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GÜLER AAVANOGLU, ÖZÇİMEN B, AYDOĞDU MS, SARI A, NUMUNE A, ERSAN NTÜZÜN, ÇOLAK S, KARADENİZ H, VASİ İ, KÜÇÜK H, YALÇINKAYA Y, ERDEN A, KAYAALP M, ÖZTÜRK MA, GÖKER B, OMMA A, YILMAZ S, KOCA SS, İNANÇ M, AKDOĞAN A, TUFAN A. Clinical characteristics and disease course before and after SARS-CoV-2 infection in a large cohort of systemic sclerosis patients. Turk J Med Sci 2023; 54:76-85. [PMID: 38812619 PMCID: PMC11031159 DOI: 10.55730/1300-0144.5768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/15/2024] [Accepted: 12/21/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The objective of this study is to evaluate the clinical presentations and adverse outcomes of Coronavirus Disease 2019 (COVID-19) in patients with systemic sclerosis (SSc) and assess the impact of SSc features on the clinical course of COVID-19. Materials and methods In this multicenter, retrospective study, SSc patients with COVID-19 were included. Clinical features of SSc, along with detailed COVID-19 data, were extracted from medical records and patient interviews. Results The study included 112 patients (mean age 51.4 ± 12.8 years; 90.2% female). SSc-associated interstitial lung disease (ILD) was evident in 57.1% of the patients. The findings revealed hospitalization in 25.5%, respiratory support in 16.3%, intensive care unit admission in 3.6%, and a mortality rate of 2.7% among SSc patients with COVID-19. Risk factors for respiratory failure, identified through univariate analysis, included ILD (OR: 7.49, 95% CI: 1.63-34.46), ≥1 comorbidity (OR: 4.55, 95% CI: 1.39-14.88), a higher physician global assessment score at the last outpatient visit (OR 2.73, 95% CI: 1.22-6.10), and the use of mycophenolate at the time of infection (OR: 5.16, 95 %CI: 1.79-14.99). Notably, ≥1 comorbidity emerged as the sole significant predictor of the need for respiratory support in COVID-19 (OR: 5.78, 95% CI: 1.14-29.23). In the early post-COVID-19 period, 17% of patients reported the progression of the Raynaud phenomenon, and 10.6% developed new digital ulcers. Furthermore, progression or new onset of dyspnea and cough were detected in 28.3% and 11.4% of patients, respectively. Conclusion This study suggests a potential association between adverse outcomes of COVID-19 and SSc-related ILD, severe disease activity, and the use of mycophenolate. Additionally, it highlights that having comorbidities is an independent risk factor for the need for respiratory support in COVID-19 cases.
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Affiliation(s)
- Aslıhan AVANOGLU GÜLER
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Büşra ÖZÇİMEN
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Mesude Seda AYDOĞDU
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazığ,
Turkiye
| | - Alper SARI
- Department of Rheumatology, Etlik City Hospital, Ankara,
Turkiye
| | - Aliyeva NUMUNE
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Nazife TÜZÜN ERSAN
- Department of Internal Medicine, Gazi University Hospital, Ankara,
Turkiye
| | - Seda ÇOLAK
- Department of Rheumatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Hazan KARADENİZ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - İbrahim VASİ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Hamit KÜÇÜK
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Yasemin YALÇINKAYA
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Abdülsamet ERDEN
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Mehmet KAYAALP
- Department of Internal Medicine, Yıldırım Beyazıt University, Ankara,
Turkiye
| | - Mehmet Akif ÖZTÜRK
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Berna GÖKER
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
| | - Ahmet OMMA
- Department of Rheumatology, Ankara City Hospital, Health Sciences University, Ankara,
Turkiye
| | - Sedat YILMAZ
- Department of Rheumatology, Gülhane Training and Research Hospital, University of Health Sciences, Ankara,
Turkiye
| | - Süleyman Serdar KOCA
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fırat University, Elazığ,
Turkiye
| | - Murat İNANÇ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, İstanbul University, İstanbul,
Turkiye
| | - Ali AKDOĞAN
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara,
Turkiye
| | - Abdurrahman TUFAN
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gazi University, Ankara,
Turkiye
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, Maryland,
USA
