 2 diabetes during the COVID-19 pandemic and the impact of telemedicine: a single-center experience. REV ROMANA MED LAB 2023. [DOI: 10.2478/rrlm-2023-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Abstract
Objective: The study aimed to evaluate the metabolic control during the COVID-19 pandemic in subjects with type 2 diabetes mellitus (T2DM) and whether care through telemedicine significantly impacted it.
Material and methods: This was a retrospective study for which three time-periods were prespecified: the COVID-19 pandemic period, pre-COVID-19 period, and before pre-COVID-19. The following information were collected: anthropometric and laboratory parameters (glycated hemoglobin (HbA1c), blood glucose, lipid profile, creatinine, eGFR, etc.), self-measured blood glucose (SMBG), blood pressure (BP), diabetes therapy, number of on-site and of telemedicine consultations. The mean values of all available measurements for HbA1c, SMBG, BP, weight, and body mass index (BMI) were calculated.
Results: During the COVID-19 pandemic, the HbA1c values increased (6.78±0.77% to 6.96±0.87%, p<0.0001; + 0.18±0.67%), despite treatment intensification (p<0.01), while BMI and total cholesterol values slightly decreased (32.01±5.5 kg/m2 to 31.7±5.4 kg/m2, p<0.0001, and 178.1±40.8 mg/dl to 170.5±38.4 mg/dl, p<0.05). The deterioration of glycemic control (to HbA1c >7%) were rather seen in males (to 7.01±0.92%, p<0.0001), patients from rural areas (to 7.08±0.96%, p<0.001) and younger than 65 y.o. (to 7.05±0.82%, p<0.001). More male patients had a mean HbA1c increase of >0.5% during the COVID-19 pandemic (32.3% vs 21.5%, p<0.05). Patients who received more diabetes care visits through telemedicine had a more attenuated increase in HbA1c (6.79±0.80% to 6.90±0.83%, p<0.05 vs 6.76±0.72% to 7.08±0.92%, p<0.0001).
Conclusions: The glycemic control slightly deteriorated during the COVID-19 pandemic (but with overall HbA1c within target), with certain patient categories being more affected. Diabetes care though telemedicine allowed the maintenance of the metabolic control.
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17
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Al‐Qudimat AR, Al Darwish MB, Elaarag M, Al‐Zoubi RM, Rejeb MA, Ojha LK, Nashwan AJ, Alshunag T, Adawi K, Omri AE, Aboumarzouk OM, Yassin A, Al‐Ansari AA. COVID‐19 effect on patients with noncommunicable diseases: A narrative review. Health Sci Rep 2023; 6:e995. [DOI: 10.1002/hsr2.995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Ahmad R. Al‐Qudimat
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
- Department of Public Health Qatar University Doha Qatar
| | - Mohamed B. Al Darwish
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
| | - Mai Elaarag
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
| | - Raed M. Al‐Zoubi
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
- Department of Biomedical Sciences, QU‐Health, College of Health Sciences Qatar University Doha Qatar
- Department of Chemistry Jordan University of Science and Technology Irbid Jordan
| | - Mohamed Amine Rejeb
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
| | - Laxmi K. Ojha
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
| | | | | | - Karam Adawi
- Department of Public Health Qatar University Doha Qatar
| | - Abdelfettah El Omri
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
| | - Omar M. Aboumarzouk
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
- College of Medicine Qatar University Doha Qatar
- School of Medicine, Dentistry and Nursing The University of Glasgow Glasgow UK
| | - Aksam Yassin
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
- Center of Medicine and Health Sciences Dresden International University Dresden Germany
| | - Abdulla A. Al‐Ansari
- Department of Surgery, Surgical Research Section Hamad Medical Corporation Doha Qatar
- Hamad General Hospital Hamad Medical Corporation Doha Qatar
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18
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Distinct blood inflammatory biomarker clusters stratify host phenotypes during the middle phase of COVID-19. Sci Rep 2022; 12:22471. [PMID: 36577783 PMCID: PMC9795438 DOI: 10.1038/s41598-022-26965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
The associations between clinical phenotypes of coronavirus disease 2019 (COVID-19) and the host inflammatory response during the transition from peak illness to convalescence are not yet well understood. Blood plasma samples were collected from 129 adult SARS-CoV-2 positive inpatient and outpatient participants between April 2020 and January 2021, in a multi-center prospective cohort study at 8 military hospitals across the United States. Plasma inflammatory protein biomarkers were measured in samples from 15 to 28 days post symptom onset. Topological Data Analysis (TDA) was used to identify patterns of inflammation, and associations with peak severity (outpatient, hospitalized, ICU admission or death), Charlson Comorbidity Index (CCI), and body mass index (BMI) were evaluated using logistic regression. The study population (n = 129, 33.3% female, median 41.3 years of age) included 77 outpatient, 31 inpatient, 16 ICU-level, and 5 fatal cases. Three distinct inflammatory biomarker clusters were identified and were associated with significant differences in peak disease severity (p < 0.001), age (p < 0.001), BMI (p < 0.001), and CCI (p = 0.001). Host-biomarker profiles stratified a heterogeneous population of COVID-19 patients during the transition from peak illness to convalescence, and these distinct inflammatory patterns were associated with comorbid disease and severe illness due to COVID-19.
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19
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Shokri‐Afra H, Moradi M, Musavi H, Moradi‐Sardareh H, Moradi poodeh B, Kazemi Veisari A, Oladi Z, Ebrahimi M. Serum calprotectin can indicate current and future severity of COVID-19. J Clin Lab Anal 2022; 37:e24809. [PMID: 36525302 PMCID: PMC9833977 DOI: 10.1002/jcla.24809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Predictive and prognostic biomarkers to guide 2019 novel coronavirus disease (COVID-19) are critically evolving. Dysregulated immune responses are the pivotal cause of severity mainly mediated by neutrophil activation. Thus, we evaluated the association of calprotectin, neutrophil secretory protein, and other mediators of inflammation with the severity and outcomes of COVID-19. METHODS This two-center prospective study focused on PCR-proven COVID-19 patients (n = 76) with different clinical presentations and SARS-CoV-2 negative control subjects (n = 24). Serum calprotectin (SC) was compared with IL-6 and other laboratory parameters. RESULTS Median levels of SC were significantly higher in COVID-19 patients in comparison to the control group (3760 vs. 2100 ng/ml, p < 0.0001). Elevated SC was significantly respective of disease severity (3760 ng/ml in mild up to 5700 ng/ml in severe cases, p < 0.0001). Moreover, the significant positive and negative correlations of SC with disease severity and oxygenation status indicated disease progression and respiratory worsening, respectively. It was found that SC was high in severe patients during hospitalization and significantly declined to normal after recovery. The logistic analysis identified the independent predictive power of SC for respiratory status or clinical severity. Indeed, SC behaved as a better discriminator for both outcomes, as it exhibited the largest area under the curve (receiver operating curve analysis), with the highest specificity and sensitivity when the predictive value of inflammatory biomarkers was compared. CONCLUSION Calprotectin can be used as a reliable prognostic tool to predict the poor clinical outcomes of COVID-19 patients.
