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Margaritopoulos GA, Proklou A, Trachalaki A, Badenes Bonet D, Kokosi M, Kouranos V, Chua F, George P, Renzoni EA, Devaraj A, Desai S, Nicholson AG, Antoniou KM, Wells AU. Overnight desaturation in interstitial lung diseases: links to pulmonary vasculopathy and mortality. ERJ Open Res 2024; 10:00740-2023. [PMID: 38348245 PMCID: PMC10860199 DOI: 10.1183/23120541.00740-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
Background Overnight desaturation predicts poor prognosis across interstitial lung diseases (ILDs). The aim of the present study was to investigate whether nocturnal desaturation is associated with pulmonary vasculopathy and mortality. Methods A retrospective single centre study of 397 new ILD patients was carried out including patients with idiopathic pulmonary fibrosis (IPF) (n=107) and patients with non-IPF fibrotic ILD (n=290). This is the largest study to date of the effect of significant nocturnal desaturation (SND) (≥10% of total sleep time with oxygen saturation ≤90% measured by pulse oximetry). Results The prevalence of SND was 28/107 (26.2%) in IPF and 80/290 (27.6%) in non-IPF ILD. The prevalence of SND was higher in non-IPF ILDs than in IPF (p=0.025) in multivariate analysis. SND was associated with noninvasive markers of pulmonary hypertension (PH): tricuspid regurgitation velocity (TRV) (p<0.0001), brain natriuretic peptide (p<0.007), carbon monoxide transfer coefficient (p<0.0001), A-a gradient (p<0.0001), desaturation >4% in 6-min walking test (p<0.03) and pulmonary artery diameter (p<0.005). SND was independently associated with high echocardiographic PH probability in the entire cohort (OR 2.865, 95% CI 1.486-5.522, p<0.002) and in non-IPF fibrotic ILD (OR 3.492, 95% CI 1.597-7.636, p<0.002) in multivariate analysis. In multivariate analysis, SND was associated with mortality in the entire cohort (OR 1.734, 95% CI 1.202-2.499, p=0.003) and in IPF (OR 1.908, 95% CI 1.120-3.251, p=0.017) and non-IPF fibrotic ILD (OR 1.663, 95% CI 1.000-2.819, p=0.041). Separate models with exclusion of each one of the diagnostic subgroups showed that no subgroup was responsible for this finding in non-IPF ILDs. SND was a stronger marker of 5-year mortality than markers of PH. Conclusion SND was associated with high echocardiographic probability and mortality and was a stronger predictor of mortality in IPF and non-IPF ILDs grouped together to power the study.
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Affiliation(s)
- George A. Margaritopoulos
- Interstitial Lung Disease Unit, London North West University Hospital Healthcare Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athanasia Proklou
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Intensive Care Unit, University Hospital of Herakleio, Heraklion, Greece
- These authors contributed equally
| | - Athina Trachalaki
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- These authors contributed equally
| | - Diana Badenes Bonet
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Peter George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | | | - Anand Devaraj
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Sujal Desai
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Andrew G. Nicholson
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Katerina M. Antoniou
- Interstitial Lung Disease Unit, University Hospital of Herakleio, Heraklion, Greece
- These authors contributed equally
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- These authors contributed equally
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Badenes Bonet D, Caguana Vélez OA, Duran Jordà X, Comas Serrano M, Posso Rivera M, Admetlló M, Herranz Blasco A, Cuadrado Godia E, Marco Navarro E, Martin Ezquerra G, Pineiro Aguin Z, Cumpli Gargallo MC, Gonzalez Garcia JG, Balcells Vilarnau E, Rodriguez Chiaradia D, Castells X, Gea J, Horcajada JP, Villar-García J. Treatment of COVID-19 during the Acute Phase in Hospitalized Patients Decreases Post-Acute Sequelae of COVID-19. J Clin Med 2023; 12:4158. [PMID: 37373850 DOI: 10.3390/jcm12124158] [Citation(s) in RCA: 2] [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: 04/22/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, with special attention to the treatment received in the acute phase, and to describe the profile of persistent symptoms in a multidisciplinary Post-Coronavirus Disease-19 (COVID-19) Unit. METHODS This one-year prospective observational study included patients following an acute COVID-19 infection, irrespective of whether they required hospital admission. A standardized symptom questionnaire and blood sampling were performed at the first follow-up visit, and demographic and clinical electronic data were collected. We compared subjects with PASC with those who had fully recovered. Multivariate logistic regression was performed to identify factors associated with PASC in hospitalized patients, and Kaplan-Meier curves were used to assess duration of symptoms according to disease severity and treatments received in the acute phase. RESULTS 1966 patients were evaluated; 1081 had mild disease, 542 moderate and 343 severe; around one third of the subjects had PASC, and were more frequently female, with obesity, asthma, and eosinophilia during acute COVID-19 disease. Patients who received treatment with dexamethasone and remdesivir during the course of the acute illness showed a lower median duration of symptoms, compared with those who received none of these treatments. CONCLUSION Treatment with dexamethasone and/or remdesivir may be useful to reduce the impact of PASC secondary to SARS-CoV-2 infection. In addition, we identified female gender, obesity, asthma, and disease severity as risk factors for having PASC.
