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Dababseh MMO, Sabaka P, Duraníková O, Horváthová S, Valkovič P, Straka I, Nagyová A, Boža V, Kravec M, Jurenka J, Koščálová A, Mihalov P, Marešová E, Bendžala M, Kušnírová A, Stankovič I. Delayed Antibody Response in the Acute Phase of Infection Is Associated with a Lower Mental Component of Quality of Life in Survivors of Severe and Critical COVID-19. J Clin Med 2024; 13:1938. [PMID: 38610703 PMCID: PMC11012816 DOI: 10.3390/jcm13071938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) significantly affects quality of life (QoL) in disease survivors. Delayed development of the adaptive immune response is associated with more severe disease and a worse prognosis in COVID-19. The effects of delayed immune response on COVID-19 sequelae and QoL are unknown. Methods: We conducted a prospective study to assess the relationship between the delayed antibody response in the acute phase of infection in naïve unvaccinated patients suffering from severe or critical COVID-19 and their QoL 12 months after hospital discharge. The 12-item Short Form Survey (SF-12) questionnaire was used for assessment of QoL. The SF-12 evaluates both mental and physical components of QoL, incorporating a mental component score (MCS-12) and a physical component score (PCS-12). A delayed antibody response was defined as testing negative for anti-spike SARS-CoV-2 antibodies at the time of hospital admission. Results: The study included 274 patients (154 men and 120 women). Of the enrolled patients, 144 had a delayed immune response. These patients had a significantly lower MCS-12 (p = 0.002), but PCS-12 (p = 0.397) was not significantly different at the 12-month follow-up compared to patients with positive anti-spike SARS-CoV-2 antibodies. The MCS-12 at the time of follow-up was negatively associated with delayed antibody response irrespective of possible confounders (p = 0.006; B = 3.609; ηp2 = 0.035; 95% CI = 1.069-6.150). An MSC-12 below 50 points at the time of follow-up was positively associated with delayed antibody response (p = 0.001; B = 1.092; OR = 2.979; 95% CI = 1.554-5.711). Conclusions: This study confirmed that, in patients with severe and critical COVID-19, a negative result for anti-spike SARS-CoV-2 antibodies at the time of hospital admission is associated with a lower mental component of QoL in unvaccinated patients naïve to COVID-19 one year after hospital discharge.
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Affiliation(s)
- Mohammad Mahmud Otman Dababseh
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Peter Sabaka
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Oľga Duraníková
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Simona Horváthová
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
- Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, 814 38 Bratislava, Slovakia
| | - Igor Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Anna Nagyová
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Vladimír Boža
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, 842 48 Bratislava, Slovakia (M.K.)
| | - Marián Kravec
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, 842 48 Bratislava, Slovakia (M.K.)
| | - Ján Jurenka
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Alena Koščálová
- Department of Infectology, Slovak Medical University, 833 05 Bratislava, Slovakia;
| | - Peter Mihalov
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Eliška Marešová
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Matej Bendžala
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Alice Kušnírová
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Igor Stankovič
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
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Sabaka P, Koščálová A, Straka I, Hodosy J, Lipták R, Kmotorková B, Kachlíková M, Kušnírová A. Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak. BMC Infect Dis 2021; 21:308. [PMID: 33781216 PMCID: PMC8006112 DOI: 10.1186/s12879-021-05945-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Covid-19 is a disease with high morbidity and mortality among elderly residents of long-term care facilities (LTCF). During an outbreak of SARS-CoV-2 infection in the LTCF an effective screening tool is essential to identify the patients at risk for severe disease. We explored the role of interleukin 6 (IL-6) as a predictor for severe disease during the outbreak of Covid-19 in one LTCF in Slovakia. METHODS We conducted a retrospective data analysis of cases of COVID-19, diagnosed during the outbreak in one LTCF in Slovakia between April 11, 2020, and May 5, 2020. Within 24 h after the diagnosis of Covid-19, clinical and laboratory screening was performed in the LTCF to identify patients in need of hospitalization. Patients with oxygen saturation below 90% were immediately referred to the hospital. Patients staying in the LFTC were monitored daily and those that developed hypoxemia were transferred to the hospital. We analyzed the association between the IL-6 at the initial assessment and development of hypoxemia during follow up and determined the cut-off of the IL-6 able to predict the development of hypoxemia requiring oxygen therapy. RESULTS Fifty-three patients (11 men, 42 women) with diagnosed Covid-19 were included in the analysis. 19 (53%) patients developed hypoxemia during the disease. Patients with hypoxemia had significantly higher concentrations of IL-6, C-reactive protein, procalcitonin, fibrinogen, total bilirubin, aspartate aminotransferase and alanine aminotransferase at initial screening. ROC analyses identified IL-6 as the most robust predictor of hypoxemia. The concentration of IL-6 > 24 pg/mL predicted the development of hypoxemia with the sensitivity of 100% and specificity of 88.9%. The positive and negative predictive values were 76.9, and 100% respectively. CONCLUSIONS The concentration of IL-6 > 24 pg/mL at initial assessment predicted the development of hypoxemia requiring hospitalization with excellent sensitivity and good specificity. IL-6 appears as a potential predictor for the development of the severe Covid-19 and might serve for early identification of patients in need of hospitalization. Further studies are needed to evaluate the robustness of the use of IL-6 as an effective screening tool for the severe course of Covid-19.