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Affiliation(s)
- Hajar Shokri‐Afra
- Gut and Liver Research Center, Non‐communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Mona Moradi
- Pediatric Infectious Diseases Research Center, Communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Hadis Musavi
- Department of Clinical Biochemistry, School of MedicineBabol University of Medical SciencesBabolIran
| | - Hemen Moradi‐Sardareh
- Department of Research and TechnologyAsadabad School of Medical ScienceAsadabadIran,Biomad companyOsloNorway
| | - Bahman Moradi poodeh
- Department of Laboratory Sciences, Lahijan BranchIslamic Azad UniversityLahijanIran
| | - Arash Kazemi Veisari
- Gut and Liver Research Center, Non‐communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Ziaeddin Oladi
- Department of Internal Medicine, School of Medicine, Ghaem Shahr Razi HospitalMazandaran University of Medical SciencesSariIran
| | - Mahboobe Ebrahimi
- Gut and Liver Research Center, Non‐communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
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Cimellaro A, Addesi D, Cavallo M, Spagnolo F, Suraci E, Cordaro R, Spinelli I, Passafaro F, Colosimo M, Pintaudi M, Pintaudi C. Monoclonal Antibodies and Antivirals against SARS-CoV-2 Reduce the Risk of Long COVID: A Retrospective Propensity Score-Matched Case-Control Study. Biomedicines 2022; 10:biomedicines10123135. [PMID: 36551891 PMCID: PMC9775930 DOI: 10.3390/biomedicines10123135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Long COVID is a complex condition affecting quality of life, with limited therapeutic options. We investigated the occurrence of long COVID in subjects receiving early therapy with monoclonal antibodies (mAbs) or antivirals to reduce the risk of COVID-19 progression. In this retrospective study we enrolled 737 adult patients (aged 65.16 ± 13.46; 361F), who experienced COVID-19 between January 2021 and March 2022. Antiviral or mAbs were administered to symptomatic patients who did not require oxygen therapy or hospital admission for SARS-CoV-2 infection, and who were at high risk of progression to severe disease, as identified by age > 65 years or the presence of comorbidities. Long COVID, defined as newly or persistent long-term symptoms 4 weeks after the onset of the acute illness, was reported in 204 cases (28%). Age (OR 1.03; p < 0.001), gender (OR 1.88; p < 0.001) and at least three comorbidities (OR 3.49; p = 0.049) were directly associated with long COVID; conversely, vaccination (OR 0.59; p = 0.005) and mAbs/antivirals (OR 0.44; p = 0.002) were independently associated with a reduced risk of long COVID. At a propensity-score-matched analysis, the mAbs/antivirals group had a significantly lower occurrence of long COVID in comparison with untreated controls (11% vs. 34%; p = 0.001). In conclusion, mAbs and antivirals administered against the progression of COVID-19 were associated with a reduced risk of long COVID.
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Affiliation(s)
- Antonio Cimellaro
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
- Correspondence:
| | - Desirée Addesi
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Michela Cavallo
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Francesco Spagnolo
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Edoardo Suraci
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Raffaella Cordaro
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Ines Spinelli
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Francesco Passafaro
- Coordination of Special Unit of Continuity Care for Local Health Authority, Via Vinicio Cortese n.25, 88100 Catanzaro, Italy
| | - Manuela Colosimo
- Microbiology and Virology Unit, Service Department, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
| | - Medea Pintaudi
- Neurophysiology and Neurobiology Unit, Department of Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo n.200, 00128 Rome, Italy
| | - Carmelo Pintaudi
- Internal Medicine Unit, Department of Medicine, “Pugliese-Ciaccio” Hospital of Catanzaro, Via Pio X n.83, 88100 Catanzaro, Italy
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21
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Tayeri K, Asadollahi K, Madani N, Haghjooy Javanmard S. Does COVID-19 Escalate Aging Process? A Possible Concern. Adv Biomed Res 2022; 11:106. [PMID: 36660763 PMCID: PMC9843595 DOI: 10.4103/abr.abr_350_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/18/2021] [Accepted: 12/29/2021] [Indexed: 01/21/2023] Open
Abstract
A key challenge after the COVID-19 pandemic will be managing the long-term sequelae for the millions of individuals who recover from the disease. Based on the available evidence, our hypothesis is that the SARS-CoV-2 pandemic and its long-term complications will lead to premature aging (in terms of health) of many people in the world. Obviously, to maintain appropriate public health and prevent poor health-care services, countries should think and plan about the health problems and the long-term consequences of SARS-CoV-2 after controlling the COVID-19 pandemic.
