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Schiano Moriello N, Pinchera B, Gentile I. Personalized care approaches to hepatitis C therapy: recent advances and future directions. Expert Rev Anti Infect Ther 2024; 22:139-151. [PMID: 38459735 DOI: 10.1080/14787210.2024.2328336] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The introduction of direct-acting antivirals (DAAs) has significantly transformed the therapeutic landscape for chronic C hepatitis virus (HCV) infection. However, there is still room for further improvement in optimizing therapy efficacy and minimizing adverse effects. AREAS COVERED This review is devoted to the rationale for adopting a personalized approach to HCV therapy. Specifically, we explore the role of host-related factors, such as sex or the presence of comorbidities. We thoroughly examine the implications of commonly encountered comorbidities, including HIV infection, chronic renal disease, liver cirrhosis, and other chronic viral hepatitis infections. Additionally, we discuss the prevalent drug-to-drug interactions between DAAs and other medications, while providing guidance on their management. Finally, we investigate viral-related issues that can influence treatment outcomes, such as viral genotype, quasi-species, and the presence of resistance-associated mutations. EXPERT OPINION Despite pivotal trials demonstrating efficacy rates exceeding 90% for currently available DAA regimens, there are still opportunities to optimize therapy outcomes and tailor treatment to each patient. This can be achieved through a meticulous evaluation of the patient's specific clinical conditions and comorbidities, a vigilant approach to manage potential drug interactions, and diligent patient follow-up.
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Affiliation(s)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Bologna E, Licari LC, Manfredi C, Ditonno F, Cirillo L, Fusco GM, Abate M, Passaro F, Di Mauro E, Crocetto F, Pandolfo SD, Aveta A, Cilio S, Di Filippo I, Barone B, Franco A, Arcaniolo D, La Rocca R, Pinchera B, Napolitano L. Carbapenem-Resistant Enterobacteriaceae in Urinary Tract Infections: From Biological Insights to Emerging Therapeutic Alternatives. Medicina (Kaunas) 2024; 60:214. [PMID: 38399502 PMCID: PMC10889937 DOI: 10.3390/medicina60020214] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Urinary tract infections (UTIs) are the second most frequent type of infection observed in clinical practice. Gram-negative Enterobacteriaceae are common pathogens in UTIs. Excessive antibiotic use in humans and animals, poor infection control, and increased global travel have accelerated the spread of multidrug-resistant strains (MDR). Carbapenem antibiotics are commonly considered the last line of defense against MDR Gram-negative bacteria; however, their efficacy is now threatened by the increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE). This comprehensive review aims to explore the biological mechanisms underlying carbapenem resistance and to present a focus on therapeutic alternatives currently available for complicated UTIs (cUTIs). A comprehensive bibliographic search was conducted on the PubMed/MEDLINE, Scopus, and Web of Science databases in December 2023. The best evidence on the topic was selected, described, and discussed. Analyzed with particular interest were the clinical trials pivotal to the introduction of new pharmacological treatments in the management of complicated cUTIs. Additional suitable articles were collected by manually cross-referencing the bibliography of previously selected papers. This overview provides a current and comprehensive examination of the treatment options available for CRE infections, offering a valuable resource for understanding this constantly evolving public health challenge.
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Affiliation(s)
- Eugenio Bologna
- Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University, 00161 Rome, Italy; (E.B.); (L.C.L.)
| | - Leslie Claire Licari
- Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, “Sapienza” University, 00161 Rome, Italy; (E.B.); (L.C.L.)
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Francesco Ditonno
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37100 Verona, Italy;
| | - Luigi Cirillo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Giovanni Maria Fusco
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Marco Abate
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Francesco Passaro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Ernesto Di Mauro
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Felice Crocetto
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
- Department of Urology, University of L’Aquila, 67010 L’Aquila, Italy
| | - Achille Aveta
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Simone Cilio
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Isabella Di Filippo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, 80131 Naples, Italy; (I.D.F.); (B.P.)
| | - Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Antonio Franco
- Department of Urology, Sant’Andrea Hospital, “Sapienza” University, 00189 Rome, Italy;
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Roberto La Rocca
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, 80131 Naples, Italy; (I.D.F.); (B.P.)
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (L.C.); (G.M.F.); (M.A.); (F.P.); (E.D.M.); (F.C.); (S.D.P.); (A.A.); (S.C.); (R.L.R.); (L.N.)
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Scialò F, Cernera G, Esposito S, Pinchera B, Gentile I, Di Domenico M, Bianco A, Pastore L, Amato F, Castaldo G. The MBL2 genotype relates to COVID-19 severity and may help to select the optimal therapy. Clin Chem Lab Med 2023; 61:2143-2149. [PMID: 37313996 DOI: 10.1515/cclm-2023-0183] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/01/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Sars-CoV-2 acute infection is clinically heterogeneous, ranging from asymptomatic cases to patients with a severe, systemic clinical course. Among the involved factors age and preexisting morbidities play a major role; genetic host susceptibility contributes to modulating the clinical expression and outcome of the disease. Mannose-binding lectin is an acute-phase protein that activates the lectin-complement pathway, promotes opsonophagocytosis and modulates inflammation, and is involved in several bacterial and viral infections in humans. Understanding its role in Sars-CoV-2 infection could help select a better therapy. METHODS We studied MBL2 haplotypes in 419 patients with acute COVID-19 in comparison to the general population and related the haplotypes to clinical and laboratory markers of severity. RESULTS We recorded an enhanced frequency of MBL2 null alleles in patients with severe acute COVID-19. The homozygous null genotypes were significantly more frequent in patients with advanced WHO score 4-7 (OR of about 4) and related to more severe inflammation, neutrophilia, and lymphopenia. CONCLUSIONS Subjects with a defective MBL2 genotype (i.e., 0/0) are predisposed to a more severe acute Sars-CoV-2 infection; they may benefit from early replacement therapy with recombinant MBL. Furthermore, a subset of subjects with the A/A MBL genotype develop a relevant increase of serum MBL during the early phases of the disease and develop a more severe pulmonary disease; in these patients, the targeting of the complement may help. Therefore, COVID-19 patients should be tested at hospitalization with serum MBL analysis and MBL2 genotype, to define the optimal therapy.
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Affiliation(s)
- Filippo Scialò
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "L. Vanvitelli", Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | - Gustavo Cernera
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | | | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Marina Di Domenico
- Dipartimento di Medicina di Precisione, Università della Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Bianco
- Dipartimento di Scienze Mediche Traslazionali, Università della Campania "L. Vanvitelli", Naples, Italy
| | - Lucio Pastore
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | - Felice Amato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
| | - Giuseppe Castaldo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, scarl, Naples, Italy
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Viceconte G, Buonomo AR, D’Agostino A, Foggia M, Di Fusco A, Pinchera B, Scotto R, Iacovazzo C, Fanasca L, Messina G, Cacciatore F, Salvatore P, Gentile I. Risk Factors for Pneumocystis jirovecii Pneumonia in Non-HIV Patients Hospitalized for COVID-19: A Case-Control Study. J Fungi (Basel) 2023; 9:838. [PMID: 37623609 PMCID: PMC10455879 DOI: 10.3390/jof9080838] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Very few cases of Pneumocystis jirovecii pneumonia (PJP) have been reported in COVID-19 so far, and mostly in patients with concomitant HIV infection or in solid-organ transplant recipients. Despite COVID-19 being associated with lymphopenia and the use of steroids, there are no studies specifically aimed at investigating the risk factors for PJP in COVID-19. METHODS A retrospective case-control study was performed. We matched PJP cases with controls with a 1:2 ratio, based on age ± 10 years, solid-organ transplantation (SOT), hematological malignancies, and in the setting of PJP development (ICU vs. non-ICU). A direct immunofluorescence assay on bronchoalveolar lavage fluid was used to diagnose PJP. RESULTS We enrolled 54 patients. Among 18 cases of PJP, 16 were diagnosed as "proven". Seven of the eighteen cases were immunocompromised, while the other patients had no previous immunological impairment. Patients with PJP had significantly lower median lymphocyte values (p = 0.033), longer COVID-19 duration (p = 0.014), a higher dose of steroid received (p = 0.026), higher CRP values (p = 0.005), and a lower SARS-CoV-2 vaccination rate than the controls (p = 0.029). Cumulative steroid dose is the independent risk factor for PJP development (OR = 1.004, 95%CI = 1-1.008, p = 0.042). CONCLUSIONS PJP develops in COVID-19 patients regardless of immunosuppressive conditions and the severity of disease, and it is correlated to the corticosteroid dose received.
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Affiliation(s)
- Giulio Viceconte
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Alessia D’Agostino
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Maria Foggia
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Antonio Di Fusco
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy;
| | - Luca Fanasca
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, 8031 Naples, Italy; (L.F.); (P.S.)
| | - Gaetana Messina
- Thoracic Surgery Unit, University of Campania “Luigi Vanvitelli”, Via Sergio Pansini n.5, 8031 Naples, Italy;
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy;
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, 8031 Naples, Italy; (L.F.); (P.S.)
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Via Sergio Pansini n.5, 8031 Naples, Italy; (A.R.B.); (A.D.); (M.F.); (A.D.F.); (B.P.); (R.S.); (I.G.)
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Pinchera B, Scotto R, Zappulo E, Buonomo AR, Maraolo AE, Schiano Moriello N, Viceconte G, Cattaneo L, Villari R, Gison F, De Filippis F, Ercolini D, Gentile I. Impact of oral antiviral therapy against HCV on gut microbiota. A prospective study. New Microbiol 2023; 46:196-201. [PMID: 37247240] [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] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 05/31/2023]
Abstract
The intestinal microbiota plays a fundamental role in physiological homeostasis as well as in pathologic conditions. Hepatitis C virus is the leading cause of chronic liver diseases worldwide. The treatment of this infection has been revolutionized by the availability of direct-acting antiviral agents which guarantee a high rate (about 95%) of viral clearance. Few studies have assessed the change in the gut microbiota of patients treated with direct-acting antiviral agents against HCV, and many aspects still need to be clarified. The aim of the study was to evaluate the effects of antiviral therapy on gut microbiota. We enrolled patients with HCV-related chronic liver disease attending the Infectious Diseases Unit of the A.O.U. Federico II of Naples from January 2017 to March 2018 and treated with DAAs. For each patient, a fecal sample was collected and analyzed for the assessment of microbial diversity before the start of therapy and by SVR12 time. We excluded patients who had received antibiotics in the previous 6 months. Twelve patients were enrolled (6 male, 8 genotype 1 (1 subtype 1a), 4 genotype 2). Fibrosis scores were F0 in 1 patient, F2 in 1 patient, F3 in 4 patients and cirrhosis in the remaining 6 (all in Child-Pugh class A). All were treated with DAAs for 12 weeks (5 with Paritaprevir-Ombitasvir-Ritonavir-Dasabuvir, 3 with Sofosbuvir-Ledipasvir, 1 with Sofosbuvir-Ribavirin, 1 with Sofosbuvir-Daclatasvir, 1 with Sofosbuvir-Velpatasvir) and 100% achieved SVR12. In all patients, we observed a trend in reduction of potentially pathogenic microorganisms (i.e., Enterobacteriaceae). Furthermore, a trend of increase in α-diversity was observed in patients by SVR12 compared to baseline. This trend was markedly more evident in patients without liver cirrhosis than in those with cirrhosis. Our study shows that viral eradication obtained with DAA is associated with a trend in restoring the heterogeneity of α-diversity and in reducing the percentage of potentially pathogenic microbial species, although this benefit is less evident in patients with cirrhosis. Further studies with larger sample size are needed to confirm these data.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Alberto Enrico Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Letizia Cattaneo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Flavia Gison
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - Francesca De Filippis
- Task Force on Microbiome Studies, University of Naples "Federico II"
- Department of Agricultural Sciences, Division of Microbiology, University of Naples "Federico II", Portici, Italy
| | - Danilo Ercolini
- Task Force on Microbiome Studies, University of Naples "Federico II"
- Department of Agricultural Sciences, Division of Microbiology, University of Naples "Federico II", Portici, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
- Task Force on Microbiome Studies, University of Naples "Federico II"
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Pinchera B, Zappulo E, Buonomo AR, Cotugno MR, Di Filippo G, Borrelli F, Mercinelli S, Villari R, Gentile I. Effect of Direct Antiviral Therapy Against HCV on CD4+ T Cell Count in Patients with HIV-HCV Coinfection. HIV AIDS (Auckl) 2023; 15:23-28. [PMID: 36777459 PMCID: PMC9908739 DOI: 10.2147/hiv.s395969] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Background HCV-related liver disease is an important cause of morbidity and mortality in patients with HIV infection. It is well known that the response rates to HCV therapy are similar between HCV-monoinfected patients and HIV-HV coinfected ones. The aim of this study was to evaluate the impact of HCV eradication on CD4 + T cell count in a population of HIV-HCV coinfected patients. Materials and Methods We enrolled patients with HIV-HCV coinfection attending the Infectious Diseases Unit of the A.O.U. Federico II of Naples, from January 2016 to February 2019, treated with ART (AntiRetroviral Therapy) and DAAs (Direct Antiviral Agents). For each patient, we evaluated HIV and HCV viral load and CD4+ T cell count before starting therapy with DAAs, by SVR12 time and by SVR48 time. Fibrosis was evaluated by the mean of Fibroscan®. Results Fifty-two patients were enrolled, 40 males. Fibrosis score was F0-F3 in 15 patients and cirrhosis in the remaining 11 (all in Child-Pugh class A). All had been receiving ART, and all were treated with DAAs. Only patient who had not achieved HIV viral suppression for non-compliance also experienced a relapse of HCV infection after the end of DAAs. In all patients, we observed that the CD4+ T cell count at baseline did not show significant variations compared to SVR12 and SVR48 time. We also assessed CD4 count in relation to HIV categories and stage of liver disease, see Table 1. Also, based on the assessments of the subclasses considered, there were no significant changes in the CD4 + T cell count. Conclusion Our study shows that HCV viral eradication obtained with DAAs in patients with HIV-HCV coinfection is not associated with significant changes in the CD4 + T cell count, regardless of CDC category and stage of liver disease.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy,Correspondence: Biagio Pinchera, Email
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Maria Rosaria Cotugno
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Giovanni Di Filippo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Francesco Borrelli
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Simona Mercinelli
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Naples, Italy
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Pinchera B, Moriello NS, Buonomo AR, Zappulo E, Viceconte G, Villari R, Gentile I. Microbiota and hepatitis C virus in the era of direct-acting antiviral agents. Microb Pathog 2023; 175:105968. [PMID: 36626945 DOI: 10.1016/j.micpath.2023.105968] [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: 10/25/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
The gut microbiota plays a fundamental role in Hepatitis C Virus (HCV)-related liver disease. Indeed, HCV infection alters the gut microbiota, whereas intestinal dysbiosis induces an underlying inflammatory state. This status may lead to liver disease progression. The advent of direct acting antivirals (DAAs) was a turning point in the history of HCV infection, which enhances the chances of recovery. Beyond the elimination of the virus, DAA therapy can affect the gut microbiota of the HCV patient. The study of the gut microbiota in the patient with HCV-related liver disease could be the first step in understanding the etiopathogenesis of hepatopathy thereby opening the way to new therapeutic opportunities. Herein we evaluate current knowledge regarding the gut microbiota in patients with HCV infection and the impact of DAA therapy.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy.