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Affiliation(s)
- P. Sabaka
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - A. Koščálová
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - I. Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - J. Hodosy
- Emergency Department, University Hospital in Bratislava, Bratislava, Slovakia
- Institute of Molecular Biomedicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - R. Lipták
- Emergency Department, University Hospital in Bratislava, Bratislava, Slovakia
- Institute of Physiology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - B. Kmotorková
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - M. Kachlíková
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - A. Kušnírová
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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Gmitterová K, Minár M, Žigrai M, Košutzká Z, Kušnírová A, Valkovič P. Tacrolimus-induced parkinsonism in a patient after liver transplantation - case report. BMC Neurol 2018; 18:44. [PMID: 29678162 PMCID: PMC5909232 DOI: 10.1186/s12883-018-1052-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatic encephalopathy may manifest by a wide spectrum of neuropsychiatric symptoms, including cognitive impairment, seizures or extrapyramidal symptoms. The liver transplant can lead to improvement of the signs of encephalopathy but subsequent immunosuppressive treatment might possess pronounced neurotoxicity. CASE PRESENTATION We present a case report of a patient with chronic liver disease who developed signs of Parkinsonism after an orthotopic liver transplant, with consecutive immunosuppressant treatment with tacrolimus. Despite the improvement of liver functions due to the cytostatic treatment, a progressive worsening of neuropsychiatric symptoms associated with the presence of tremor was observed. Metabolic as well as endocrine dysfunctions were excluded as the primary causes of this condition. A brain CT did not reveal structural pathology. Signs of severe, symmetric Parkinsonism - with resting tremor, bradykinesia, rigidity and severe postural instability were observed. A brain MRI was performed with the presence of T2- hyperintensities in basal ganglia bilaterally. Tacrolimus blood concentration was elevated; hence the dose was reduced and later switched to less toxic sirolimus. Subsequently, clinical signs markedly improved after treatment modification. Improvement of clinical symptomatology after tacrolimus discontinuation supports the drug-induced etiology of this neurological condition. CONCLUSIONS Cytostatic treatment after solid organ transplantation often leads to signs of encephalopathy. If necessary, the dose of cytostatics needs to be reduced, or a less toxic agent must be chosen for the therapy. This modification is usually efficient with no further need for neurological intervention.
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Affiliation(s)
- Karin Gmitterová
- Second Department of Neurology, Comenius University, Limbova 5, 833 05, Bratislava, Slovakia.
| | - Michal Minár
- Second Department of Neurology, Comenius University, Limbova 5, 833 05, Bratislava, Slovakia
| | - Miroslav Žigrai
- First Department of Internal Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Zuzana Košutzká
- Second Department of Neurology, Comenius University, Limbova 5, 833 05, Bratislava, Slovakia
| | - Alice Kušnírová
- Second Department of Neurology, Comenius University, Limbova 5, 833 05, Bratislava, Slovakia
| | - Peter Valkovič
- Second Department of Neurology, Comenius University, Limbova 5, 833 05, Bratislava, Slovakia.,Institute of Normal and Pathological Physiology, Slovak Academy of Science, Bratislava, Slovakia
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Marková J, Hajdúk M, Košutzká Z, Kušnírová A, Pápayová M, Egryová M, Valkovič P, Cséfalvay Z. Sentence comprehension in Slovak-speaking patients with Parkinson disease. Cesk Slov Neurol N 2018. [DOI: 10.14735/amcsnn201860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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