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Affiliation(s)
- Katayoun Tayeri
- Department of Infectious Diseases, Iranian Research Center of HIV and AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Navid Madani
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shaghayegh Haghjooy Javanmard
- Department of Physiology, School of Medicine, Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan, Iran,Address for correspondence: Prof. Shaghayegh Haghjooy Javanmard, Department of Physiology, School of Medicine, Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan, Iran. E-mail:
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22
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AlShammeri O, AL Saif S, Al Shehri H, Alasng M, Qaddoura F, Al Shehri M, Turkistani Y, Tash A, Alharbi W, Al Qahtani F, Diaz R, Mahaimeed W, Al habeeb W, Alfaraidy K. Saudi Heart Association Guidelines on Best Practices in the Management of Chronic Coronary Syndromes. J Saudi Heart Assoc 2022; 34:182-211. [PMID: 36578770 PMCID: PMC9762239 DOI: 10.37616/2212-5043.1320] [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: 08/10/2022] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of both chronic coronary syndrome (CCS) and its risk factors is alarming in Saudi Arabia and only a minority of patients achieve optimal medical management. Context-specific CCS guidelines outlining best clinical practices are therefore needed to address local gaps and challenges. Consensus panel A panel of experts representing the Saudi Heart Association (SHA) reviewed existing evidence and formulated guidance relevant to local clinical practice considering the characteristics of the Saudi population, the Saudi healthcare system, its resources and medical expertise. They were reviewed by external experts to ensure scientific and medical accuracy. Consensus findings Recommendations are provided on the clinical assessment and management of CCS, along with supporting evidence. Risk reduction through non-pharmacological therapy (lifestyle modifications) remains at the core of CCS management. Great emphasis should be placed on the use of available pharmacological options (anti-anginal therapy and event prevention) only as appropriate and necessary. Lifestyle counseling and pharmacological strategy must be optimized before considering revascularization, unless otherwise indicated. Revascularization strategies should be carefully considered by the Heart Team to ensure the appropriate choice is made in accordance to current guidelines and patient preference. Conclusion Conscientious, multidisciplinary, and personalized clinical management is necessary to navigate the complex landscape of CCS in Saudi Arabia considering its population and resource differences. The reconciliation of international evidence and local characteristics is critical for the improvement of healthcare outcomes among CCS patients in Saudi Arabia.
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Affiliation(s)
- Owayed AlShammeri
- Dr. Sulaiman Al-Habib Hospital, Riyadh,
Saudi Arabia,Corresponding author at: Dr. Sulaiman Alhabib Hospital, Ar Rayyan Hospital, Riyadh, 14212, Saudi Arabia. E-mail address: (O. AlShammeri)
| | | | - Halia Al Shehri
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Mirvat Alasng
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah,
Saudi Arabia
| | | | | | | | - Adel Tash
- National Heart Center, Saudi Health Council,
Saudi Arabia
| | - Walid Alharbi
- King Fahad Cardiac Center, King Saud University, Riyadh,
Saudi Arabia
| | - Fahad Al Qahtani
- King Salman Heart Centre, King Fahad Medical City, Riyadh,
Saudi Arabia
| | - Rafael Diaz
- ECLA (Estudios Clínicos Latino América), Instituto Cardiovascular de Rosario, Rosario,
Argentina
| | - Wael Mahaimeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi,
United Arab Emirates
| | - Waleed Al habeeb
- Saudi Heart Association, Department of Cardiac Sciences, King Saud University Riyadh,
Saudi Arabia
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23
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Vidal-Perez R, Brandão M, Pazdernik M, Kresoja KP, Carpenito M, Maeda S, Casado-Arroyo R, Muscoli S, Pöss J, Fontes-Carvalho R, Vazquez-Rodriguez JM. Cardiovascular disease and COVID-19, a deadly combination: A review about direct and indirect impact of a pandemic. World J Clin Cases 2022; 10:9556-9572. [PMID: 36186196 PMCID: PMC9516905 DOI: 10.12998/wjcc.v10.i27.9556] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known to present with respiratory symptoms, which can lead to severe pneumonia and respiratory failure. However, it can have multisystem complications such as cardiovascular manifestations. The cardiovascular manifestations reported comprise myocarditis, cardiogenic shock, arrhythmias, pulmonary embolism, deep vein embolism, acute heart failure, and myocardial infarction. There is also an indirect impact of the pandemic on the management of cardiovascular care that has been shown clearly in multiple publications. In this review, we summarize the deadly relation of COVID-19 with cardiovascular events and the wider impact on several cardiovascular care areas by the pandemic situation
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Affiliation(s)
- Rafael Vidal-Perez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
| | - Mariana Brandão
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
| | - Michal Pazdernik
- Intensive Care Unit, Department of Cardiology, Institute for Clinical and Experimental Medicine Prague, Prague 14021, Czech Republic
| | | | - Myriam Carpenito
- Unit of Cardiac Sciences, Department of Medicine, Campus Bio-Medico University of Rome, Rome 00128, Italy
| | - Shingo Maeda
- Arrhythmia Advanced Therapy Center, AOI Universal Hospital, Kawasaki 210-0822, Japan
| | - Rubén Casado-Arroyo
- Department of Cardiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels 1070, Belgium
| | - Saverio Muscoli
- Unit of Cardiology, Policlinico Tor Vergata, Rome 00133, Italy
| | - Janine Pöss
- Heart Center Leipzig, University of Leipzig, Leipzig 04289, Germany
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Gaia, Gaia 4400-020, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto 4200-319, Portugal
| | - Jose Manuel Vazquez-Rodriguez
- Servicio de Cardiología, Unidad de Imagen y Función Cardíaca, Complexo Hospitalario Universitario A Coruña Centro de Investigación Biomédica en Red-Instituto de Salud Carlos III, A Coruña 15006, Spain
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24
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Flavonols and Flavones as Potential anti-Inflammatory, Antioxidant, and Antibacterial Compounds. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9966750. [PMID: 36111166 PMCID: PMC9470311 DOI: 10.1155/2022/9966750] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/04/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
Plant preparations have been used to treat various diseases and discussed for centuries. Research has advanced to discover and identify the plant components with beneficial effects and reveal their underlying mechanisms. Flavonoids are phytoconstituents with anti-inflammatory, antimutagenic, anticarcinogenic, and antimicrobial properties. Herein, we listed and contextualized various aspects of the protective effects of the flavonols quercetin, isoquercetin, kaempferol, and myricetin and the flavones luteolin, apigenin, 3
,4
-dihydroxyflavone, baicalein, scutellarein, lucenin-2, vicenin-2, diosmetin, nobiletin, tangeretin, and 5-O-methyl-scutellarein. We presented their structural characteristics and subclasses, importance, occurrence, and food sources. The bioactive compounds present in our diet, such as fruits and vegetables, may affect the health and disease state. Therefore, we discussed the role of these compounds in inflammation, oxidative mechanisms, and bacterial metabolism; moreover, we discussed their synergism with antibiotics for better disease outcomes. Indiscriminate use of antibiotics allows the emergence of multidrug-resistant bacterial strains; thus, bioactive compounds may be used for adjuvant treatment of infectious diseases caused by resistant and opportunistic bacteria via direct and indirect mechanisms. We also focused on the reported mechanisms and intracellular targets of flavonols and flavones, which support their therapeutic role in inflammatory and infectious diseases.