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy; Task Force on Microbiome Studies, University of Naples "Federico II", Naples, Italy
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8
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Scotto R, Buonomo AR, Iuliano A, Foggia M, Sardanelli A, Villari R, Pinchera B, Gentile I. Remdesivir Alone or in Combination with Monoclonal Antibodies as an Early Treatment to Prevent Severe COVID-19 in Patients with Mild/Moderate Disease at High Risk of Progression: A Single Centre, Real-Life Study. Vaccines (Basel) 2023; 11:vaccines11020200. [PMID: 36851078 PMCID: PMC9964994 DOI: 10.3390/vaccines11020200] [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: 12/06/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Early treatment with antivirals against SARS-CoV-2 infection can prevent the onset of severe COVID-19 in fragile and immunocompromised patients. In this real-life, prospective, observational study, we evaluated efficacy and safety of a 3-day early treatment with remdesivir in adult and fragile patients with a diagnosis of SARS-CoV-2 infection who referred to the COVID-19 early treatment service of Infectious Diseases Unit of University of Naples Federico from 10 January 2022 to 31 March 2022. The included patients could be treated with either remdesivir alone or with remdesivir plus a monoclonal antibody with activity against SARS-CoV-2. Among the 62 included patients, we showed low rates of hospitalization (8%), increase in oxygen supplementation (3.2%), ICU admission (1.6%) and death (1.6%). The rate of disease progression was 8% and it was similar in patients treated with remdesivir alone or in combination with monoclonal antibodies (6.7% and 9.4%, respectively; p = 0.531). The rate of adverse drug reaction was low and similar in the two groups (13.3% in patients treated with remdesivir, 15.6% in patients treated with the combination; p = 0.543). Most common adverse events were headache and fever. In conclusion, in our cohort of patients at a high risk of worse COVID-19 outcomes, an early course of remdesivir showed low rates of disease progression and adverse drug reactions.
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9
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Pinchera B, Schiano Moriello N, Buonomo AR, Di Filippo I, Tanzillo A, Buzzo G, Villari R, Gentile I. Diabetes and SARS-CoV-2 Infection: The Potential Role of Antidiabetic Therapy in the Evolution of COVID-19. Microorganisms 2023; 11:microorganisms11010145. [PMID: 36677437 PMCID: PMC9865860 DOI: 10.3390/microorganisms11010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Diabetes mellitus represents one of the most frequent comorbidities among patients with COVID-19, constituting a risk factor for a more severe prognosis than that of non-diabetic patients. However, the pathophysiological mechanism underlying this unfavorable outcome is still not completely clear. The goal of our study was to evaluate the potential role of antidiabetic therapy in the evolution of COVID-19.
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10
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Nardelli C, Scaglione GL, Testa D, Setaro M, Russo F, Di Domenico C, Atripaldi L, Zollo M, Corrado F, Salvatore P, Pinchera B, Gentile I, Capoluongo E. Nasal Microbiome in COVID-19: A Potential Role of Corynebacterium in Anosmia. Curr Microbiol 2023; 80:53. [PMID: 36583787 PMCID: PMC9802018 DOI: 10.1007/s00284-022-03106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/31/2022] [Indexed: 12/31/2022]
Abstract
The evolution and the development of the symptoms of Coronavirus disease 19 (COVID-19) are due to different factors, where the microbiome plays a relevant role. The possible relationships between the gut, lung, nasopharyngeal, and oral microbiome with COVID-19 have been investigated. We analyzed the nasal microbiome of both positive and negative SARS-CoV-2 individuals, showing differences in terms of bacterial composition in this niche of respiratory tract. The microbiota solution A (Arrow Diagnostics) was used to cover the hypervariable V1-V3 regions of the bacterial 16S rRNA gene. MicrobAT Suite and MicrobiomeAnalyst program were used to identify the operational taxonomic units (OTUs) and to perform the statistical analysis, respectively. The main taxa identified in nasal microbiome of COVID-19 patients and in Healthy Control subjects belonged to three distinct phyla: Proteobacteria (HC = 14%, Cov19 = 35.8%), Firmicutes (HC = 28.8%, Cov19 = 30.6%), and Actinobacteria (HC = 56.7%, Cov19 = 14.4%) with a relative abundance > 1% in all groups. A significant reduction of Actinobacteria in Cov19 group compared to controls (P < 0.001, FDR = 0.01) was found. The significant reduction of Actinobacteria was identified in all taxonomic levels down to the genus (P < 0.01) using the ANOVA test. Indeed, a significantly reduced relative abundance of Corynebacterium was found in the patients compared to healthy controls (P = 0.001). Reduced abundance of Corynebacterium has been widely associated with anosmia, a common symptom of COVID-19 as suffered from our patients. Contrastingly, the Corynebacterium genus was highly represented in the nasal mucosa of healthy subjects. Further investigations on larger cohorts are necessary to establish functional relationships between nasal microbiota content and clinical features of COVID-19.
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Affiliation(s)
- Carmela Nardelli
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Naples, Italy
- Task Force On Microbiome Studies, University of Naples Federico II, Naples, Italy
| | - Giovanni Luca Scaglione
- CEINGE Biotecnologie Avanzate S.C.a R.L., Naples, Italy
- Istituto Dermopatico Dell'Immacolata IDI-IRCSS, Rome, Italy
| | - Domenico Testa
- Department of Otorhinolaryngology, Luigi Vanvitelli University of Naples, Naples, Italy
| | - Mario Setaro
- CEINGE Biotecnologie Avanzate S.C.a R.L., Naples, Italy
| | - Filippo Russo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Naples, Italy
| | | | - Lidia Atripaldi
- Clinical Biochemistry Unit, AORN Ospedale Dei Colli, Naples, Italy
| | - Massimo Zollo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Naples, Italy
| | - Federica Corrado
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ettore Capoluongo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.
- Department of Clinical Pathology and Genomics, Azienda Ospedaliera Per L'Emergenza Cannizzaro, Catania, Italy.
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11
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Viceconte G, Ponsiglione A, Buonomo AR, Camera L, Scotto R, De Giorgi M, Pinto L, Pinchera B, Villari R, Foggia M, Gerundo G, Abete P, Brunetti A, Gentile I. COVID-19 chest CT and laboratory features of B.1.617.2 (Delta variant) vs B.1.1.7 (Alpha variant) surge: a single center case-control study. Infez Med 2022; 30:555-562. [PMID: 36482955 PMCID: PMC9714998 DOI: 10.53854/liim-3004-10] [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] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess clinical, laboratory and radiological differences between Delta and Alpha SARS-CoV-2 variants. MATERIALS AND METHODS Twenty SARS-CoV-2 patients admitted from 30th of August to 30th of October 2021 (period with estimated highest prevalence of Delta variant circulation in Italy) were enrolled. Patients were matched in a 1:1 ratio with same gender and same age +/- 2 years controls admitted from 1st of September 2020 to 30th of January 2021 (predominant circulation of Alpha variant). Chest computed tomography (CT) were retrospectively evaluated. Main clinical parameters, radiological and laboratory findings were compared between two groups. RESULTS Patients with probable Delta variant had significantly higher CT severity scores, lower PaO2/FiO2 ratio and higher C-reactive protein and lactate dehydrogenase levels at admission. On multivariate analysis, probable Delta variant infection was associated with higher CT severity score. Ground glass opacities and crazy paving patterns were more frequently noticed than consolidation, with the latter being more frequent in Delta cohort, even though not significantly. According to prevalent imaging pattern, the consolidation one was significantly associated with pregnancy (p=0.008). CONCLUSIONS Patients admitted during predominance of Delta variant circulation had a more severe lung involvement compared to patients in infected when Alpha variant was predominant. Despite imaging pattern seems to be not influenced by viral variant and other clinical variables, the consolidative pattern was observed more frequently in pregnancy.
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Affiliation(s)
- Giulio Viceconte
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples,
Italy
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples,
Italy
| | | | - Luigi Camera
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples,
Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples,
Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples,
Italy
| | - Lorenzo Pinto
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples,
Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples,
Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples,
Italy
| | - Maria Foggia
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples,
Italy
| | - Gerardo Gerundo
- Department of Translational Medical Sciences, University of Naples Federico II, Naples,
Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples,
Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples,
Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples,
Italy
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12
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Brusa S, Terracciano D, Bruzzese D, Fiorenza M, Stanziola L, Pinchera B, Valente V, Gentile I, Cittadini A, Mormile I, Mormile M, Portella G. Circulating tissue inhibitor of metalloproteinases 1 (TIMP-1) at COVID-19 onset predicts severity status. Front Med (Lausanne) 2022; 9:1034288. [PMID: 36523781 PMCID: PMC9744795 DOI: 10.3389/fmed.2022.1034288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/01/2022] [Accepted: 11/15/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Systemic biomarkers for severity of SARS-CoV-2 infection are of great interest. In this study, we evaluated a set of collagen metabolites and extracellular matrix remodeling biomarkers including procollagen type III amino terminal propeptide (PIIINP), tissue inhibitor of metalloproteinases 1 (TIMP-1) and hyaluronic acid (HA) as prognostic indicators in COVID-19 patients. METHODS Ninety COVID-19 patients with the absence of chronic liver diseases were enrolled. Serum PIIINP, TIMP-1, and HA were measured and correlated with inflammatory indices and clinical variables. Patients were stratified for disease severity according to WHO criteria in two groups, based on the requirement of oxygen support. RESULTS Serum TIMP-1, but not PIIINP and HA was significantly higher in patients with WHO score ≥5 compared to patients with WHO score <5 [PIIINP: 7.2 (5.4-9.5) vs. 7.1 (4.5-9.9), p = 0.782; TIMP-1: 298.1 (20.5-460) vs. 222.2 (28.5-452.8), p = 0.01; HA: 117.1 (55.4-193.7) vs. 75.1 (36.9-141.8), p = 0.258]. TIMP-1 showed moderate correlation with CRP (r = 0.312, p = 0.003) and with LDH (r = 0.263, p = 0.009). CRP and serum LDH levels were significantly higher in COVID-19 patients with WHO score ≥5 compared to the group of patients with WHO score < 5 [15.8 (9-44.5) vs. 9.3 (3.4-33.8), p = 0.039 and 373 (282-465) vs. 289 (218-383), p = 0.013, respectively]. CONCLUSION In patients with COVID-19, circulating TIMP-1 was associated with disease severity and with systemic inflammatory index, suggesting that TIMP-1 could represent a promising non-invasive prognostic biomarker in COVID-19 patients. Interestingly, our results prompted that serum TIMP-1 level may potentially be used to select the patients for therapeutic approaches targeting matrix metalloproteases pathway.
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Affiliation(s)
- Stefano Brusa
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Daniela Terracciano
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Mariano Fiorenza
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Lucia Stanziola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Valeria Valente
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Ilaria Mormile
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Mauro Mormile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Portella
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
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13
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Scotto R, Lanzardo A, Buonomo AR, Pinchera B, Cattaneo L, Sardanelli A, Mercinelli S, Viceconte G, Perrella A, Esposito V, Codella AV, Maggi P, Zappulo E, Villari R, Foggia M, Gentile I. A Simple Non-Invasive Score Based on Baseline Parameters Can Predict Outcome in Patients with COVID-19. Vaccines (Basel) 2022; 10:vaccines10122043. [PMID: 36560453 PMCID: PMC9781962 DOI: 10.3390/vaccines10122043] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 12/03/2022] Open
Abstract
We evaluated the role of CRP and other laboratory parameters in predicting the worsening of clinical conditions during hospitalization, ICU admission, and fatal outcome among patients with COVID-19. Consecutive adult inpatients with SARS-CoV-2 infection and respiratory symptoms treated in three different COVID centres were enrolled, and they were tested for laboratory parameters within 48 h from admission. Three-hundred ninety patients were enrolled. Age, baseline CRP, and LDH were associated with a P/F ratio < 200 during hospitalization. Male gender and CRP > 60 mg/L were shown to be independently associated with ICU admission. Lymphocytes < 1000 cell/μL were associated with the worst P/F ratio. CRP > 60 mg/L predicted exitus. We subsequently devised an 11-points numeric ordinary scoring system based on age, sex, CRP, and LDH at admission (ASCL score). Patients with an ASCL score of 0 or 2 were shown to be protected against a P/F ratio < 200, while patients with an ASCL score of 6 to 8 were shown to be at risk for P/F ratio < 200. Patients with an ASCL score ≥ 7 had a significantly increased probability of death during hospitalization. In conclusion, patients with elevated CRP and LDH and an ASCL score > 6 at admission should be prioritized for careful respiratory function monitoring and early treatment to prevent a progression of the disease.