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Karadeniz H, Avanoğlu Güler A, Özger HS, Yıldız PA, Erbaş G, Bozdayı G, Deveci Bulut T, Gülbahar Ö, Yapar D, Küçük H, Öztürk MA, Tufan A. The Prognostic Value of Lung Injury and Fibrosis Markers, KL-6,
TGF-β1, FGF-2 in COVID-19 Patients. Biomark Insights 2022; 17:11772719221135443. [PMCID: PMC9643117 DOI: 10.1177/11772719221135443] [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: 07/07/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022] Open
Abstract
Background: Biomarkers of lung injury and interstitial fibrosis give insight about the
extent of involvement and prognosis in well-known interstitial lung diseases
(ILD). Serum Krebs von den Lungen-6 (KL-6) reflects direct alveolar injury
and, transforming growth factor-beta1 (TGF-β1) and fibroblast growth
factor-2 (FGF-2) are principal mediators of fibrosis in ILD and in almost
all fibrotic diseases. In this sense, we aimed to assess associations of
these biomarkers with traditional inflammatory markers and clinical course
of COVID-19. Methods: Patients with COVID-19 who had confirmed diagnosis with SARS-CoV-2 nucleic
acid RT-PCR were enrolled and followed up prospectively with a standardized
approach one month after diagnosis. Patients were divided into severe and
non-severe groups according to National Institutes of Health criteria.
Outcome was assessed for the requirement of intensive care unit (ICU)
admission, long term respiratory support and death. Blood samples were
collected at enrollment and serum levels of KL-6, TGF-β1, FGF-2 were
determined by ELISA. Association between these markers with other prognostic
markers and prognosis were analyzed. Results: Overall 31 severe and 28 non-severe COVID-19 patients were enrolled and were
compared with healthy control subjects (n = 30). Serum KL-6 levels in
COVID-19 patients were significantly higher (median [IQR]; 11.54 [4.86] vs
8.54 [3.98] ng/mL, P = .001] and FGF-2 levels were lower
(median [IQR]; 76.84 [98.2] vs 101.62 [210.6] pg/mL) compared to healthy
control group. A significant correlation was found between KL-6 values and
CRP, fibrinogen, d-dimer and lymphocyte counts. However, we did not
find an association between these markers and subsequent severity of
COVID-19, mortality and long-term prognosis. Conclusions: Serum KL-6 levels were significantly elevated at the diagnosis of COVID-19
and correlated well with the other traditional prognostic inflammatory
markers. Serum levels of principal fibrosis mediators, TGF-β1, FGF-2, were
not elevated at diagnosis of COVID-19, therefore did not help to anticipate
long term prognosis.
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Affiliation(s)
- Hazan Karadeniz
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey,Hazan Karadeniz, Department of Internal
Medicine, Division of Rheumatology, Gazi University Faculty of Medicine,
Bahriucok Street, Ankara 06100, Turkey.
| | - Aslıhan Avanoğlu Güler
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hasan Selçuk Özger
- Department of Infectious Disease, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Pınar Aysert Yıldız
- Department of Infectious Disease, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Gonca Erbaş
- Department of Radiology, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Gülendam Bozdayı
- Department of Medical Microbiology,
Gazi University Faculty of Medicine, Ankara, Turkey
| | - Tuba Deveci Bulut
- Department of Biochemistry, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Özlem Gülbahar
- Department of Biochemistry, Gazi
University Faculty of Medicine, Ankara, Turkey
| | - Dilek Yapar
- Department of Public Health and
Biostatistics Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Hamit Küçük
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of
Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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Yildirim D, Inan MA, Akyurek N, Tufan A. Vexas Syndrome Presenting As Long Covid-19. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1887-5341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Abstract
Objective VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic)
syndrome is a recently described systemic inflammatory syndrome caused by
somatic mutations of UBA1. COVID-19 is a viral infection that was described in
2019 and spread widely and quickly all around the world. Constitutional,
thrombotic and pulmonary symptoms of these two conditions are similar, which is
why cases of VEXAS syndrome may be misdiagnosed as a COVID infection.