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25
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Nagatomo I, Nakanishi K, Yamamoto R, Ide S, Ishibashi C, Moriyama T, Yamauchi-Takihara K. Soluble angiotensin-converting enzyme 2 association with lipid metabolism. Front Med (Lausanne) 2022; 9:955928. [PMID: 36035417 PMCID: PMC9399413 DOI: 10.3389/fmed.2022.955928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Increased expression of angiotensin-converting enzyme 2 (ACE2) is one of the likely explanations for disease severity in patients with coronavirus disease 2019 (COVID-19). In this study, we aimed to test whether soluble ACE2 (sACE2) levels are correlated to known risk factors of severe COVID-19 including biochemical parameters, body mass index and smoking habits. We cross-sectionally evaluated serum sACE2 levels in obese or tobacco-smoking populations and compared them to those in non-obese and non-smoking healthy participants. Additionally, fibroblast growth factor-21 (FGF21) was investigated as a candidate regulator of sACE2. A total of 220 male participants aged 30–59 years undergoing an annual health checkup were enrolled in this study: 59 obese, 80 smokers, and 81 healthy. Serum sACE2 levels were significantly higher in obese participants but not in tobacco-smoking participants when compared to healthy participants. sACE2 levels were significantly correlated with total cholesterol and triglycerides but not with body mass index. Furthermore, no regulatory relationship was found between FGF21 and sACE2. Lipid metabolism disorders accompanied by upregulation of serum sACE2 may be underlying mechanisms of COVID-19 aggravation and might be a novel breakthrough treatment target.
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26
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Abdulah DM, Mirza AMS. Receiving COVID-19 vaccine, hospitalization, and outcomes of patients with COVID-19: A prospective study. Monaldi Arch Chest Dis 2022; 93. [PMID: 35754392 DOI: 10.4081/monaldi.2022.2194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/04/2022] [Indexed: 11/23/2022] Open
Abstract
Despite Iraq having started the COVID-19 vaccine in January 2020, there is no official data on vaccination and hospitalization across the country. We aimed to explore the role of the COVID-19 vaccine on the hospitalization and outcomes of patients with COVID-19 in Iraqi Kurdistan. In this prospective study, patients who were admitted to two COVID-19 hospitals in Iraqi Kurdistan in 2021 were followed-up by the discharge time between August and November 2021. The mean age of the patients was 57.6 (27-98 years) of both genders. Most of the patients were illiterate (69.3%) or had a lower level of education (20.5%). A small percentage of patients had previous thrombotic disorders (4.7%) and close to half of the patients had chronic diseases (44.9%). The patients had mild to moderate (44.9%), moderate-severe (36.2%), and critical (18.9%) status. The median hospitalization day was 9 days (1-45 days). The study found that 91.3% of the COVID-19 hospitalized patients did not receive the vaccine and 26.8% of patients died. We did not find a significant association between receiving vaccination and patients' outcomes or disease severity. No patients with previous thrombotic disorders received the COVID-19 vaccine. The male patients were more likely to receive the COVID-19 vaccine compared to female patients; 14.55% vs. 4.17%, p=0.0394. This study showed that most patients with COVID-19 who were admitted to the hospitals have not received the COVID-19 vaccine. A high percentage of the COVID-19 hospitalized patients died of the disease in this region.
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Affiliation(s)
- Deldar Morad Abdulah
- Community Health Unit, College of Nursing, University of Duhok, Iraqi Kurdistan, Duhok.
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27
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Vollbracht C, Kraft K. Oxidative Stress and Hyper-Inflammation as Major Drivers of Severe COVID-19 and Long COVID: Implications for the Benefit of High-Dose Intravenous Vitamin C. Front Pharmacol 2022; 13:899198. [PMID: 35571085 PMCID: PMC9100929 DOI: 10.3389/fphar.2022.899198] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/14/2022] [Indexed: 12/25/2022] Open
Abstract
Oxidative stress is a pivotal point in the pathophysiology of COVID-19 and presumably also in Long-COVID. Inflammation and oxidative stress are mutually reinforcing each other, thus contributing to the systemic hyperinflammatory state and coagulopathy which are cardinal pathological mechanisms of severe stages. COVID-19 patients, like other critically ill patients e.g. with pneumonia, very often show severe deficiency of the antioxidant vitamin C. So far, it has not been investigated how long this deficiency lasts or whether patients with long COVID symptoms also suffer from deficiencies. A vitamin C deficit has serious pathological consequences because vitamin C is one of the most effective antioxidants, but also co-factor of many enzymatic processes that affect the immune and nervous system, blood circulation and energy metabolism. Because of its anti-oxidative, anti-inflammatory, endothelial-restoring, and immunomodulatory effects the supportive intravenous (iv) use of supraphysiological doses has been investigated so far in 12 controlled or observational studies with altogether 1578 inpatients with COVID-19. In these studies an improved oxygenation, a decrease in inflammatory markers and a faster recovery were observed. In addition, early treatment with iv high dose vitamin C seems to reduce the risks of severe courses of the disease such as pneumonia and also mortality. Persistent inflammation, thrombosis and a dysregulated immune response (auto-immune phenomena and/or persistent viral load) seem to be major contributors to Long-COVID. Oxidative stress and inflammation are involved in the development and progression of fatigue and neuro-psychiatric symptoms in various diseases by disrupting tissue (e.g. autoantibodies), blood flow (e.g. immune thrombosis) and neurotransmitter metabolism (e.g. excitotoxicity). In oncological diseases, other viral infections and autoimmune diseases, which are often associated with fatigue, cognitive disorders, pain and depression similar to Long-COVID, iv high dose vitamin C was shown to significantly relieve these symptoms. Supportive iv vitamin C in acute COVID-19 might therefore reduce the risk of severe courses and also the development of Long-COVID.