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Affiliation(s)
- Riccardo Scotto
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Amedeo Lanzardo
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-347-630-5933; Fax: +39-081-746-3740
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Letizia Cattaneo
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Alessia Sardanelli
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Simona Mercinelli
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Alessandro Perrella
- Emerging Infectous Disease with High Contagiousness Unit, Cotugno Hospital, 80131 Naples, Italy
| | - Vincenzo Esposito
- IVth Division of Immunodeficiency and Gender Infectious Diseases, Cotugno Hospital, 80131 Naples, Italy
| | - Alessio Vinicio Codella
- Department of Medical Sciences—Unit of Infectious Diseases, "Gaetano Rummo” Hospital, 82100 Benevento, Italy
| | - Paolo Maggi
- Infectious and Tropical Diseases Clinic, AORN Sant'Anna and San Sebastiano, 81100 Caserta, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Foggia
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Federico II COVID-Team
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
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14
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Pinchera B, Buonomo AR, Schiano Moriello N, Scotto R, Villari R, Gentile I. Update on the Management of Surgical Site Infections. Antibiotics (Basel) 2022; 11:1608. [PMID: 36421250 PMCID: PMC9686970 DOI: 10.3390/antibiotics11111608] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/25/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 10/29/2023] Open
Abstract
Surgical site infections are an increasingly important issue in nosocomial infections. The progressive increase in antibiotic resistance, the ever-increasing number of interventions and the ever-increasing complexity of patients due to their comorbidities amplify this problem. In this perspective, it is necessary to consider all the risk factors and all the current preventive and prophylactic measures which are available. At the same time, given multiresistant microorganisms, it is essential to consider all the possible current therapeutic interventions. Therefore, our review aims to evaluate all the current aspects regarding the management of surgical site infections.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy
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15
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Cardiero G, Palma D, Vano M, Anastasio C, Pinchera B, Ferrandino M, Gianfico C, Gentile L, Savoia M, Gentile I, Di Taranto MD, Fortunato G. Calprotectin Levels and Neutrophil Count Are Prognostic Markers of Mortality in COVID-19 Patients. Diagnostics (Basel) 2022; 12:diagnostics12102554. [PMID: 36292243 PMCID: PMC9601504 DOI: 10.3390/diagnostics12102554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Inflammation plays a crucial role in worsening coronavirus disease (COVID-19). Calprotectin is a pro-inflammatory molecule produced by monocytes and neutrophilic granulocytes. The aim of the study was to evaluate both the prognostic role of circulating calprotectin levels and neutrophil count toward fatal outcome in COVID-19 patients. We retrospectively collected and analyzed data on 195 COVID-19 adult patients, 156 hospitalized in the infectious disease unit and 39 in the intensive care unit (ICU). Calprotectin levels and neutrophil counts measured at the first hospitalization day were higher in the patients with a fatal outcome than in surviving ones. The association of high calprotectin levels and neutrophil count to patient death remain significant by logistic regression, independent of patient age. ROC curves analysis for calprotectin levels and neutrophil count revealed a good discriminatory power toward survival (area under the curve of 0.759 and 0.843, respectively) and identified the best cut-off (1.66 mg/L and 16.39 × 103/µL, respectively). Kaplan–Meier analysis confirmed the prognostic role of high calprotectin levels and neutrophil count in death prediction. In conclusion, this study highlights that calprotectin levels together with neutrophil count should be considered as biomarkers of mortality in COVID-19 patients.
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Affiliation(s)
- Giovanna Cardiero
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
| | - Daniela Palma
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
| | - Martina Vano
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Claudia Anastasio
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie Infettive, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Martina Ferrandino
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Carlo Gianfico
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Luca Gentile
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Marcella Savoia
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Malattie Infettive, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
| | - Maria Donata Di Taranto
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
- Correspondence:
| | - Giuliana Fortunato
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, 80131 Naples, Italy
- CEINGE-Biotecnologie Avanzate Franco Salvatore, 80145 Naples, Italy
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16
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Gentile I, Scotto R, Schiano Moriello N, Pinchera B, Villari R, Trucillo E, Ametrano L, Fusco L, Castaldo G, Buonomo AR. Nirmatrelvir/Ritonavir and Molnupiravir in the Treatment of Mild/Moderate COVID-19: Results of a Real-Life Study. Vaccines (Basel) 2022; 10:vaccines10101731. [PMID: 36298596 PMCID: PMC9607194 DOI: 10.3390/vaccines10101731] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 12/04/2022] Open
Abstract
Molnupiravir and nirmatrelvir were the first available oral antivirals (OAs) active against SARS-CoV-2. Trials evaluating the efficacy of OAs involved patients unvaccinated and infected with variants different from those currently circulating. We conducted a retrospective study on patients with confirmed SARS-CoV-2 infection treated with OAs during the omicron surge in Italy in order to provide real-life data on the efficacy and safety of OAs during the omicron surge of the COVID-19 pandemic. Among 257 patients, 56.8% received molnupiravir, while 43.2% received nirmatrelvir/ritonavir. Patients in the molnupiravir group were older, had a lower body mass index, and had a higher rate of chronic heart disease than those treated with nirmatrelvir/ritonavir. Three hospitalizations were recorded in the molnupiravir (2.1%) group and one in the nirmatrelvir/ritonavir (0.9%) group. One patient treated with molnupiravir died. The median time to negativity was 8 days in the nirmatrelvir/ritonavir group vs. 10 days in the molnupiravir group, p < 0.01. We recorded 37 ADRs (mainly dysgeusia, diarrhea, and nausea) in 31 individuals (12.1%). Only two patients (0.8%) treated with molnupiravir terminated treatment due to ADRs. In conclusion, in a population of mostly vaccinated patients treated with OAs, we observed a low rate of hospitalization, death, and adverse drug reactions. These rates were lower than those reported in pivotal trials.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-3495601446
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Emilia Trucillo
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Luigi Ametrano
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Ludovica Fusco
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
- CEINGE—Advanced Biotechnologies, 80131 Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery—Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy
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Buonomo AR, Esposito N, Di Filippo I, Saccone G, Pinchera B, Scotto R, Bifulco G, Gentile I. Safety and efficacy of monoclonal antibodies anti SARS-CoV-2 in pregnancy. Expert Opin Drug Saf 2022; 21:1137-1141. [PMID: 36082789 DOI: 10.1080/14740338.2022.2122436] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND SARS CoV-2 infection in pregnant women has become an urgent medical concern since it has been demonstrated a high rate of severe course of COVID-19, with evidence of increased mortality and peri-partum complications, especially when the infect.
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Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Nunzia Esposito
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Isabella Di Filippo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II - Naples Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Giuseppe Bifulco
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
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18
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Gentile I, Iorio M, Zappulo E, Scotto R, Maraolo AE, Buonomo AR, Pinchera B, Muto G, Iervolino C, Villari R, Schiano Moriello N, Scirocco MM, Triassi M, Paternoster M, Russo V, Viceconte G. COVID-19 Post-Exposure Evaluation (COPE) Study: Assessing the Role of Socio-Economic Factors in Household SARS-CoV-2 Transmission within Campania Region (Southern Italy). Int J Environ Res Public Health 2022; 19:10262. [PMID: 36011895 PMCID: PMC9408501 DOI: 10.3390/ijerph191610262] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Campania is the sixth poorest region of Italy, and it is the region with the highest income inequality. The secondary attack rates of SARS-CoV-2 among households are found to be substantially heterogeneous among published studies and are influenced by socio-economic factors. We conducted a retrospective study to describe the role of socio-economic factors in the household transmission of SARS-CoV-2 among patients living in Campania Region and referring to "Federico II" Hospital. We interviewed 413 subjects followed-up for COVID-19 between the 8 March 2020 and the 24 May 2021 with the aim to collect demographic, clinical, economic, and social data regarding their household and the index cases. The variables associated with SARS-CoV-2 attack rate higher than 50% among households were higher age (p = 0.023) and higher Charlson Comorbidity Index of the index case (p = 0.023) and, for household characteristics, higher number of families per house (p = 0.02), location of the houses in Naples' suburbs (Chi2 = 5.3, p = 0.02) and in Caserta City area (Chi2 = 4, p = 0.04), and renting the house compared to owning it (Chi2 = 5.83, p = 0.01). This study confirms the finding described by other authors that household transmission of SARS-CoV-2 is correlated with the income inequality of the analyzed geographical area as well as with the indicators of health and economic wealth of the families, and this correlation also applies to the Campania Region.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Martina Iorio
- Department of Economist, Roma Tre University, 00154 Rome, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Alberto Enrico Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, 80131 Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Giuseppina Muto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Carmela Iervolino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Nicola Schiano Moriello
- Ninth Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, 80131 Naples, Italy
| | - Maria Michela Scirocco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Mariano Paternoster
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Vincenzo Russo
- Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
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Scalia G, Raia M, Gelzo M, Cacciapuoti S, Rosa AD, Pinchera B, Scotto R, Tripodi L, Mormile M, Fabbrocini G, Gentile I, Parrella R, Castaldo G, Scialò F. Lymphocyte Population Changes at Two Time Points during the Acute Period of COVID-19 Infection. J Clin Med 2022; 11:jcm11154306. [PMID: 35893398 PMCID: PMC9329935 DOI: 10.3390/jcm11154306] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/13/2022] [Revised: 07/14/2022] [Accepted: 07/23/2022] [Indexed: 12/15/2022] Open
Abstract
We previously observed an increase of serum interleukins (IL) and a reduction of most lymphocyte subpopulations in hospitalized COVID-19 patients. Herein, we aimed to evaluate the changes in serum IL-6, IL-10, and IL-17A levels and cytometric lymphocyte profiles in 144 COVID-19 patients at admission and after one week, also in relation to steroid treatment before hospitalization. After one week of hospitalization, we found that: (i) total lymphocytes were increased in all patients; (ii) neutrophils and IL-6 were reduced in mild/moderate patients; (iii) B lymphocytes were increased in severe patients; (iv) T lymphocyte populations increased in mild/moderate patients. In the eight patients that died during hospitalization, total leukocytes increased while T, T helper, T cytotoxic, T regulatory, and NK lymphocytes showed a reducing trend in five of the eight patients. Even if seven days are too few to evaluate the adaptive immunity of patients, we found that the steroid therapy was associated with a reduced COVID-19 inflammation and cytokine activation only in patients with severe disease, while in patients with less severe disease, the steroid therapy seems to have immunosuppressive effects on lymphocyte populations, and this could hamper the antiviral response. A better knowledge of cytokine and lymphocyte alterations in each COVID-19 patient could be useful to plan better treatment with steroids or cytokine targeting.
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Affiliation(s)
- Giulia Scalia
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy; (G.S.); (M.R.); (M.G.); (L.T.); (F.S.)
| | - Maddalena Raia
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy; (G.S.); (M.R.); (M.G.); (L.T.); (F.S.)
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy; (G.S.); (M.R.); (M.G.); (L.T.); (F.S.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (R.S.); (M.M.); (G.F.); (I.G.)
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (R.S.); (M.M.); (G.F.); (I.G.)
| | - Riccardo Scotto
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (R.S.); (M.M.); (G.F.); (I.G.)
| | - Lorella Tripodi
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy; (G.S.); (M.R.); (M.G.); (L.T.); (F.S.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (R.S.); (M.M.); (G.F.); (I.G.)
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (R.S.); (M.M.); (G.F.); (I.G.)
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (R.S.); (M.M.); (G.F.); (I.G.)
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy; (G.S.); (M.R.); (M.G.); (L.T.); (F.S.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
- Correspondence:
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate, Scarl, 80131 Naples, Italy; (G.S.); (M.R.); (M.G.); (L.T.); (F.S.)
- Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, 80131 Naples, Italy
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Pinchera B, Viceconte G, Buonomo AR, Zappulo E, Mercinelli S, Moriello NS, Cattaneo L, Scotto R, Giaccone A, Avallone RC, Tosone G, Gentile I. Epidemiological and clinical features of syphilis in the 21st century: A seven-year observational retrospective study of outpatients. Clinical Epidemiology and Global Health 2022. [DOI: 10.1016/j.cegh.2022.101100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Pinchera B, Buonomo AR, Scotto R, Carrano R, Salemi F, Galluccio F, Guarino M, Viceconte G, Schiano Moriello N, Giaccone A, Gallicchio A, Zappulo E, Villari R, Gentile I. Sotrovimab in Solid Organ Transplant Patients With Early, Mild/Moderate SARS-CoV-2 Infection: A Single-center Experience. Transplantation 2022; 106:e343-e345. [PMID: 35349534 PMCID: PMC9213056 DOI: 10.1097/tp.0000000000004150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Rosa Carrano
- Department of Public Health, Section of Nephrology, University of Naples "Federico II," Naples, Italy
| | - Fabrizio Salemi
- Department of Public Health, Section of Nephrology, University of Naples "Federico II," Naples, Italy
| | - Fabiana Galluccio
- Department of Public Health, Section of Nephrology, University of Naples "Federico II," Naples, Italy
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology and Hepatology Unit, University of Naples "Federico II," Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Agnese Giaccone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Antonella Gallicchio
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
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22
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Pinchera B, Spirito L, Buonomo AR, Foggia M, Carrano R, Salemi F, Schettino E, Papa F, La Rocca R, Crocetto F, Napolitano L, Villari R, Gentile I. mTOR Inhibitor Use Is Associated With a Favorable Outcome of COVID-19 in Patients of Kidney Transplant: Results of a Retrospective Study. Front Med (Lausanne) 2022; 9:852973. [PMID: 35801204 PMCID: PMC9254357 DOI: 10.3389/fmed.2022.852973] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/29/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction In solid organ transplant recipients, COVID-19 is associated with a poor prognosis because of immunosuppression. Some studies suggest a potential therapeutic role of mammalian Target of Rapamycin (mTOR) inhibitors in SARS-CoV-2 infection. This study aimed to assess the impact of mTOR employment on the evolution and outcome of SARS-CoV-2 infection in solid organ transplant recipients. Methods We enrolled kidney transplant patients attending the Azienda Ospedaliera Universitaria Federico II in Naples and followed up on these patients from March 2020 to June 2021. We evaluated the risk of acquiring the SARS-CoV-2 infection, the clinical presentation of the disease, and its outcome together with the type of immunosuppressive therapy. Finally, we assessed the impact of mTOR inhibitors on relevant clinical metrics of SARS-CoV-2 infection. Results We enrolled 371 patients, of whom 56 (15.1%) contracted SARS-CoV-2 infection during the period of the study. There were no differences observed among the different immunosuppressive therapies concerning the risk of acquiring SARS-CoV-2 infection. In contrast, the type of immunosuppressive therapy had a significant impact on the outcome of the disease. In detail, patients who received mTOR inhibitors, as part of their immunosuppressive therapy, compared to other regimens had a lower chance of developing a moderate or severe form of the disease (OR = 0.8, 95, CI: (0.21-0.92), P = 0.041). Conclusion In kidney transplant patients, the use of mTOR inhibitors as part of an immunosuppressive regimen is associated with a better prognosis in the case of COVID-19.