Case report We introduced a case report of a 72-year-old male patient with
VEXAS syndrome who had fever, fatigue, deep vein thrombosis and a cough and was
thought to have a long COVID-19 infection for one year. Then we diagnosed him
with VEXAS syndrome with vacuoles in myelomonocytic cells, skin lesions and a
mutation of the UBA-1 gene.
Conclusion VEXAS and long COVID are two new conditions with overlapping
clinical presentations. Physicians must be aware of these clinical conditions
because of their different treatment strategy and prognosis.
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Affiliation(s)
- Derya Yildirim
- Rheumatology, Gazi Universitesi Tip Fakultesi, Ankara,
Turkey
| | | | - Nalan Akyurek
- pathology, Gazi Universitesi Tip Fakultesi, Ankara,
Turkey
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Avanoglu Guler A, Yuce Inel T, Kasifoglu T, Coskun C, Karadeniz H, Yildirim D, Bilici R, Satis H, Kucuk H, Haznedaroglu S, Goker B, Ozturk MA, Sari I, Tufan A. COVID-19 in Familial Mediterranean Fever: Clinical Course and Complications Related to Primary Disease. Mod Rheumatol 2022:6647632. [PMID: 35860978 PMCID: PMC9384523 DOI: 10.1093/mr/roac074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/06/2022] [Accepted: 07/20/2022] [Indexed: 01/08/2023]
Abstract
Objectives To evaluate the impact of familial Mediterranean fever (FMF) features on the clinical course and outcomes of coronavirus disease 2019 (COVID-19) and clinical course of FMF after COVID-19. Methods Consecutive FMF patients with COVID-19 were enrolled from three referral hospitals. Clinical features of FMF and detailed COVID-19 information were obtained from patient interviews and medical records. Results Seventy-three FMF patients were included in the study. 94.5% of patients had clinical symptoms of COVID-19. We found 24.7% hospitalization, 12.3% respiratory support, 4.1% intensive care unit admission, 6.8% complication, and 1.4% mortality rate in patients. The risk factors of hospitalization for respiratory support were male gender [OR: 7.167 (95% CI: 1.368–37.535)], greater age [OR: 1.067 (95% CI: 1.016–1.121)], and non-adherence to colchicine treatment before the infection [OR: 7.5 (95% CI: 1.348–41.722)]. One-third of patients had reported attacks after COVID-19. The patterns of triggered attacks were fever, peritonitis, pleuritis, transient arthritis, chronic knee mono-arthritis, and protracted febrile myalgia. Conclusions FMF characteristics were not associated with worse outcomes of COVID-19. Colchicine non-adherence was the risk factor of hospitalization for oxygen support. The rate of FMF attacks after COVID-19 is prominently increased, with some of them being protracted and destructive.
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Affiliation(s)
| | - Tuba Yuce Inel
- Dokuz Eylul University Faculty of Medicine Hospital Rheumatology Department, Izmir, Turkey
| | - Timucin Kasifoglu
- Eskisehir Osmangazi University Faculty of Medicine Hospital Rheumatology Department, Eskisehir, Turkey
| | - Cansu Coskun
- Gazi University Faculty of Medicine Hospital Internal Medicine Department, Ankara, Turkey
| | - Hazan Karadeniz
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Derya Yildirim
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Reyhan Bilici
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Hasan Satis
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Hamit Kucuk
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Seminur Haznedaroglu
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Berna Goker
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Mehmet Akif Ozturk
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
| | - Ismail Sari
- Dokuz Eylul University Faculty of Medicine Hospital Rheumatology Department, Izmir, Turkey
| | - Abdurrahman Tufan
- Gazi University Faculty of Medicine Hospital Rheumatology Department, Ankara, Turkey
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