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Affiliation(s)
- Claudia Vollbracht
- Medical Science Department, Pascoe Pharmazeutische Präparate GmbH, Giessen, Germany
| | - Karin Kraft
- Chair of Naturopathy, University Medicine Rostock, Rostock, Germany
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28
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Frara S, Loli P, Allora A, Santini C, di Filippo L, Mortini P, Fleseriu M, Giustina A. COVID-19 and hypopituitarism. Rev Endocr Metab Disord 2022; 23:215-231. [PMID: 34387832 PMCID: PMC8363093 DOI: 10.1007/s11154-021-09672-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 02/07/2023]
Abstract
Besides the pulmonary manifestations caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), an emerging endocrine phenotype, which can heavily impact on the severity of the syndrome, has been recently associated with coronavirus disease 2019 (COVID-19). Patients with pituitary diseases or the pituitary gland itself may also be involved in COVID-19 clinical presentation and/or severity, causing pituitary apoplexy.Moreover, hypopituitarism is frequently burdened by several metabolic complications, including arterial hypertension, hyperglycemia, obesity and vertebral fractures, which have all been associated with poor outcomes and increased mortality in patients infected by SARS-CoV-2.This review will discuss hypopituitarism as a condition that might have a bidirectional relationship with COVID-19 due to the frequent presence of metabolic comorbidities, to the direct or indirect pituitary damage or being per se a potential risk factor for COVID-19. Finally, we will address the current recommendations for the clinical management of vaccines in patients with hypopituitarism and adrenal insufficiency.
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Affiliation(s)
- Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Paola Loli
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Santini
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pietro Mortini
- Neurosurgery Department and Radiosurgery Unit, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Maria Fleseriu
- Pituitary Center, Departments of Medicine and Neurological Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
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29
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IgG Antibody Response to the Pfizer BNT162b2 SARS-CoV-2 Vaccine in Healthcare Workers with Healthy Weight, Overweight, and Obesity. Vaccines (Basel) 2022; 10:vaccines10040512. [PMID: 35455261 PMCID: PMC9025933 DOI: 10.3390/vaccines10040512] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
Obesity is a significant factor for increased morbidity and mortality upon infection with SARS-CoV-2. Because of the higher potential for negative outcomes following infection of individuals with obesity, the impact of body mass index (BMI) on vaccine immunogenicity and efficacy is an important public health concern. Few studies have measured the magnitude and durability of the vaccine-specific response in relation to BMI. We measured the receptor binding domain (RBD)-specific serum IgG and surrogate neutralizing titers in a cohort of 126 vaccinated individuals with no clinical history or serological evidence of previous SARS-CoV-2 infection 50 and 200 days following vaccination. BMI had no significant impact on RBD-specific IgG titers and surrogate neutralizing titers 50 days following immunization, and leptin levels had no correlation with the response to immunization. Two hundred days following immunization, antibody titers in all groups had declined by approximately 90%. The responses were also similar between male and female participants and did not significantly vary across age groups. These results indicate that the magnitude and durability of the antibody response to mRNA-based vaccines are unaffected by BMI in this cohort.
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30
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Carmona-Pírez J, Gimeno-Miguel A, Bliek-Bueno K, Poblador-Plou B, Díez-Manglano J, Ioakeim-Skoufa I, González-Rubio F, Poncel-Falcó A, Prados-Torres A, Gimeno-Feliu LA. Identifying multimorbidity profiles associated with COVID-19 severity in chronic patients using network analysis in the PRECOVID Study. Sci Rep 2022; 12:2831. [PMID: 35181720 PMCID: PMC8857317 DOI: 10.1038/s41598-022-06838-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
A major risk factor of COVID-19 severity is the patient's health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly cardiovascular ones, associated with poor prognosis. However, chronic diseases tend to cluster into patterns, each with its particular repercussions on the clinical outcome of infected patients. Network analysis in our population revealed that not all cardiovascular patterns have the same risk of COVID-19 hospitalization or mortality and that this risk depends on the pattern of multimorbidity, besides age and sex. We evidenced that negative outcomes were strongly related to patterns in which diabetes and obesity stood out in older women and men, respectively. In younger adults, anxiety was another disease that increased the risk of severity, most notably when combined with menstrual disorders in women or atopic dermatitis in men. These results have relevant implications for organizational, preventive, and clinical actions to help meet the needs of COVID-19 patients.
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Affiliation(s)
- Jonás Carmona-Pírez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain. .,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain. .,Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain.
| | - Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Kevin Bliek-Bueno
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Preventive Medicine and Public Health Teaching Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Jesús Díez-Manglano
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain
| | - Ignatios Ioakeim-Skoufa
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,WHO Collaborating Centre for Drug Statistics Methodology, Norwegian Institute of Public Health, NO-0213, Oslo, Norway.,Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, NO-0213, Oslo, Norway.,Drug Utilization Work Group, Spanish Society of Family and Community Medicine (SEMFYC), S08009, Barcelona, Spain
| | - Francisca González-Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.,Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain.,Drug Utilization Work Group, Spanish Society of Family and Community Medicine (SEMFYC), S08009, Barcelona, Spain
| | - Antonio Poncel-Falcó
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.,Aragon Health Service (SALUD), 50017, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain
| | - Luis A Gimeno-Feliu
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.,Health Services Research On Chronic Patients Network (REDISSEC), Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.,San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), University of Zaragoza, Zaragoza, Spain
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31
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Onnis C, Muscogiuri G, Paolo Bassareo P, Cau R, Mannelli L, Cadeddu C, Suri JS, Cerrone G, Gerosa C, Sironi S, Faa G, Carriero A, Pontone G, Saba L. Non-invasive coronary imaging in patients with COVID-19: a narrative review. Eur J Radiol 2022; 149:110188. [PMID: 35180580 PMCID: PMC8805958 DOI: 10.1016/j.ejrad.2022.110188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/14/2022]
Abstract
SARS-CoV-2 infection, responsible for COVID-19 outbreak, can cause cardiac complications, worsening outcome and prognosis. In particular, it can exacerbate any underlying cardiovascular condition, leading to atherosclerosis and increased plaque vulnerability, which may cause acute coronary syndrome. We review current knowledge on the mechanisms by which SARS-CoV-2 can trigger endothelial/myocardial damage and cause plaque formation, instability and deterioration. The aim of this review is to evaluate current non-invasive diagnostic techniques for coronary arteries evaluation in COVID-19 patients, such as coronary CT angiography and atherosclerotic plaque imaging, and their clinical implications. We also discuss the role of artificial intelligence, deep learning and radiomics in the context of coronary imaging in COVID-19 patients.