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Affiliation(s)
- Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lorenzo Spirito
- Section of Urology, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Riccardo Buonomo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Foggia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rosa Carrano
- Section of Nephrology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fabrizio Salemi
- Section of Nephrology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elisa Schettino
- Section of Nephrology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Fortuna Papa
- Section of Nephrology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Roberto La Rocca
- Section of Urology, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Section of Urology, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Luigi Napolitano
- Section of Urology, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Riccardo Villari
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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23
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Buonomo AR, Viceconte G, Pinchera B, Scotto R, Zappulo E, Foggia M, Gentile I. Should SARS CoV-2 infection be considered an independent risk factor for Pneumocystis jirovecii pneumonia? Emerging data after two years of pandemic from a single center experience. Rev Recent Clin Trials 2022; 17:RRCT-EPUB-123369. [PMID: 35546746 DOI: 10.2174/1574887117666220511123826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/28/2022] [Revised: 03/09/2022] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Antonio Riccardo Buonomo
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Giulio Viceconte
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Biagio Pinchera
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Riccardo Scotto
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Emanuela Zappulo
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Maria Foggia
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Ivan Gentile
- Infectious Diseases Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
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24
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Pinchera B, Spirito L, Ferreri L, Rocca RL, Celentano G, Buonomo AR, Foggia M, Scotto R, Federico S, Gentile I, Carrano R. SARS-CoV-2 in Kidney Transplant Patients: A Real-Life Experience. Front Med (Lausanne) 2022; 9:864865. [PMID: 35419375 PMCID: PMC8995796 DOI: 10.3389/fmed.2022.864865] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background The COVID-19 pandemic has significantly impacted the management of solid organ transplant recipients and on clinical evolution in post-transplantation. Little is known on the impact of SARS-CoV-2 infection in these patients. The severity and lethality of this disease in solid organ transplant patients are higher thanin the general population. This study aims to describe clinical characteristics of SARS-CoV-2 infection in solid organ transplant recipients followed in our center. Methods In this observational study, we enrolled all kidney transplant recipientsattending the A.O.U. Federico II of Naples from March 2020 to January 2021. For each patient we evaluated the epidemiological and clinical characteristics as well as outcome. Results We enrolled 369 kidney transplant patients (229, male, 62%). Of these, 51 (13.8%) acquired SARS-CoV-2 infection and 29 showed symptomatic disease. Of the 51 patients with the infection, 48 (94.11%) had at least one comorbidity and such comorbidities did not constitute a risk factor for a more severe disease. Hospitalization was necessary for 7 (13.7%) patients. Of these, 2 required low-flow oxygen supplementation, 3 non-invasive/high flow ventilation and 2 invasive ventilation. Finally, 2 patients died. Conclusions Our study shows a lower mortality and hospitalization rate compared to figures available in the literature (4% vs. 13–30% and 14% vs. 32–100%, respectively). Furthermore, the comorbidities examined (hypertension, dyslipidemia, and diabetes) did not constitute a risk factor for a more severe disease condition in this patient category. Further studies with larger sample size are necessary to confirm these data.
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Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Spirito
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Section of Urology, University of Naples "Federico II", Naples, Italy
| | - Lucia Ferreri
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Section of Urology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Section of Urology, University of Naples "Federico II", Naples, Italy
| | | | - Maria Foggia
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Stefano Federico
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Rosa Carrano
- Department of Public Health, University of Naples "Federico II", Naples, Italy
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25
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Zappulo E, Buonomo AR, Moccia M, Pinchera B, Villari R, Petracca M, Lanzillo R, Scotto R, Carotenuto A, Viceconte G, Moriello NS, Bruno L, Gentile I, Morra VB. Impact of an anti-infective screening and monitoring protocol together with Infectious Disease consultation in preventing infective adverse events in patients treated with anti-CD20/CD52 agents for Multiple Sclerosis. Mult Scler Relat Disord 2022; 63:103814. [DOI: 10.1016/j.msard.2022.103814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 01/18/2023]
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26
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Pinchera B, Scotto R, Buonomo AR, Zappulo E, Stagnaro F, Gallicchio A, Viceconte G, Sardanelli A, Mercinelli S, Villari R, Foggia M, Gentile I. Diabetes and COVID-19: The potential role of mTOR. Diabetes Res Clin Pract 2022; 186:109813. [PMID: 35248653 PMCID: PMC8891119 DOI: 10.1016/j.diabres.2022.109813] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Abstract
Diabetes is the most frequent comorbidity among patients with COVID-19. COVID-19 patients with diabetes have a more severe prognosis than patients without diabetes. However, the etiopathogenetic mechanisms underlying this more unfavorable outcome in these patients are not clear. Probably the etiopathogenetic mechanisms underlying diabetes could represent a favorable substrate for a greater development of the inflammatory process already dysregulated in COVID-19 with a more severe evolution of the disease. In the attempt to shed light on the possible etiopathogenetic mechanisms, we wanted to evaluate the possible role of mTOR (mammalian Target Of Rapamycin) pathway in this context. We searched the PubMed and Scopus databases to identify articles involving diabetes and the mTOR pathway in COVID-19. The mTOR pathway could be involved in this etiopathogenetic mechanism, in particular, the activation and stimulation of this pathway could favor an inflammatory process that is already dysregulated in itself, while its inhibition could be a way to regulate this dysregulated inflammatory process. However, much remains to be clarified about the mechanisms of the mTOR pathway and its role in COVID-19. The aim of this review is to to understand the etiopathogenesis underlying COVID-19 in diabetic patients and the role of mTOR pathway in order to be able to search for new weapons to deal with this disease.
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Affiliation(s)
- B Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy.
| | - R Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - A R Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - E Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - F Stagnaro
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - A Gallicchio
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - G Viceconte
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - A Sardanelli
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - S Mercinelli
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - R Villari
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - M Foggia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - I Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
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27
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Cannavo A, Liccardo D, Gelzo M, Amato F, Gentile I, Pinchera B, Femminella GD, Parrella R, DE Rosa A, Gambino G, Marzano F, Ferrara N, Paolocci N, Rengo G, Castaldo G. Serum Galectin-3 and Aldosterone: potential biomarkers of cardiac complications in patients with COVID-19. Minerva Endocrinol (Torino) 2022; 47:270-278. [PMID: 35266671 DOI: 10.23736/s2724-6507.22.03789-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite severe acute respiratory syndrome (SARS)-Coronavirus (CoV2) primarily targeting the lungs, the heart represents another critical virus target. Thus, the identification of SARS-CoV-2 disease of 2019 (COVID-19)-associated biomarkers would be beneficial to stratify prognosis and the risk of developing cardiac complications. Aldosterone and galectin-3 promote fibrosis and inflammation and are considered a prognostic biomarker of lung and adverse cardiac remodeling. Here, we tested whether galectin-3 and aldosterone levels can predict adverse cardiac outcomes in COVID-19 patients. METHODS To this aim, we assessed galectin-3 and aldosterone serum levels in 51 patients diagnosed with COVID-19, using a population of 19 healthy subjects as controls. In in vitro studies, we employed 3T3 fibroblasts to assess the potential roles of aldosterone and galectin-3 in fibroblast activation. RESULTS Serum galectin-3 levels were more elevated in COVID-19 patients than healthy controls and correlated with COVID-19 severity classification and cardiac Troponin-I (cTnI) serum levels. Furthermore, we observed an augmented secretion of aldosterone in COVID-19 patients. This adrenal hormone is a direct stimulator of galectin-3 secretion; therefore, we surmised that this axis could perpetrate fibrosis and adverse remodeling in these subjects. Thus, we stimulated fibroblasts with 10% of serum from COVID-19 patients. This challenge markedly rose the expression of smooth muscle alpha (α)-2 actin (ACTA2), a myofibroblast marker. CONCLUSIONS Our study suggests that COVID-19 can affect cardiac structure and function by triggering aldosterone and galectin-3 release that may serve as prognostic and therapeutic biomarkers while monitoring the course of cardiac complications in patients suffering from COVID-19.
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Affiliation(s)
- Alessandro Cannavo
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Daniela Liccardo
- Center for Translational Medicine, Temple University, Philadelphia, PA, USA
| | - Monica Gelzo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate S.c.a.r.l., Naples, Italy
| | - Felice Amato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate S.c.a.r.l., Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Grazia D Femminella
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Roberto Parrella
- Respiratory Infectious Diseases Unit, Cotugno Hospital- A.O.R.N. Dei Colli, Naples, Italy
| | - Annunziata DE Rosa
- Respiratory Infectious Diseases Unit, Cotugno Hospital- A.O.R.N. Dei Colli, Naples, Italy
| | - Giuseppina Gambino
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Istituti Clinici Scientifici ICS Maugeri -S.p.A. - Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Scientifico di Telese Terme, Telese Terme, Benevento, Italy
| | - Nazareno Paolocci
- Division of Cardiology, Johns Hopkins University Medical Institutions, Baltimore, MD, USA.,Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy - .,Istituti Clinici Scientifici ICS Maugeri -S.p.A. - Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Scientifico di Telese Terme, Telese Terme, Benevento, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate S.c.a.r.l., Naples, Italy
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28
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Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, Comegna M, Mormile M, Fabbrocini G, Parrella R, Corso G, Gentile I, Castaldo G. Matrix metalloproteinases (MMP) 3 and 9 as biomarkers of severity in COVID-19 patients. Sci Rep 2022; 12:1212. [PMID: 35075175 PMCID: PMC8786927 DOI: 10.1038/s41598-021-04677-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/15/2021] [Indexed: 12/31/2022] Open
Abstract
The molecular basis of the wide clinical heterogeneity of Coronavirus disease 2019 (COVID-19) is still unknown. Matrix metalloproteinases (MMPs) may have a role in the lung damage and regeneration that occur in severe patients. We studied serum MMP3 and MMP9 as potential biomarkers of COVID-19 severity, in 108 hospitalized patients with different World Health Organization (WHO) severity stage and in 48 controls. At hospital admission, serum MMP3 was increased in COVID-19 patients with a significant trend along the progression of the WHO stage, while serum levels of MMP9 were significantly increased in COVID-19 patients with no correlation with disease severity. At 1 week from hospitalization, MMP3 was reduced, suggesting an early pathogenic role of the protein in lung inflammation, while MMP9 levels were further increased, indicating a late role of the protein in the inflammatory process, specifically during the repairing phase. Furthermore, serum MMP9 was positively correlated with serum interleukin-6, myeloperoxidase, and circulating neutrophils and monocytes number. In conclusion, serum MMP3 may help to early predict the severity of COVID-19 and both proteins, MMP3 and MMP9, may contribute to define severe COVID-19 patients that may benefit from a targeted therapy on MMPs.
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Affiliation(s)
- Monica Gelzo
- CEINGE-Biotecnologie Avanzate, Scarl, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Annunziata De Rosa
- Divisione di Malattie Infettive Respiratorie, Dipartimento di Malattie Infettive e Emergenze Infettive, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate, Scarl, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate, Scarl, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, Naples, Italy
| | - Marika Comegna
- CEINGE-Biotecnologie Avanzate, Scarl, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Roberto Parrella
- Divisione di Malattie Infettive Respiratorie, Dipartimento di Malattie Infettive e Emergenze Infettive, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Gaetano Corso
- CEINGE-Biotecnologie Avanzate, Scarl, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, Foggia, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Scarl, via Gaetano Salvatore 486, 80145, Naples, Italy. .,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy.
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29
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Scalia G, Raia M, Gelzo M, Cacciapuoti S, De Rosa A, Pinchera B, Scotto R, Giaccone A, Mormile M, Fabbrocini G, Gentile I, Parrella R, Castaldo G. Cytometric analysis of patients with COVID-19: what is changed in the second wave? J Transl Med 2021; 19:403. [PMID: 34556132 PMCID: PMC8460184 DOI: 10.1186/s12967-021-03072-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/19/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic had a 1st wave in Europe from March to May 2020 and a 2nd wave since September 2020. We previously studied 35 hospitalized COVID-19 patients of the 1st wave demonstrating a cytokine storm and the exhaustion of most lymphocyte subpopulations. Herein, we describe the results obtained from COVID-19 patients of the 2nd wave. Methods We analyzed interleukin (IL)-6 by human-specific enzyme-linked immunosorbent assay and a large set of lymphocyte subpopulations by flow cytometry in 274 COVID-19 patients hospitalized from September 2020 to May 2021. Results Patients of 2nd wave compared with those of 1st wave showed lower serum IL-6 levels and a higher number of B and most T lymphocyte subpopulations in advanced stages, in relation with the age and the gender. On the other hand, we observed in 2nd wave patients: (i) a reduction of most lymphocyte subpopulations at mild and moderate stages; (ii) a reduction of natural killer cells and T regulatory cells together with a higher number of activated T helper (TH) 17 lymphocytes in all stages, which were mainly related to steroid and azithromycin therapies before hospitalization. Conclusions COVID-19 had a less severe impact in patients of the 2nd wave in advanced stages, while the impact appeared more severe in patients of mild and moderate stages, as compared with 1st wave patients. This finding suggests that in COVID-19 patients with milder expression at diagnosis, steroid and azithromycin therapies appear to worsen the immune response against the virus. Furthermore, the cytometric profile may help to drive targeted therapies by monoclonal antibodies to modulate specific IL/lymphocyte inhibition or activation in COVID-19 patients.
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Affiliation(s)
- Giulia Scalia
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Maddalena Raia
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di malattie infettive respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Riccardo Scotto
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Agnese Giaccone
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di malattie infettive respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, via Gaetano Salvatore 486, 80145, Naples, Italy. .,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy.
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30
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Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, Comegna M, Mormile M, Fabbrocini G, Parrella R, Corso G, Gentile I, Castaldo G. Further Findings Concerning Endothelial Damage in COVID-19 Patients. Biomolecules 2021; 11:biom11091368. [PMID: 34572581 PMCID: PMC8468524 DOI: 10.3390/biom11091368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 12/22/2022] Open
Abstract
Systemic vascular damage with micro/macro-thrombosis is a typical feature of severe COVID-19. However, the pathogenesis of this damage and its predictive biomarkers remain poorly defined. For this reason, in this study, serum monocyte chemotactic protein (MCP)-2 and P- and E-selectin levels were analyzed in 204 patients with COVID-19. Serum MCP-2 and P-selectin were significantly higher in hospitalized patients compared with asymptomatic patients. Furthermore, MCP-2 increased with the WHO stage in hospitalized patients. After 1 week of hospitalization, MCP-2 levels were significantly reduced, while P-selectin increased in patients in WHO stage 3 and decreased in patients in WHO stages 5–7. Serum E-selectin was not significantly different between asymptomatic and hospitalized patients. The lower MCP-2 levels after 1 week suggest that endothelial damage triggered by monocytes occurs early in COVID-19 disease progression. MCP-2 may also predict COVID-19 severity. The increase in P-selectin levels, which further increased in mild patients and reduced in severe patients after 1 week of hospitalization, suggests that the inactive form of the protein produced by the cleavage of the active protein from the platelet membrane is present. This may be used to identify a subset of patients that would benefit from targeted therapies. The unchanged levels of E-selectin in these patients suggest that endothelial damage is less relevant.