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32
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Bradley SA, Banach M, Alvarado N, Smokovski I, Bhaskar SMM. Prevalence and impact of diabetes in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Diabetes 2022; 14:144-157. [PMID: 34939735 PMCID: PMC9060142 DOI: 10.1111/1753-0407.13243] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Diabetes is a cardiometabolic comorbidity that may predispose COVID-19 patients to worse clinical outcomes. This study sought to determine the prevalence of diabetes in hospitalized COVID-19 patients and investigate the association of diabetes severe COVID-19, rate of acute respiratory distress syndrome (ARDS), mortality, and need for mechanical ventilation by performing a systematic review and meta-analysis. METHODS Individual studies were selected using a defined search strategy, including results up until July 2021 from PubMed, Embase, and Cochrane Central Register of Controlled Trials. A random-effects meta-analysis was performed to estimate the proportions and level of association of diabetes with clinical outcomes in hospitalized COVID-19 patients. Forest plots were generated to retrieve the odds ratios (OR), and the quality and risk assessment was performed for all studies included in the meta-analysis. RESULTS The total number of patients included in this study was 10 648, of whom 3112 had diabetes (29.23%). The overall pooled estimate of prevalence of diabetes in the meta-analysis cohort was 31% (95% CI, 0.25-0.38; z = 16.09, P < .0001). Diabetes significantly increased the odds of severe COVID-19 (OR 3.39; 95% CI, 2.14-5.37; P < .0001), ARDS (OR 2.55; 95% CI, 1.74-3.75; P = <.0001), in-hospital mortality (OR 2.44; 95% CI, 1.93-3.09; P < .0001), and mechanical ventilation (OR 3.03; 95% CI, 2.17-4.22; P < .0001). CONCLUSIONS Our meta-analysis demonstrates that diabetes is significantly associated with increased odds of severe COVID-19, increased ARDS rate, mortality, and need for mechanical ventilation in hospitalized patients. We also estimated an overall pooled prevalence of diabetes of 31% in hospitalized COVID-19 patients.
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Affiliation(s)
- Sian A. Bradley
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences StreamIngham Institute for Applied Medical ResearchSydneyNew South WalesAustralia
- University of New South Wales (UNSW)South‐Western Sydney Clinical SchoolSydneyNew South WalesAustralia
| | - Maciej Banach
- Polish Mother's Memorial Hospital Research Institute and Department of HypertensionMedical University of LodzLodzPoland
- Cardiovascular Research CentreUniversity of Zielona GóraZielona GoraPoland
| | - Negman Alvarado
- Peripheral Neurophysiology ServiceNEUROMED‐ArgentinaGodoy CruzArgentina
- Department of NeurophysiologyMendoza Medical CenterGodoy CruzArgentina
| | - Ivica Smokovski
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders Skopje, Faculty of Medical SciencesUniversity Goce Delčev ŠtipŠtipNorth Macedonia
| | - Sonu M. M. Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences StreamIngham Institute for Applied Medical ResearchSydneyNew South WalesAustralia
- University of New South Wales (UNSW)South‐Western Sydney Clinical SchoolSydneyNew South WalesAustralia
- NSW Brain Clot BankNew South Wales Health PathologySydneyNew South WalesAustralia
- Department of Neurology and Neurophysiology, Comprehensive Stroke CenterLiverpool Hospital and South‐Western Sydney Local Health DistrictSydneyNew South WalesAustralia
- Stroke and Neurology Research GroupIngham Institute for Applied Medical ResearchLiverpoolNew South WalesAustralia
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Di Ciaula A, Krawczyk M, Filipiak KJ, Geier A, Bonfrate L, Portincasa P. Noncommunicable diseases, climate change and iniquities: What COVID-19 has taught us about syndemic. Eur J Clin Invest 2021; 51:e13682. [PMID: 34551123 PMCID: PMC8646618 DOI: 10.1111/eci.13682] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND COVID-19 is generating clinical challenges, lifestyle changes, economic consequences. The pandemic imposes to familiarize with concepts as prevention, vulnerability and resilience. METHODS We analysed and reviewed the most relevant papers in the MEDLINE database on syndemic, noncommunicable diseases, pandemic, climate changes, pollution, resilience, vulnerability, health costs, COVID-19. RESULTS We discuss that comprehensive strategies must face multifactorial consequences since the pandemic becomes syndemic due to interactions with noncommunicable diseases, climate changes and iniquities. The lockdown experience, on the other hand, demonstrates that it is rapidly possible to reverse epidemiologic trends and to reduce pollution. The worst outcome is evident in eight highly industrialized nations, where 12% of the world population experienced about one-third of all COVID-19-deaths worldwide. Thus, a great economic power has not been fully protective, and a change of policy is obviously needed to avoid irreversible consequences. CONCLUSIONS We are accumulating unhealthy populations living in unhealthy environments and generating unhealthy offspring. The winning policy should tackle structural inequities through a syndemic approach, to protect vulnerable populations from present and future harms.