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Affiliation(s)
- Monica Gelzo
- CEINGE-Biotecnologie Avanzate, scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (G.F.); (I.G.)
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (G.F.); (I.G.)
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate, scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate, scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, 80131 Naples, Italy
| | - Marika Comegna
- CEINGE-Biotecnologie Avanzate, scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (G.F.); (I.G.)
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (G.F.); (I.G.)
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Gaetano Corso
- CEINGE-Biotecnologie Avanzate, scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, 71121 Foggia, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (G.F.); (I.G.)
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-3737759
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31
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Scotto R, Buonomo AR, De Pascalis S, Nerilli M, Pinchera B, Staiano L, Mercinelli S, Cattaneo L, Stanzione M, Stornaiuolo G, Martini S, Messina V, Coppola C, Coppola N, Gentile I. Changing epidemiology of patients treated with direct acting antivirals for HCV and persistently high SVR12 in an endemic area for HCV infection in Italy: real-life 'LIver Network Activity' (LINA) cohort update results. Expert Rev Gastroenterol Hepatol 2021; 15:1057-1063. [PMID: 33573411 DOI: 10.1080/17474124.2021.1890029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Second generation direct acting antivirals (DAAs) drastically changed the landscape of chronic HCV (CHCV). Aim of this paper was to assess the effectiveness of DAAs, also looking at the demographic characteristics of subjects enrolled. RESEARCH DESIGN AND METHODS Ambispective multi-center real-life study conducted among patients with CHCV treated with DAAs in Campania Region (Southern Italy). Patient were enrolled in two cohorts according to time of enrolment. RESULTS 1,479 patients were enrolled. Patients aged ≥60 years were 74.7% in the historic cohort (953 patients) and 70.2% in the prospective cohort (526 patients. Patients aged ≥ 60 years showed a higher prevalence of genotype 1b (p<0.001) and 2 (p<0.001), while patients aged < 60 years showed a higher prevalence of genotype 1a (p<0.001), 3 (p<0.001) and 4 (p<0.05). SVR12 was 98.5% in both cohorts. SVR12 was similar among patients of the prospective cohort aged < and ≥ 60 years (99.4% vs 98.1%). SVR12 among patients with and without cirrhosis was 96.0% and 98.9%, respectively. CONCLUSIONS DAAs provide high efficacy also in harder to treat patients. The effectiveness of DAAs is leading to a shift in patients characteristics with a greater prevalence of younger subjects and persons with mild liver disease.
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Affiliation(s)
- Riccardo Scotto
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | | | - Mariagiovanna Nerilli
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Laura Staiano
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography, OORR Area Stabiese Plesso Nuovo Gragnano, Naples, Italy
| | - Simona Mercinelli
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Letizia Cattaneo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | | | | | | | | | - Carmine Coppola
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography, OORR Area Stabiese Plesso Nuovo Gragnano, Naples, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
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32
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Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, Comegna M, Mormile M, Gallicchio A, Fabbrocini G, Parrella R, Corso G, Gentile I, Castaldo G. A Transient Increase in the Serum ANCAs in Patients with SARS-CoV-2 Infection: A Signal of Subclinical Vasculitis or an Epiphenomenon with No Clinical Manifestations? A Pilot Study. Viruses 2021; 13:v13091718. [PMID: 34578298 PMCID: PMC8473224 DOI: 10.3390/v13091718] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/04/2023] Open
Abstract
A relationship is emerging between SARS-CoV-2 infections and ANCA-associated vasculitis (AAV) because: (i) the pulmonary involvement of COVID-19 may mimic that observed in patients with AAV; (ii) the two diseases may occur together; (iii) COVID-19 may trigger AAV. However, few cases of AAV have been identified so far in COVID-19 patients. To define the frequency of ANCA autoimmunity in patients with SARS-CoV-2 infection, we analyzed the serum ANCAs and the serum PR3 and MPO antigens by immunoassays in 124 adult patients with a diagnosis of SARS-CoV-2 infection (16 were asymptomatic and 108 were hospitalized) and 48 control subjects. The serum ANCAs were significantly higher in the hospitalized patients compared with either the controls or the asymptomatic patients and increased with the progression of the COVID-19 severity. After one week of hospitalization, the values were significantly lower. In contrast, no differences emerged among the controls, asymptomatic and hospitalized patients for the PR3 and MPO serum levels. None of the patients had clinical signs of AAV with the exception of a severe pulmonary involvement. Further studies are necessary to define whether the increase in the serum ANCAs might mask subclinical vasculitis in a percentage of patients with SARS-CoV-2 infection or it is an epiphenomenon of SARS-CoV-2 infection with no clinical manifestations.
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Affiliation(s)
- Monica Gelzo
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, 80131 Naples, Italy
| | - Marika Comegna
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Antonella Gallicchio
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, 80131 Naples, Italy; (A.D.R.); (R.P.)
| | - Gaetano Corso
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Clinica e Sperimentale, Università di Foggia, 71121 Foggia, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, 80131 Naples, Italy; (S.C.); (B.P.); (M.M.); (A.G.); (G.F.); (I.G.)
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Scarl, 80145 Naples, Italy; (M.G.); (G.C.); (F.S.); (M.C.); (G.C.)
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-0813737759
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Capoluongo E, Nardelli C, Esposito MV, Buonomo AR, Gelzo M, Pinchera B, Zappulo E, Viceconte G, Portella G, Setaro M, Gentile I, Castaldo G. Case Report: Discovery a Novel SARS-CoV-2 Variant in a Six-Months Long-Term Swab Positive Female Suffering From Non-Hodgkin Lymphoma. Front Oncol 2021; 11:705948. [PMID: 34354952 PMCID: PMC8329552 DOI: 10.3389/fonc.2021.705948] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We report the case of a woman with non-Hodgkin lymphoma who remained positive on the molecular assay for SARS-CoV-2 for six months: she has never experienced a severe form of COVID-19 although in absence of seroconversion. METHODS The whole SARS-CoV-2 genome analysis was performed by the CleanPlex SARS-CoV-2 Research and Surveillance NGS Panel (PARAGON GENOMICS, Hayward, USA). RESULTS We found twenty-two mutations in SARS-CoV-2 genome and a novel deleterious ORF3a frameshift c.766_769del corresponding to a unique and novel lineage. The region affected by this frameshift variant is reported as being important in determining SARS-CoV-2 immunogenicity. Patient's immunophenotype showed the absence of B lymphocytes and significantly reduced T-cell count. Only after the treatment with hyperimmune plasma she finally became negative on the swab. CONCLUSIONS Our findings could be helpful in the management of patients with immunodeficiency, particularly when novel variants, potentially altering the virus immune response, are present.
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Affiliation(s)
- Ettore Capoluongo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
| | - Carmela Nardelli
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
- Task Force on Microbiome Studies, University of Naples Federico II, Napoli, Italy
| | | | | | - Monica Gelzo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Portella
- Department of Translational Medical Sciences, University of Naples Federico II, Napoli, Italy
| | - Mario Setaro
- CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy
- CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
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34
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Pisaturo M, Calò F, Russo A, Camaioni C, Giaccone A, Pinchera B, Gentile I, Simeone F, Iodice A, Maggi P, Coppola N. Dementia as Risk Factor for Severe Coronavirus Disease 2019: A Case-Control Study. Front Aging Neurosci 2021; 13:698184. [PMID: 34267649 PMCID: PMC8276052 DOI: 10.3389/fnagi.2021.698184] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/02/2021] [Indexed: 01/19/2023] Open
Abstract
Background The aim of the present study was to investigate the outcome of patients with SARS-CoV-2 infection and dementia. Patients and Methods In a multicenter, observational, 1:2 matched case-control study all 23 patients with a history of dementia, hospitalized with a diagnosis of SARS-CoV-2 infection from February 28th 2020 to January 31st 2021 were enrolled. For each Case, 2 patients without dementia observed in the same period study, pair matched for gender, age (±5 years), PaO2/FiO2 (P/F) ratio at admission (<200, or >200), number of comorbidities (±1; excluding dementia) were chosen (Control group). Results The majority of patients were males (60.9% of Cases and Controls) and very elderly [median age 82 years (IQR: 75.5–85) in the Cases and 80 (IQR: 75.5–83.75) in the Controls]. The prevalence of co-pathologies was very high: all the Cases and 43 (93.5%) Controls showed a Charlson comorbidity index of at least 2. During hospitalization the patients in the Case group less frequently had a moderate disease of COVID-19 (35 vs. 67.4%, p = 0.02), more frequently a severe disease (48 vs. 22%, p = 0.03) and more frequently died (48 vs. 22%, p = 0.03). Moreover, during coronavirus disease 2019 (COVID-19), 14 (60.8%) patients in the Case group and 1 (2.1%; p < 0.000) in the Control group showed signs and symptoms of delirium. Conclusion Patients with dementia are vulnerable and have an increased risk of a severe disease and death when infected with COVID-19.
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Affiliation(s)
- Mariantonietta Pisaturo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federica Calò
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Russo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Clarissa Camaioni
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Agnese Giaccone
- Infectious Diseases Unit, Federico II University, Naples, Italy
| | - Biagio Pinchera
- Infectious Diseases Unit, Federico II University, Naples, Italy
| | - Ivan Gentile
- Infectious Diseases Unit, Federico II University, Naples, Italy
| | | | - Angelo Iodice
- Infectious Disease Unit, AORN Caserta, Caserta, Italy
| | - Paolo Maggi
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy.,Infectious Disease Unit, AORN Caserta, Caserta, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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35
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de Falco R, Vargas M, Palma D, Savoia M, Miscioscia A, Pinchera B, Vano M, Servillo G, Gentile I, Fortunato G. B-Type Natriuretic Peptides and High-Sensitive Troponin I as COVID-19 Survival Factors: Which One Is the Best Performer? J Clin Med 2021; 10:2726. [PMID: 34205536 PMCID: PMC8235158 DOI: 10.3390/jcm10122726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/27/2021] [Revised: 06/04/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Increased concentrations of B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (HsTnI) in COVID-19 patients have already been reported. The aim of this study is to evaluate which of these common markers of cardiac disease is the most useful predictor of fatal outcome in COVID-19 patients. One hundred and seventy-four patients affected with COVID-19 were recruited, and markers of cardiac disease and the clinical history of the patients were collected at admission in the infectious disease unit or intensive care unit. NT-proBNP, BNP and HsTnI values were higher in in-hospital non-surviving patients. Receiver operating characteristic (ROC) curve analysis of NT-proBNP, BNP and HsTnI was performed, with NT-proBNP (AUC = 0.951) and HsTnI (AUC = 0.947) being better performers (p = 0.01) than BNP (AUC = 0.777). Logistic regression was performed assessing the relation of HsTnI and NT-proBNP to fatal outcome adjusting for age and gender, with only NT-proBNP being significant. The population was then divided into two groups, one with higher NT-proBNP values at admission than the cut-off resulted from the ROC curve (511 ng/L) and a second one with lower values. The Kaplan-Meier analysis showed an absence of fatal outcome in the group of patients with NT-proBNP values lower than the cut-off (p < 0.001). NT-proBNP proved to be the best prognostic tool for fatal outcome among markers of cardiac disease in COVID-19 patients.
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Affiliation(s)
- Renato de Falco
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Maria Vargas
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.V.); (G.S.)
| | - Daniela Palma
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
- CEINGE Biotecnologie Avanzate s.c. a r.l., Via Gaetano Salvatore 486, 80145 Naples, Italy
| | - Marcella Savoia
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Anna Miscioscia
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (B.P.); (I.G.)
| | - Martina Vano
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
| | - Giuseppe Servillo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (M.V.); (G.S.)
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (B.P.); (I.G.)
- Staff UNESCO Chair for Health Education and Sustainable Development, University of Naples Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuliana Fortunato
- Department of Biochemistry and Medical Biotechnology, University of Naples “Federico II”, Via Sergio Pansini 5, 80131 Naples, Italy; (R.d.F.); (D.P.); (M.S.); (A.M.); (M.V.)
- CEINGE Biotecnologie Avanzate s.c. a r.l., Via Gaetano Salvatore 486, 80145 Naples, Italy
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Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, Mormile M, Fabbrocini G, Parrella R, Gentile I, Castaldo G. Prognostic Role of Neutrophil to Lymphocyte Ratio in COVID-19 Patients: Still Valid in Patients That Had Started Therapy? Front Public Health 2021; 9:664108. [PMID: 34211953 PMCID: PMC8239130 DOI: 10.3389/fpubh.2021.664108] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 02/04/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 may appear with a widely heterogeneous clinical expression. Thus, predictive markers of the outcome/progression are of paramount relevance. The neutrophil/lymphocyte ratio (NLR) has been suggested as a good predictive marker of disease severity and mortality. Accordingly, we found that NLR significantly increased in parallel with the WHO severity stage in COVID-19 patients during the Ist wave (March-May 2020; n = 49), due to the significant reduction of lymphocyte and the significant increase of neutrophil in severe COVID-19 patients. While, we did not observe significant differences of NLR between the WHO severity stage among COVID-19 patients of the IInd wave (September 2020-April 2021; n = 242). In these patients, the number of lymphocytes and neutrophils did not change significantly between patients of different severity subgroups. This difference likely depends on the steroids therapy that the patients of the IInd wave performed before hospitalization while most patients of the Ist wave were hospitalized soon after diagnosis. This is also confirmed by serum interleukin (IL)-6 and myeloperoxidase (MPO) that gradually increased with the disease stage in patients of the Ist wave, while such biomarkers (whose production is inhibited by steroids) did not show differences among patients of the IInd wave in different stages. Thus, the NLR could be tested at diagnosis in naïve patients before starting therapies.
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Affiliation(s)
- Monica Gelzo
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Annunziata De Rosa
- Divisione di Malattie Infettive Respiratorie, Dipartimento di Malattie Infettive e Emergenze Infettive, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Gustavo Cernera
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Traslazionale, Università della Campania L. Vanvitelli, Naples, Italy
| | - Mauro Mormile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Roberto Parrella
- Divisione di Malattie Infettive Respiratorie, Dipartimento di Malattie Infettive e Emergenze Infettive, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate Scarl, Naples, Italy.,Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
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37
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Bruno R, Cauda R, Gialluisi A, Guaraldi G, Menicanti L, Mennuni M, My I, Parruti A, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Ageno W, Aiello L, Agostoni P, Al Moghazi S, Arboretti R, Aucella F, Barbieri G, Barchitta M, Bartoloni A, Bologna C, Bonfanti P, Caiano L, Carrozzi L, Cascio A, Castiglione G, Chiarito M, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Dalena G, Dal Pra C, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Filippini T, Maria Fusco F, Gaudiosi C, Gentile I, Gini G, Grandone E, Guarnieri G, Lamanna GLF, Larizza G, Leone A, Lio V, Losito AR, Maccagni G, Maitan S, Mancarella S, Manuele R, Mapelli M, Maragna R, Marra L, Maresca G, Marotta C, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Milic J, Minutolo F, Molena B, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Perroni A, Petri F, Pinchera B, Pivato CA, Poletti V, Ravaglia C, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Spinicci M, Trecarichi EM, Veronesi G, Vettor R, Vianello A, Vinceti M, Visconti E, Vocciante L, De Caterina R, Iacoviello L. Lopinavir/Ritonavir and Darunavir/Cobicistat in Hospitalized COVID-19 Patients: Findings From the Multicenter Italian CORIST Study. Front Med (Lausanne) 2021; 8:639970. [PMID: 34179035 PMCID: PMC8221239 DOI: 10.3389/fmed.2021.639970] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/10/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Protease inhibitors have been considered as possible therapeutic agents for COVID-19 patients. Objectives: To describe the association between lopinavir/ritonavir (LPV/r) or darunavir/cobicistat (DRV/c) use and in-hospital mortality in COVID-19 patients. Study Design: Multicenter observational study of COVID-19 patients admitted in 33 Italian hospitals. Medications, preexisting conditions, clinical measures, and outcomes were extracted from medical records. Patients were retrospectively divided in three groups, according to use of LPV/r, DRV/c or none of them. Primary outcome in a time-to event analysis was death. We used Cox proportional-hazards models with inverse probability of treatment weighting by multinomial propensity scores. Results: Out of 3,451 patients, 33.3% LPV/r and 13.9% received DRV/c. Patients receiving LPV/r or DRV/c were more likely younger, men, had higher C-reactive protein levels while less likely had hypertension, cardiovascular, pulmonary or kidney disease. After adjustment for propensity scores, LPV/r use was not associated with mortality (HR = 0.94, 95% CI 0.78 to 1.13), whereas treatment with DRV/c was associated with a higher death risk (HR = 1.89, 1.53 to 2.34, E-value = 2.43). This increased risk was more marked in women, in elderly, in patients with higher severity of COVID-19 and in patients receiving other COVID-19 drugs. Conclusions: In a large cohort of Italian patients hospitalized for COVID-19 in a real-life setting, the use of LPV/r treatment did not change death rate, while DRV/c was associated with increased mortality. Within the limits of an observational study, these data do not support the use of LPV/r or DRV/c in COVID-19 patients.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Roma, Italy
| | | | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Agostino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS, Roma, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Luca Aiello
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Filippo Aucella
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Giacomo Castiglione
- Servizio di Anestesia e Rianimazione II UO Rianimazione Ospedale San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Mauro Chiarito
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giovanni Dalena
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Chiara Dal Pra
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Giancarlo Gini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Veronica Lio
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | | | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord - Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Rosa Manuele
- UOC Malattie Infettive e Tropicali, P.O. San Marco, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milano, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
| | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | | | - Franco Mastroianni
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Beatrice Molena
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - R. Mussinelli
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Roma, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Annalisa Perroni
- Department of Medicine and Aging, Clinica Medica, SS. Annunziata Hospital and University of Chieti, Chieti, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Carlo A. Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena, Modena, Italy
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Elena Visconti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S.Maria di Loreto Nuovo, Napoli, Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Monari C, Sagnelli C, Maggi P, Sangiovanni V, Numis FG, Gentile I, Masullo A, Rescigno C, Calabria G, Megna AS, Gambardella M, Manzillo E, Russo G, Esposito V, Camaioni C, Messina V, Pisaturo M, Allegorico E, Pinchera B, Pisapia R, Catalano M, Salzillo A, Porta G, Signoriello G, Coppola N. More Severe COVID-19 in Patients With Active Cancer: Results of a Multicenter Cohort Study. Front Oncol 2021; 11:662746. [PMID: 34026639 PMCID: PMC8139554 DOI: 10.3389/fonc.2021.662746] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 02/01/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the study was to compare coronavirus disease 2019 (COVID-19) severity presentation between oncologic and non-oncologic patients and to evaluate the impact of cancer type and stage on COVID-19 course. METHODS We performed a multicentre, retrospective study involving 13 COVID-19 Units in Campania region from February to May 2020. We defined as severe COVID-19 presentation the cases that required mechanical ventilation and/or admission to Intensive Care Units (ICU) and/or in case of death. RESULTS We enrolled 371 COVID-19 patients, of whom 34 (9.2%) had a history or a diagnosis of cancer (24 solid, 6 onco-hematological). Oncologic patients were older (p<0.001), had more comorbidities (p<0.001) and showed a higher rate of severe COVID-19 presentation (p=0.001) and of death (p<0.001). Compared to 12 patients with non-active cancer and to 337 without cancer, the 17 patients with active cancer had more comorbidities and showed a higher rate of severe COVID-19 and of mortality (all p values <0.001). Compared to the 281 non-severe patients, the 90 subjects with a severe presentation of COVID-19 were older (p<0.01), with more comorbidities (p<0.001) and with a higher rate of cancer (p=0.001). At multivariate analysis, age (OR 1.08, 95% CI: 1.04-1.11) and suffering from cancer in an active stage (OR 5.33, 95% CI: 1.77-16.53) were independently associated with severe COVID-19. CONCLUSIONS Since the higher risk of severe evolution of COVID-19, cancer patients, especially those with an active malignancy, should be candidates for early evaluation of symptoms and early treatment for COVID-19.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Caterina Sagnelli
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Paolo Maggi
- Infectious Diseases Unit, A.O. S Anna e S Sebastiano Caserta, Caserta, Italy
| | | | | | - Ivan Gentile
- Infectious Diseases Unit, University Federico II, Naples, Italy
| | - Alfonso Masullo
- Infectious Diseases Unit, A.O. San Giovanni di Dio e Ruggi D’Aragona Salerno, Salerno, Italy
| | - Carolina Rescigno
- First Infectious Diseases Unit, AORN dei Colli, PO Cotugno, Naples, Italy
| | - Giosuele Calabria
- IX Infectious Diseases Unit, AORN dei Colli, PO Cotugno, Naples, Italy
| | | | - Michele Gambardella
- Infectious Disease Unit, PO S. Luca, Vallo della Lucania, ASL Salerno, Vallo della Lucania, Italy
| | - Elio Manzillo
- IV Infectious Diseases Unit, AORN dei Colli, PO Cotugno, Naples, Italy
| | - Grazia Russo
- Infectious Diseases Unit, Ospedale Maria S.S. Addolorata di Eboli, ASL Salerno, Eboli, Italy
| | - Vincenzo Esposito
- VIII Infectious Diseases Unit, AORN dei Colli, PO Cotugno, Naples, Italy
| | - Clarissa Camaioni
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Vincenzo Messina
- Infectious Diseases Unit, A.O. S Anna e S Sebastiano Caserta, Caserta, Italy
| | | | | | - Biagio Pinchera
- Infectious Diseases Unit, University Federico II, Naples, Italy
| | - Raffaella Pisapia
- First Infectious Diseases Unit, AORN dei Colli, PO Cotugno, Naples, Italy
| | - Mario Catalano
- IX Infectious Diseases Unit, AORN dei Colli, PO Cotugno, Naples, Italy
| | - Angela Salzillo
- Infectious Diseases Unit, A.O. S Anna e S Sebastiano Caserta, Caserta, Italy
| | - Giovanni Porta
- Emergency Unit, PO Santa Maria delle Grazie, Pozzuoli, Italy
| | - Giuseppe Signoriello
- Statistical Unit, Department of Mental Health and Public Medicine, University of Campania, Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “L. Vanvitelli”, Naples, Italy
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Viceconte G, Buonomo AR, Lanzardo A, Pinchera B, Zappulo E, Scotto R, Schiano Moriello N, Vargas M, Iacovazzo C, Servillo G, Gentile I. Pneumocystis jirovecii pneumonia in an immunocompetent patient recovered from COVID-19. Infect Dis (Lond) 2021; 53:382-385. [PMID: 33645461 DOI: 10.1080/23744235.2021.1890331] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Several cases of invasive fungal diseases in patients with COVID-19 have been reported, mostly due to Aspergillus spp., with anecdotic reports of Pneumocystis jirovecii pneumonia (PJP) as co-infections in immunocompromised patients. We describe the first case of PJP in an immunocompetent patient who recovered from COVID-19 pneumonia. CASE DESCRIPTION Our patient was hospitalized for 18 d for respiratory failure due to Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pneumonia and successfully treated with continuous positive airway pressure (CPAP) respiratory support, enoxaparin, ceftaroline and intravenous 6 mg of dexamethasone for 10 d, then with oral prednisone tapering. Despite his improved radiological and clinical conditions at discharge, he was admitted again after 18 d for worsening of respiratory conditions. Upon the second admission, a high-resolution CT-scan of the chest showed the development of new ground-glass opacities and P. jirovecii was detected on bronchoalveolar lavage fluid. A therapy with trimethoprim-sulphamethoxazole 20 mg/kg and methylprednisolone 40 mg i.v. bis in die (BID) was started, with improvement of clinical, biochemical and radiological conditions. CONCLUSIONS COVID-19 patients may have multiple risk factors for development of PJP, in particular lymphopaenia and use of steroids. PJP must be ruled out with direct microbiological methods in patients presenting with radiologic and clinical features of possible or probable PJP, even in immunocompetent hosts.
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Affiliation(s)
- Giulio Viceconte
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Amedeo Lanzardo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Scotto R, Pinchera B, Perna F, Atripaldi L, Giaccone A, Sequino D, Zappulo E, Sardanelli A, Schiano Moriello N, Stanziola A, Bocchino M, Gentile I, Sanduzzi A. Serum KL-6 Could Represent a Reliable Indicator of Unfavourable Outcome in Patients with COVID-19 Pneumonia. Int J Environ Res Public Health 2021; 18:ijerph18042078. [PMID: 33672761 PMCID: PMC7924557 DOI: 10.3390/ijerph18042078] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 01/08/2023]
Abstract
KL-6 is a sialoglycoprotein antigen which proved elevated in the serum of patients with different interstitial lung diseases, especially in those with a poorer outcome. Given that interstitial pneumonia is the most common presentation of SARS-CoV2 infection, we evaluated the prognostic role of KL-6 in patients with COVID-19 pneumonia. Patients with COVID-19 pneumonia were prospectively enrolled. Blood samples were collected at the time of enrolment (TOE) and on day 7 (T1). Serum KL-6 concentrations were measured by chemiluminescence enzyme immunoassay using a KL-6 antibody kit (LUMIPULSE G1200, Fujirebio) and the cut-off value was set at >1000 U/mL. Fifteen out of 34 enrolled patients (44.1%) died. Patients with unfavourable outcome showed significantly lower P/F ratio and higher IL-6 values and plasmatic concentrations of KL-6 at TOE compared with those who survived (median KL-6: 1188 U/mL vs. 260 U/mL, p < 0.001). KL-6 > 1000 U/mL resulted independently associated with death (aOR: 11.29, p < 0.05) with a positive predictive value of 83.3%. Our results suggest that KL-6 is a reliable indicator of pulmonary function and unfavourable outcome in patients with COVID-19 pneumonia. A KL-6 value > 1000 U/mL resulted independently associated with death and showed good accuracy in predicting a poorer outcome. KL-6 may thus represent a quick, inexpensive, and sensitive parameter to stratify the risk of severe respiratory failure and death.
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Affiliation(s)
- Riccardo Scotto
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
- Correspondence:
| | - Francesco Perna
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Lidia Atripaldi
- Laboratory of Clinical Biochemistry, Monaldi Hospital, 80131 Naples, Italy;
| | - Agnese Giaccone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Davide Sequino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Emanuela Zappulo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Alessia Sardanelli
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Nicola Schiano Moriello
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
| | - Anna Stanziola
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Marialuisa Bocchino
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy; (R.S.); (A.G.); (E.Z.); (A.S.); (N.S.M.); (I.G.)
- Staff of United Nations Educational, Scientific and Cultural Organization (UNESCO), Health Education and Sustainable Development, University Federico II of Naples, 80131 Naples, Italy
| | - Alessandro Sanduzzi
- Section of Respiratory Diseases, Department of Clinical Medicine and Surgery, Monaldi Hospital, University of Naples Federico II, 80131 Naples, Italy; (F.P.); (D.S.); (A.S.); (M.B.); (A.S.)