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Affiliation(s)
- Agostino Di Ciaula
- Department of Biomedical Sciences and Human OncologyClinica Medica ‘A. Murri’University of Bari ‘Aldo Moro’ Medical SchoolBariItaly
| | - Marcin Krawczyk
- Department of Medicine IISaarland University Medical CenterSaarland UniversityHomburgGermany
- Laboratory of Metabolic Liver DiseasesDepartment of General, Transplant and Liver SurgeryCentre for Preclinical ResearchMedical University of WarsawWarsawPoland
| | | | - Andreas Geier
- Division of HepatologyDepartment of Internal Medicine IIUniversity Hospital WürzburgWürzburgGermany
| | - Leonilde Bonfrate
- Department of Biomedical Sciences and Human OncologyClinica Medica ‘A. Murri’University of Bari ‘Aldo Moro’ Medical SchoolBariItaly
| | - Piero Portincasa
- Department of Biomedical Sciences and Human OncologyClinica Medica ‘A. Murri’University of Bari ‘Aldo Moro’ Medical SchoolBariItaly
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Gimeno-Miguel A, Bliek-Bueno K, Poblador-Plou B, Carmona-Pírez J, Poncel-Falcó A, González-Rubio F, Ioakeim-Skoufa I, Pico-Soler V, Aza-Pascual-Salcedo M, Prados-Torres A, Gimeno-Feliu LA. Chronic diseases associated with increased likelihood of hospitalization and mortality in 68,913 COVID-19 confirmed cases in Spain: A population-based cohort study. PLoS One 2021; 16:e0259822. [PMID: 34767594 PMCID: PMC8589220 DOI: 10.1371/journal.pone.0259822] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background Clinical outcomes among COVID-19 patients vary greatly with age and underlying comorbidities. We aimed to determine the demographic and clinical factors, particularly baseline chronic conditions, associated with an increased risk of severity in COVID-19 patients from a population-based perspective and using data from electronic health records (EHR). Methods Retrospective, observational study in an open cohort analyzing all 68,913 individuals (mean age 44.4 years, 53.2% women) with SARS-CoV-2 infection between 15 June and 19 December 2020 using exhaustive electronic health registries. Patients were followed for 30 days from inclusion or until the date of death within that period. We performed multivariate logistic regression to analyze the association between each chronic disease and severe infection, based on hospitalization and all-cause mortality. Results 5885 (8.5%) individuals showed severe infection and old age was the most influencing factor. Congestive heart failure (odds ratio -OR- men: 1.28, OR women: 1.39), diabetes (1.37, 1.24), chronic renal failure (1.31, 1.22) and obesity (1.21, 1.26) increased the likelihood of severe infection in both sexes. Chronic skin ulcers (1.32), acute cerebrovascular disease (1.34), chronic obstructive pulmonary disease (1.21), urinary incontinence (1.17) and neoplasms (1.26) in men, and infertility (1.87), obstructive sleep apnea (1.43), hepatic steatosis (1.43), rheumatoid arthritis (1.39) and menstrual disorders (1.18) in women were also associated with more severe outcomes. Conclusions Age and specific cardiovascular and metabolic diseases increased the risk of severe SARS-CoV-2 infections in men and women, whereas the effects of certain comorbidities are sex specific. Future studies in different settings are encouraged to analyze which profiles of chronic patients are at higher risk of poor prognosis and should therefore be the targets of prevention and shielding strategies.
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Affiliation(s)
- Antonio Gimeno-Miguel
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Kevin Bliek-Bueno
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Preventive Medicine and Public Health Teaching Unit, Miguel Servet University Hospital, Zaragoza, Spain
- * E-mail:
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Jonás Carmona-Pírez
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Antonio Poncel-Falcó
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
| | - Francisca González-Rubio
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- Delicias-Sur Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), Barcelona, Spain
| | - Ignatios Ioakeim-Skoufa
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), Barcelona, Spain
- WHO Collaborating Centre for Drug Statistics Methodology, Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Victoria Pico-Soler
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- Torrero-La Paz Primary Care Health Centre, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Mercedes Aza-Pascual-Salcedo
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- Primary Care Pharmacy Service Zaragoza III, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
| | - Luis Andrés Gimeno-Feliu
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), ISCIII, Madrid, Spain
- San Pablo Primary Care Health Centre, Aragon Health Service (SALUD), University of Zaragoza, Zaragoza, Spain
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Kantroo V, Kanwar MS, Goyal P, Rosha D, Modi N, Bansal A, Ansari AP, Wangnoo SK, Sobti S, Kansal S, Chawla R, Jasuja S, Gupta I. Mortality and Clinical Outcomes among Patients with COVID-19 and Diabetes. Med Sci (Basel) 2021; 9:medsci9040065. [PMID: 34842758 PMCID: PMC8628982 DOI: 10.3390/medsci9040065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Diabetes mellitus (DM) is a decisive risk factor for severe illness in coronavirus disease 2019 (COVID-19). India is home to a large number of people with DM, and many of them were infected with COVID-19. It is critical to understand the impact of DM on mortality and other clinical outcomes of COVID-19 infection from this region. Aims The primary objective of our study was to analyze the mortality rate in people with DM infected with COVID-19. The secondary objectives were to assess the effect of various comorbidities on mortality and study the impact of DM on other clinical outcomes. Methods This is a retrospective study of COVID-19 infected patients admitted to a tertiary care hospital in north India in the early phase of the pandemic. Results Of the 1211 cases admitted, 19 were excluded because of incomplete data, and 1192 cases were finally considered for analysis. DM constituted 26.8% of total patients. The overall mortality rate was 6.1%, and the rate was 10.7% in the presence of diabetes (p < 0.01, OR 2.55). In univariate analysis, increased age, chronic kidney disease (CKD), coronary artery disease (CAD), stroke, and cancer were associated with mortality. On multiple logistic regression, the independent predictors of mortality were CAD, CKD, and cancer. Breathlessness and low SpO2 at presentation, extensive involvement in CXR, and elevated ANC/ALC ratio were also significantly associated with mortality. Conclusions The presence of comorbidities such as DM, hypertension, CAD, CKD, and cancer strongly predict the risk of mortality in COVID-19 infection. Early triaging and aggressive therapy of patients with these comorbidities can optimize clinical outcomes.
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Affiliation(s)
- Viny Kantroo
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
- Correspondence:
| | - Manjit S. Kanwar
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Piyush Goyal
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Deepak Rosha
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Nikhil Modi
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Avdhesh Bansal
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Athar Parvez Ansari
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Subhash Kumar Wangnoo
- Department of Apollo Centre of Diabetes and Endocrinology, Indraprastha Apollo Hospitals, New Delhi 110076, India;
| | - Sanjay Sobti
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Sudha Kansal
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Rajesh Chawla
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
| | - Sanjiv Jasuja
- Department of Nephrology and Kidney Transplant, Indraprastha Apollo Hospitals, New Delhi 110076, India;
| | - Ishan Gupta
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi 110076, India; (M.S.K.); (P.G.); (D.R.); (N.M.); (A.B.); (A.P.A.); (S.S.); (S.K.); (R.C.); (I.G.)