- Staff of United Nations Educational, Scientific and Cultural Organization (UNESCO), Health Education and Sustainable Development, University Federico II of Naples, 80131 Naples, Italy
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Nardelli C, Gentile I, Setaro M, Di Domenico C, Pinchera B, Buonomo AR, Zappulo E, Scotto R, Scaglione GL, Castaldo G, Capoluongo E. Nasopharyngeal Microbiome Signature in COVID-19 Positive Patients: Can We Definitively Get a Role to Fusobacterium periodonticum? Front Cell Infect Microbiol 2021; 11:625581. [PMID: 33659220 PMCID: PMC7919745 DOI: 10.3389/fcimb.2021.625581] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 11/17/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the pandemic Coronavirus Disease 2019 (COVID-19). This virus is highly transmissible among individuals through both droplets and aerosol leading to determine severe pneumonia. Among the various factors that can influence both the onset of disease and the severity of its complications, the microbiome composition has also been investigated. Recent evidence showed the possible relationship between gut, lung, nasopharyngeal, or oral microbiome and COVID-19, but very little is known about it. Therefore, we aimed to verify the relationships between nasopharyngeal microbiome and the development of either COVID-19 or the severity of symptoms. To this purpose, we analyzed, by next generation sequencing, the hypervariable V1-V2-V3 regions of the bacterial 16S rRNA in nasopharyngeal swabs from SARS-CoV-2 infected patients (n=18) and control (CO) individuals (n=12) using Microbiota solution A (Arrow Diagnostics). We found a significant lower abundance of Proteobacteria and Fusobacteria in COVID-19 patients in respect to CO (p=0.003 and p<0.0001, respectively) from the phylum up to the genus (p<0.001). The Fusobacterium periodonticum (FP) resulted as the most significantly reduced species in COVID-19 patients respect to CO. FP is reported as being able to perform the surface sialylation. Noteworthy, some sialic acids residues on the cell surface could work as additional S protein of SARS-CoV-2 receptors. Consequently, SARS-CoV-2 could use sialic acids as receptors to bind to the epithelium of the respiratory tract, promoting its clustering and the disease development. We can therefore speculate that the significant reduction of FP in COVID-19 patients could be directly or indirectly linked to the modulation of sialic acid metabolism. Finally, viral or environmental factors capable of interfering with sialic metabolism could determine a fall in the individual protection from SARS-CoV-2. Further studies are necessary to clarify the precise role of FP in COVID-19.
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Affiliation(s)
- Carmela Nardelli
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy.,CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy.,Task Force on Microbiome Studies, University of Naples Federico II, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Mario Setaro
- CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
| | | | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | | | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | | | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy.,CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
| | - Ettore Capoluongo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Napoli, Italy.,CEINGE Biotecnologie Avanzate S.C.a R.L., Napoli, Italy
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42
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Di Castelnuovo A, Costanzo S, Antinori A, Berselli N, Blandi L, Bonaccio M, Cauda R, Guaraldi G, Menicanti L, Mennuni M, Parruti G, Patti G, Santilli F, Signorelli C, Vergori A, Abete P, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Arboretti R, Astuto M, Aucella F, Barbieri G, Bartoloni A, Bonfanti P, Cacciatore F, Caiano L, Carrozzi L, Cascio A, Ciccullo A, Cingolani A, Cipollone F, Colomba C, Colombo C, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Tano G, D'Offizi G, Fantoni M, Fusco FM, Gentile I, Gianfagna F, Grandone E, Graziani E, Grisafi L, Guarnieri G, Larizza G, Leone A, Maccagni G, Madaro F, Maitan S, Mancarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marongiu S, Marotta C, Marra L, Mastroianni F, Mazzitelli M, Mengozzi A, Menichetti F, Meschiari M, Milic J, Minutolo F, Molena B, Montineri A, Mussini C, Musso M, Niola D, Odone A, Olivieri M, Palimodde A, Parisi R, Pasi E, Pesavento R, Petri F, Pinchera B, Poletti V, Ravaglia C, Rognoni A, Rossato M, Rossi M, Sangiovanni V, Sanrocco C, Scorzolini L, Sgariglia R, Simeone PG, Taddei E, Torti C, Vettor R, Vianello A, Vinceti M, Virano A, Vocciante L, De Caterina R, Iacoviello L. Heparin in COVID-19 Patients Is Associated with Reduced In-Hospital Mortality: The Multicenter Italian CORIST Study. Thromb Haemost 2021; 121:1054-1065. [PMID: 33412596 DOI: 10.1055/a-1347-6070] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A hypercoagulable condition was described in patients with coronavirus disease 2019 (COVID-19) and proposed as a possible pathogenic mechanism contributing to disease progression and lethality. AIM We evaluated if in-hospital administration of heparin improved survival in a large cohort of Italian COVID-19 patients. METHODS In a retrospective observational study, 2,574 unselected patients hospitalized in 30 clinical centers in Italy from February 19, 2020 to June 5, 2020 with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 infection were analyzed. The primary endpoint in a time-to event analysis was in-hospital death, comparing patients who received heparin (low-molecular-weight heparin [LMWH] or unfractionated heparin [UFH]) with patients who did not. We used multivariable Cox proportional-hazards regression models with inverse probability for treatment weighting by propensity scores. RESULTS Out of 2,574 COVID-19 patients, 70.1% received heparin. LMWH was largely the most used formulation (99.5%). Death rates for patients receiving heparin or not were 7.4 and 14.0 per 1,000 person-days, respectively. After adjustment for propensity scores, we found a 40% lower risk of death in patients receiving heparin (hazard ratio = 0.60; 95% confidence interval: 0.49-0.74; E-value = 2.04). This association was particularly evident in patients with a higher severity of disease or strong coagulation activation. CONCLUSION In-hospital heparin treatment was associated with a lower mortality, particularly in severely ill COVID-19 patients and in those with strong coagulation activation. The results from randomized clinical trials are eagerly awaited to provide clear-cut recommendations.
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Affiliation(s)
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Marco Mennuni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Vergori
- Department of HIV/AIDS, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Rome, Italy
| | - Pasquale Abete
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli "Federico II," Napoli, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia," University of Catania; AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Luca Aiello
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Rosa Arboretti
- Department of Civil Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | - Marinella Astuto
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, U.O. Anestesia, Rianimazione 1. P.O. "G. Rodolico," AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Surgical, Medical and Molecular Medicine and Critical Care, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy.,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Francesco Cacciatore
- Dipartimento di Scienze Mediche Traslazionali, Università degli studi di Napoli "Federico II," Napoli, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Arturo Ciccullo
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Crizia Colombo
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | | | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | | | - Gianpiero D'Offizi
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L, Spallanzani, IRCCS, Roma, Italy
| | - Massimo Fantoni
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy.,Dipartimento di Sicurezza e Bioetica Sede di Roma, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Maria Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Francesco Gianfagna
- Mediterranea Cardiocentro, Napoli, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Elvira Grandone
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | - Emauele Graziani
- Medicina Interna, Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giovanni Larizza
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Ferruccio Madaro
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Stefano Maitan
- UOC, Anestesia e Rianimazione, Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Sandro Mancarella
- ASST Milano Nord, Ospedale Edoardo Bassini Cinisello Balsamo, Milan, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Riccardo Maragna
- Centro Cardiologico Monzino IRCCS, Milan, Italy.,Section of Cardiovascular, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Giulio Maresca
- UOC di Medicina - Presidio Ospedaliero S. Maria di Loreto Nuovo. ASL Napoli 1 Centro. Napoli. Italy
| | | | | | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Franco Mastroianni
- COVID-19 Unit, EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Marianna Meschiari
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Beatrice Molena
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Arturo Montineri
- U.O. C. Malattie Infettive e Tropicali, P.O. "San Marco." AOU Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | - Daniela Niola
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | | | - Roberta Parisi
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Emanuela Pasi
- Medicina Interna, Ospedale di Ravenna, AUSL della Romagna, Ravenna, Italy
| | - Raffaele Pesavento
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Andrea Rognoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani," IRCCS, Rome, Italy
| | | | - Paola Giustina Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Eleonora Taddei
- Fondazione Policlinico Universitario A, Gemelli IRCCS, Rome, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States
| | - Alexandra Virano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Laura Vocciante
- UOC di Medicina - Presidio Ospedaliero S. Maria di Loreto Nuovo. ASL Napoli 1 Centro. Napoli. Italy
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana and University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Isernia, Italy.,Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Spirito L, Pinchera B, Patrì A, Delfino M, Imbimbo C, Salvatore P, Gentile I, Fabbrocini G. No Detection of SARS-CoV-2 RNA on Urethral Swab in Patients with Positive Nasopharyngeal Swab. Adv Virol 2020; 2020:8826943. [PMID: 33376490 PMCID: PMC7729391 DOI: 10.1155/2020/8826943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/04/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 infection has caused one of the worst pandemics that history has ever known. SARS-CoV-2 can lead to multiple organ failure, which is life-threatening. Viral RNA is found in the lung, intestine, testicle, kidney, etc., which suggests the virus can be transmitted also via routes besides respiratory droplets. The aim of our study was to evaluate the presence of SARS-CoV-2 in urethral swabs. METHODS We enrolled ten patients with SARS-CoV-2 infection who attended the Infectious Diseases Unit of the A.O.U. Federico II of Naples, from March 2020 to April 2020. One urethral swab and one rhino-oropharyngeal swab were collected from each patient during SARS-CoV-2 infection. RESULTS All ten patients had a negative urethral swab for SARS-CoV-2 RNA, whereas the rhino-oropharyngeal swab was positive for SARS-CoV-2 RNA. This finding demonstrates that, in our patients, the virus did not affect the urinary tract and therefore would not be found in the urine, and even more importantly, it would not be transmitted via urine. This result was independent of the stage of the disease. CONCLUSION If confirmed in larger studies, this observation could be the key to understanding the role of SARS-CoV-2 in relation to the genitourinary system.
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Affiliation(s)
- Lorenzo Spirito
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Section of Urology, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Angela Patrì
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Mario Delfino
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Section of Urology, University of Naples Federico II, Naples, Italy
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
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44
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Patrì A, Pinchera B, Spirito L, Delfino M, Imbimbo C, Salvatore P, Gentile I, Fabbrocini G. Gastrointestinal tract diseases as a risk factor for SARSCoV2 rectal shedding? An Italian report on 10 COVID-19 patients. Intest Res 2020; 19:354-356. [PMID: 33147898 PMCID: PMC8322022 DOI: 10.5217/ir.2020.00084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Angela Patrì
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lorenzo Spirito
- Section of Urology, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Mario Delfino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ciro Imbimbo
- Section of Urology, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Salvatore
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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45
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Di Castelnuovo A, Bonaccio M, Costanzo S, Gialluisi A, Antinori A, Berselli N, Blandi L, Bruno R, Cauda R, Guaraldi G, My I, Menicanti L, Parruti G, Patti G, Perlini S, Santilli F, Signorelli C, Stefanini GG, Vergori A, Abdeddaim A, Ageno W, Agodi A, Agostoni P, Aiello L, Al Moghazi S, Aucella F, Barbieri G, Bartoloni A, Bologna C, Bonfanti P, Brancati S, Cacciatore F, Caiano L, Cannata F, Carrozzi L, Cascio A, Cingolani A, Cipollone F, Colomba C, Crisetti A, Crosta F, Danzi GB, D'Ardes D, de Gaetano Donati K, Di Gennaro F, Di Palma G, Di Tano G, Fantoni M, Filippini T, Fioretto P, Fusco FM, Gentile I, Grisafi L, Guarnieri G, Landi F, Larizza G, Leone A, Maccagni G, Maccarella S, Mapelli M, Maragna R, Marcucci R, Maresca G, Marotta C, Marra L, Mastroianni F, Mengozzi A, Menichetti F, Milic J, Murri R, Montineri A, Mussinelli R, Mussini C, Musso M, Odone A, Olivieri M, Pasi E, Petri F, Pinchera B, Pivato CA, Pizzi R, Poletti V, Raffaelli F, Ravaglia C, Righetti G, Rognoni A, Rossato M, Rossi M, Sabena A, Salinaro F, Sangiovanni V, Sanrocco C, Scarafino A, Scorzolini L, Sgariglia R, Simeone PG, Spinoni E, Torti C, Trecarichi EM, Vezzani F, Veronesi G, Vettor R, Vianello A, Vinceti M, De Caterina R, Iacoviello L. Common cardiovascular risk factors and in-hospital mortality in 3,894 patients with COVID-19: survival analysis and machine learning-based findings from the multicentre Italian CORIST Study. Nutr Metab Cardiovasc Dis 2020; 30:1899-1913. [PMID: 32912793 PMCID: PMC7833278 DOI: 10.1016/j.numecd.2020.07.031] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS There is poor knowledge on characteristics, comorbidities and laboratory measures associated with risk for adverse outcomes and in-hospital mortality in European Countries. We aimed at identifying baseline characteristics predisposing COVID-19 patients to in-hospital death. METHODS AND RESULTS Retrospective observational study on 3894 patients with SARS-CoV-2 infection hospitalized from February 19th to May 23rd, 2020 and recruited in 30 clinical centres distributed throughout Italy. Machine learning (random forest)-based and Cox survival analysis. 61.7% of participants were men (median age 67 years), followed up for a median of 13 days. In-hospital mortality exhibited a geographical gradient, Northern Italian regions featuring more than twofold higher death rates as compared to Central/Southern areas (15.6% vs 6.4%, respectively). Machine learning analysis revealed that the most important features in death classification were impaired renal function, elevated C reactive protein and advanced age. These findings were confirmed by multivariable Cox survival analysis (hazard ratio (HR): 8.2; 95% confidence interval (CI) 4.6-14.7 for age ≥85 vs 18-44 y); HR = 4.7; 2.9-7.7 for estimated glomerular filtration rate levels <15 vs ≥ 90 mL/min/1.73 m2; HR = 2.3; 1.5-3.6 for C-reactive protein levels ≥10 vs ≤ 3 mg/L). No relation was found with obesity, tobacco use, cardiovascular disease and related-comorbidities. The associations between these variables and mortality were substantially homogenous across all sub-groups analyses. CONCLUSIONS Impaired renal function, elevated C-reactive protein and advanced age were major predictors of in-hospital death in a large cohort of unselected patients with COVID-19, admitted to 30 different clinical centres all over Italy.
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Affiliation(s)
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy
| | | | - Andrea Antinori
- UOC Immunodeficienze Virali, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Nausicaa Berselli
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Blandi
- IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ilaria My
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | | | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Perlini
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Carlo Signorelli
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Alessandra Vergori
- HIV/AIDS Department, National Institute for Infectious Diseases "Lazzaro Spallanzani"-IRCCS, Roma, Italy
| | - Amina Abdeddaim
- UOC Malattie Infettive-Epatologia, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Luca Aiello
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Samir Al Moghazi
- UOC Infezioni Sistemiche dell'Immunodepresso, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Filippo Aucella
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Greta Barbieri
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | | | - Paolo Bonfanti
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Serena Brancati
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences. University of Naples, Federico II, Naples, Italy
| | - Lucia Caiano
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Francesco Cannata
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Laura Carrozzi
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Antonella Cingolani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Francesco Cipollone
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Claudia Colomba
- Infectious and Tropical Diseases Unit- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) - University of Palermo, Palermo, Italy
| | - Annalisa Crisetti
- Fondazione I.R.C.C.S "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Francesca Crosta
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Gian B Danzi
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Damiano D'Ardes
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | | | | | - Gisella Di Palma
- UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Massimo Fantoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Tommaso Filippini
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Fioretto
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Francesco M Fusco
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Leonardo Grisafi
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Landi
- UOC Anestesia e Rianimazione. Dipartimento di Chirurgia Generale Ospedale Morgagni-Pierantoni Forlì, Italy
| | - Giovanni Larizza
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Armando Leone
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Gloria Maccagni
- Department of Cardiology, Ospedale di Cremona, Cremona, Italy
| | - Sandro Maccarella
- ASST Milano Nord - Ospedale Edoardo Bassini, Cinisello Balsamo, Italy
| | - Massimo Mapelli
- Centro Cardiologico Monzino IRCCS, Milano, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Riccardo Maragna
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Giulio Maresca
- Centro Cardiologico Monzino IRCCS, Milano, Italy; UOC Medicina - PO S. Maria di Loreto Nuovo -ASL Napoli 1 Centro, Napoli, Italy
| | | | - Lorenzo Marra
- UOC di Pneumologia, P.O. San Giuseppe Moscati, Taranto, Italy
| | - Franco Mastroianni
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Francesco Menichetti
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Jovana Milic
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rita Murri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore- Dipartimento di Sicurezza e Bioetica Sede di Roma, Italy
| | - Arturo Montineri
- U.O. C. Malattie Infettive e Tropicali, P.O. "San Marco", AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | | | - Cristina Mussini
- Infectious Disease Unit, Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Musso
- UOC Malattie Infettive-Apparato Respiratorio, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Anna Odone
- School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | - Marco Olivieri
- Computer Service, University of Molise, Campobasso, Italy
| | - Emanuela Pasi
- Medicina Interna. Ospedale di Ravenna. AUSL della Romagna, Ravenna, Italy
| | - Francesco Petri
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples "Federico II". Napoli, Italy
| | - Carlo A Pivato
- Humanitas Clinical and Research Hospital IRCCS, Rozzano-Milano, Italy
| | - Roberto Pizzi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Venerino Poletti
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | | | - Claudia Ravaglia
- UOC Pneumologia, Dipartimento di Malattie Apparato Respiratorio e Torace, Ospedale Morgagni-Pierantoni Forlì, Forlì, Italy
| | - Giulia Righetti
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Andrea Rognoni
- Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
| | - Marco Rossato
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Marianna Rossi
- UOC Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Anna Sabena
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Francesco Salinaro
- Emergency Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Vincenzo Sangiovanni
- UOC Infezioni Sistemiche e dell'Immunodepresso, Azienda Ospedaliera dei Colli, Ospedale Cotugno, Napoli, Italy
| | - Carlo Sanrocco
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Antonio Scarafino
- COVID-19 Unit. EE Ospedale Regionale F. Miulli, Acquaviva delle Fonti, BA, Italy
| | - Laura Scorzolini
- UOC Malattie Infettive ad Alta Intensità di Cura, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | | | - Paola G Simeone
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, Pescara, Italy
| | - Enrico Spinoni
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Enrico M Trecarichi
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences "Magna Graecia" University, Catanzaro, Italy
| | - Francesca Vezzani
- Department of Medicine and Aging, Clinica Medica, "SS. Annunziata" Hospital and University of Chieti, Chieti, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine - DIMED, University hospital of Padova, Padova, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Marco Vinceti
- Section of Public Health, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Raffaele De Caterina
- Cardiovascular and Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, and University of Pisa, Pisa, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, IS, Italy; Department of Medicine and Surgery, University of Insubria, Varese, Italy.
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Cacciapuoti S, De Rosa A, Gelzo M, Megna M, Raia M, Pinchera B, Pontarelli A, Scotto R, Scala E, Scarano F, Scalia G, Castaldo G, Fabbrocini G, Gentile I, Parrella R. Immunocytometric analysis of COVID patients: A contribution to personalized therapy? Life Sci 2020; 261:118355. [PMID: 32871183 PMCID: PMC7456265 DOI: 10.1016/j.lfs.2020.118355] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 08/10/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/29/2022]
Abstract
AIMS This study aims to cast light on immunocytometric alterations in COVID-19, a potentially fatal viral infection with heterogeneous clinical expression and a not completely defined pathophysiology. METHODS We studied 35 COVID patients at hospital admission testing by cytofluorimetry a large panel of lymphocyte subpopulations and serum tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-17A and the soluble receptor of IL-17A (IL-17RA). KEY FINDINGS At hospital admission, total lymphocytes and most T and B subpopulations were reduced in 50-80% of patients, with close relationship to disease severity. While activated T helper 1 (TH1) and TH17 cells resulted normal or higher. Serum IL-6 was increased in all patients, while TNF-α and IL-17A were higher in advanced stages. A patient subset with low severity had very high IL-17RA levels. Tocilizumab treatment caused an increase of IL-17A in 3/6 patients and a reduction in 3 others, while the lymphocyte number increased in 3 patients and did not change in the others. SIGNIFICANCE Cytofluorimetry revealed a functional exhaustion of most lymphocyte populations in COVID patients not involving activated TH1 and TH17. Consequently, there was a relevant cytokines production that contributes to impair the respiratory inflammation. The increase of TH17 and IL-17 in a subset of cases and the evidence of a significant increase of IL-17RA (that prevents the interaction of IL-17 with the cell receptor) in patients with low severity suggest that some patients could benefit from monoclonal antibodies treatment targeting IL-17 pathway. Immunocytofluorimetric markers may contribute to a personalized therapy in COVID patients.
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Affiliation(s)
- Sara Cacciapuoti
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Annunziata De Rosa
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate, Scarl, Naples, Italy; Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Matteo Megna
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | | | - Biagio Pinchera
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Agostina Pontarelli
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | - Riccardo Scotto
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Emanuele Scala
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Francesco Scarano
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
| | | | - Giuseppe Castaldo
- CEINGE-Biotecnologie Avanzate, Scarl, Naples, Italy; Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy.
| | - Gabriella Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Ivan Gentile
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Roberto Parrella
- Dipartimento di Malattie Infettive e Emergenze Infettive, Divisione di Malattie Infettive Respiratorie, Ospedale Cotugno, AORN dei Colli, Naples, Italy
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Di Minno MND, Ambrosino P, Buonomo AR, Pinchera B, Calcaterra I, Crispo M, Scotto R, Borgia F, Mattia C, Gentile I. Direct-acting antivirals improve endothelial function in patients with chronic hepatitis: a prospective cohort study. Intern Emerg Med 2020; 15:263-271. [PMID: 31396919 DOI: 10.1007/s11739-019-02163-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/27/2019] [Indexed: 12/21/2022]
Abstract
Hepatitis C virus (HCV) infection is associated with increased cardiovascular risk. We evaluated effects of direct-acting antiviral agents (DAAs) on flow-mediated dilation (FMD), a recognized marker of cardiovascular risk. We evaluated FMD and post-ischemic hyperemia (PIH) in consecutive HCV out-patients before starting DAAs, at the end of treatment (Teot) and 12 weeks thereafter. In 22 HCV subjects (age 64.0 years), baseline FMD was 4.52% ± 1.90 and PIH of 5814.4 (IQR 3786.9-7861.9). At (Teot), all patients showed undetectable levels of HCV-RNA and FMD changed from 4.52% ± 1.90 to 9.39% ± 4.06 (p < 0.001), with a direct correlation between changes in FMD and baseline HCV-RNA levels (r = 0.494, p = 0.020). In parallel, PIH increased from 5814.4 (IQR 3786.9-7861.9) to 7277.6 (IQR 4579.8-10388.8) (p = 0.019). Twelve weeks after Teot, all patients had persistently negative HCV-RNA, FMD was 10.9% ± 4.65 and PIH was 10930.3 (IQR 6254.6-18248.2) suggesting a further significant improvement in these parameters. Results remained significant regardless of the presence of cardiovascular risk factors, whereas FMD changes were not statistically significant in subjects with cirrhosis. A persistent and significant improvement in endothelial function is observed in HCV patients obtaining viral eradication with DAAs treatment. This might suggest a beneficial effect of DAAs treatment on cardiovascular risk profile of HCV patients.
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Affiliation(s)
| | - Pasquale Ambrosino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Manuel Crispo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Francesco Borgia
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Consalvo Mattia
- Department of Medical and Surgical Sciences and Biotechnologies, Unit of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Faculty of Pharmacy and Medicine, "Polo Pontino", "Sapienza" University of Rome, Rome, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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48
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Maraolo AE, Scotto R, Zappulo E, Pinchera B, Schiano Moriello N, Nappa S, Buonomo AR, Gentile I. Novel strategies for the management of bacterial and fungal infections in patients with liver cirrhosis: focus on new antimicrobials. Expert Rev Anti Infect Ther 2020; 18:191-202. [PMID: 32011191 DOI: 10.1080/14787210.2020.1725473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Liver cirrhosis is a frequent condition caused by different etiologies. Bacterial and fungal infections are common complications, representing an independent prognostic stage in patients with cirrhosis, dramatically worsening their clinical outcomes.Areas covered: The present review article addresses manifold points and to this purpose an inductive literature search of MEDLINE database through PubMed was performed. First, it provides an overview on the mechanisms underlying immune disfunctions in patients with cirrhosis, who are prone to develop infections being at higher risk than the general population. Second, commonest types of bacterial and fungal infections in patients with advanced liver disease are described, focusing on their deleterious impact as decompensating events. Third, the rise of multidrug-resistant (MDR) bacteria and fungi as causative agents of infection in cirrhotic subjects is illustrated. Eventually, the most promising novel therapeutic options against MDR pathogens and fungi are reviewed.Expert opinion: The management of bacterial and fungal infections in patients with cirrhosis is difficult, due to the frequent co-existence of renal impairment, low platelet count and other conditions that limit the antimicrobial choice. New antibacterial and antifungal compounds may overcome this issue by providing a better tolerability profile, along with equal or superior efficacy compared with older drugs.
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Affiliation(s)
- Alberto E Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Salatore Nappa
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
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49
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Buonomo AR, Scotto R, Coppola C, Pinchera B, Viceconte G, Rapillo CM, Staiano L, Saturnino M, Scarano F, Portunato F, Pisaturo M, De Pascalis S, Martini S, Tosone G, Nappa S, Coppola N, Gentile I. Direct acting antivirals treatment for hepatitis C virus infection does not increase the incidence of de novo hepatocellular carcinoma occurrence: Results from an Italian real-life cohort (LINA cohort). Medicine (Baltimore) 2020; 99:e18948. [PMID: 32028404 PMCID: PMC7015572 DOI: 10.1097/md.0000000000018948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection is ascertained. However, some authors raised the issue of an increased incidence of de novo hepatocellular carcinoma (HCC) in patients treated with DAAs. Aim of the study was to evaluate the rate of HCC occurrence in a real-life cohort of patients who received anti-HCV treatment with DAAs.A prospective multicentre study was conducted. All adult patients with HCV infection who received treatment between March 2015 and December 2017 in 4 hospital of Campania region (South Italy) with at least 6 months of follow-up were enrolled.A total of 323 patients were included in the study. Most patients had HCV genotype 1b (61.8%). The overall SVR12 rate was 95.5%. Median time of observation was 10 months. The incidence rate of HCC was 0.2 per 100 person-months (crude incidence rate 3.4%, 95 confidence interval: 1.5%-5.3%). The median time for HCC occurrence was 11 months. HCC occurrence rate was significantly higher among patients who did not achieve SVR12 compared with patients who did (28.6% vs 2.8%, P < 0.05). No patient with F0-F3 fibrosis developed HCC. Among patients with cirrhosis, at the multivariate time-to-event analysis, no covariates were independently associated with the risk of HCC occurrence.Treatment with DAAs did not increase the risk of HCC occurrence. Patients who achieved SVR12 had a lower rate of HCC occurrence. Further studies are needed to estimate the incidence and the risk for HCC in the long-term follow-up among patients undergoing treatment with DAAs.
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Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Carmine Coppola
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Costanza Maria Rapillo
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Laura Staiano
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Mariarosaria Saturnino
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Ferdinando Scarano
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Federica Portunato
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Salvatore Martini
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Salvatore Nappa
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Nicola Coppola
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
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50
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Zappulo E, Scotto R, Buonomo AR, Maraolo AE, Pinchera B, Gentile I. Efficacy and safety of a fixed dose combination tablet of asunaprevir + beclabuvir + daclatasvir for the treatment of Hepatitis C. Expert Opin Pharmacother 2020; 21:261-273. [PMID: 31914336 DOI: 10.1080/14656566.2019.1697674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Hepatitis C virus (HCV) is estimated to infect approximately 70 million people worldwide. If left untreated, chronic infection can progress to cirrhosis, liver failure or hepatocellular carcinoma. The advent of new direct-acting antivirals (DAA) has revolutionized patients' chances of treatment and viral elimination. Currently, several DAA options are available on the market.Areas covered: This review focuses on the pharmacokinetics, efficacy, tolerability and safety profile of DCV-TRIO, a twice-daily fixed-dose combination of daclatasvir, asunaprevir and beclabuvir approved in Japan for the treatment of genotype 1 HCV infection.Expert opinion: The DCV-TRIO combination achieved good response rates in genotype 1 patients (SVR12 ≥ 95% in naïve subtype 1b), independently from IL28B genotype, cirrhotic status and prior interferon exposure. On the other hand, unsatisfying response rates were reported in DAA-experienced patients and the risk of RAS selection should not be underestimated. Moreover, DCV-TRIO lacks differentiation from its earlier-launched DAA rivals, presents an inconvenient twice-daily dosing schedule and is not recommended in patients with advanced liver and kidney disease. All these drawbacks considerably limit its effective commercial potential. However, it can be a therapeutic option against HCV in tailored approaches according to the needs of different markets across the world.Abbreviations AE: adverse event; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ASV: asunaprevir; AUC: area under the curve; BCRP: Breast Cancer Resistance Protein; BCV: boceprevir; BID: bis in die; CI: confidence intervals; CLcr: creatinine clearance; DAA: direct acting antivirals; DCV: daclatasvir; EC50: Half maximal effective concentration; GT: genotype; HCV: Hepatitis C virus; IFN: Interferon; NHL: non-Hodgkin lymphoma; OATP: Organic anion transporting polypeptides; OR: odds ratio; P-gp: P-glycoprotein; PK: pharmacokinetics; QD: quo die; RAS: resistance-associated substitutions; SVR: sustained virological response; USD: Unites States dollar.
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Affiliation(s)
- Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
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