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Du Laing G, Petrovic M, Lachat C, De Boevre M, Klingenberg GJ, Sun Q, De Saeger S, De Clercq J, Ide L, Vandekerckhove L, Schomburg L. Course and Survival of COVID-19 Patients with Comorbidities in Relation to the Trace Element Status at Hospital Admission. Nutrients 2021; 13:nu13103304. [PMID: 34684306 PMCID: PMC8541297 DOI: 10.3390/nu13103304] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/22/2022] Open
Abstract
Selenium (Se) and zinc (Zn) are essential trace elements needed for appropriate immune system responses, cell signalling and anti-viral defence. A cross-sectional observational study was conducted at two hospitals in Ghent, Belgium, to investigate whether Se and/or Zn deficiency upon hospital admission correlates to disease severity and mortality risk in COVID-19 patients with or without co-morbidities. Trace element concentrations along with additional biomarkers were determined in serum or plasma and associated to disease severity and outcome. An insufficient Se and/or Zn status upon hospital admission was associated with a higher mortality rate and a more severe disease course in the entire study group, especially in the senior population. In comparison to healthy European adults, the patients displayed strongly depressed total Se (mean ± SD: 59.2 ± 20.6 vs. 84.4 ± 23.4 µg L−1) and SELENOP (mean ± SD: 2.2 ± 1.9 vs. 4.3 ± 1.0 mg L−1) concentrations at hospital admission. Particularly strong associations were observed for death risk of cancer, diabetes and chronic cardiac disease patients with low Se status, and of diabetes and obese patients with Zn deficiency. A composite biomarker based on serum or plasma Se, SELENOP and Zn at hospital admission proved to be a reliable tool to predict severe COVID-19 course and death, or mild disease course. We conclude that trace element assessment at hospital admission may contribute to a better stratification of patients with COVID-19 and other similar infectious diseases, support clinical care, therapeutic interventions and adjuvant supplementation needs, and may prove of particular relevance for patients with relevant comorbidities.
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Affiliation(s)
- Gijs Du Laing
- Laboratory of Analytical Chemistry and Applied Ecochemistry, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium
- Correspondence:
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium; (M.P.); (J.D.C.); (L.V.)
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Coupure Links 653, 9000 Gent, Belgium;
| | - Marthe De Boevre
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ottergemsesteenweg 460, 9000 Gent, Belgium; (M.D.B.); (S.D.S.)
| | - Georg J. Klingenberg
- Institute of Experimental Endocrinology, Charité Universitätsmedizin, Hessische Straße 3-4, 10115 Berlin, Germany; (G.J.K.); (Q.S.); (L.S.)
| | - Qian Sun
- Institute of Experimental Endocrinology, Charité Universitätsmedizin, Hessische Straße 3-4, 10115 Berlin, Germany; (G.J.K.); (Q.S.); (L.S.)
| | - Sarah De Saeger
- Centre of Excellence in Mycotoxicology and Public Health, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ottergemsesteenweg 460, 9000 Gent, Belgium; (M.D.B.); (S.D.S.)
| | - Jozefien De Clercq
- Department of Internal Medicine and Paediatrics, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium; (M.P.); (J.D.C.); (L.V.)
| | - Louis Ide
- Laboratory Medicine, AZ Jan Palfijn AV, Watersportlaan 5, 9000 Gent, Belgium;
| | - Linos Vandekerckhove
- Department of Internal Medicine and Paediatrics, Ghent University Hospital, C. Heymanslaan 10, 9000 Gent, Belgium; (M.P.); (J.D.C.); (L.V.)
| | - Lutz Schomburg
- Institute of Experimental Endocrinology, Charité Universitätsmedizin, Hessische Straße 3-4, 10115 Berlin, Germany; (G.J.K.); (Q.S.); (L.S.)
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Ramos-Lopez O, San-Cristobal R, Martinez-Urbistondo D, Micó V, Colmenarejo G, Villares-Fernandez P, Daimiel L, Martinez JA. Proinflammatory and Hepatic Features Related to Morbidity and Fatal Outcomes in COVID-19 Patients. J Clin Med 2021; 10:jcm10143112. [PMID: 34300279 PMCID: PMC8306049 DOI: 10.3390/jcm10143112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE to screen putative associations between liver markers and proinflammatory-related features concerning infectious morbidity and fatal outcomes in COVID-19 patients. METHODS a total of 2094 COVID-19 positive patients from the COVID-DATA-SAFE-LIFES cohort (HM hospitals consortium) were classified according to median values of hepatic, inflammatory, and clinical indicators. Logistic regression models were fitted and ROC cures were generated to explain disease severity and mortality. RESULTS intensive care unit (ICU) assistance plus death outcomes were associated with liver dysfunction, hyperinflammation, respiratory insufficiency, and higher associated comorbidities. Four models including age, sex, neutrophils, D-dimer, oxygen saturation lower than 92%, C-reactive protein (CRP), Charlson Comorbidity Index (CCI), FIB-4 and interactions with CRP, neutrophils, and CCI explained ICU plus death variance in more than 28%. The predictive values of ROC curves were: FIB-4 (0.7339), AST/ALT ratio (0.7107), CRP (0.7003), CCI index (0.6778), neutrophils (0.6772), and platelets (0.5618) concerning ICU plus death outcomes. CONCLUSIONS the results of this research revealed that liver and proinflammatory features are important determinants of COVID-19 morbidity and fatal outcomes, which could improve the current understanding of the COVID-19 physiopathology as well as to facilitate the clinical management and therapy decision-making of this disease under a personalized medicine scope.
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Affiliation(s)
- Omar Ramos-Lopez
- Medicine and Psychology School, Autonomous University of Baja California, Tijuana 22390, Mexico;
| | - Rodrigo San-Cristobal
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain;
| | | | - Víctor Micó
- Nutritional Control of the Epigenome Group, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain; (V.M.); (L.D.)
| | - Gonzalo Colmenarejo
- Biostatistics and Bioinformatics Unit, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain;
| | | | - Lidia Daimiel
- Nutritional Control of the Epigenome Group, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain; (V.M.); (L.D.)
| | - J. Alfredo Martinez
- Precision Nutrition and Cardiometabolic Health, IMDEA Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain;
- Department of Nutrition, Food Science, Physiology and Toxicology, Centre for Nutrition Research, University of Navarra, 31009 Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31009 Pamplona, Spain
- Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBERobn), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948-425600
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