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Affiliation(s)
- Diana Badenes Bonet
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Oswaldo Antonio Caguana Vélez
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Xavier Duran Jordà
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Assessoria Metodològica i Bioestadística (AMIB), 08003 Barcelona, Spain
| | - Merce Comas Serrano
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Margarita Posso Rivera
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Mireia Admetlló
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | | | - Ester Marco Navarro
- Physical Medicine and Rehabilitation Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Zenaida Pineiro Aguin
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Otorrinolaringology Department, Hospital del Mar, 08003 Barcelona, Spain
| | | | - Jose Gregorio Gonzalez Garcia
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Eva Balcells Vilarnau
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Diego Rodriguez Chiaradia
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar, REDISSEC, RICAPPS, 08003 Barcelona, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Juan P Horcajada
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, (CIBERES), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
| | - Judit Villar-García
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
- Infectious Diseases Department, Hospital del Mar, 08003 Barcelona, Spain
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González-García JG, Pascual-Guardia S, Aguilar Colindres RJ, Ausín Herrero P, Alvarado Miranda M, Arita Guevara M, Badenes Bonet D, Bellido Calduch S, Caguana Vélez OA, Cumpli Gargallo C, Dominguez-Alvarez M, Gea J, Grau N, Khilzi K, Martínez-Llorens J, Sánchez Ortiz M, Sánchez-Font A, Sancho-Muñoz A, Parrilla-Gómez FJ, Marín Corral J, Pérez Terán P, Rodríguez-Sevilla JJ, Chalela R, Rodríguez-Chiaradia D. Incidence of pulmonary embolism in patients with non-invasive respiratory support during COVID-19 outbreak. Respir Med 2021; 178:106325. [PMID: 33581510 PMCID: PMC7857998 DOI: 10.1016/j.rmed.2021.106325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
While the incidence of thrombotic complications in critically ill patients is very high, in patients under non-invasive respiratory support (NIS) is still unknown. The specific incidence of thrombotic events in each of the clinical scenarios within the broad spectrum of severity of COVID-19, is not clearly established, and this has not allowed the implementation of thromboprophylaxis or anticoagulation for routine care in COVID-19. Patients admitted in a semi-critical unit treated initially with NIS, especially Continuous-Positive Airway Pressure (CPAP), were included in the study. The cumulative incidence of pulmonary embolism was analyzed and compared between patients with good response to NIS and patients with clinical deterioration that required orotracheal intubation. 93 patients were included and 16% required mechanical ventilation (MV) after the NIS. The crude cumulative incidence of the PE was 14% (95%, CI 8-22) for all group. In patients that required orotracheal intubation and MV, the cumulative incidence was significantly higher [33% (95%, CI 16-58)] compared to patients that continued with non-invasive support [11% (CI 5-18)] (Log-Rank, p = 0.013). Patients that required mechanical ventilation were at higher risk of PE for a HR of 4.3 (95%CI 1.2-16). In conclusion, cumulative incidence of PE is remarkably higher in critically patients with a potential impact in COVID-19 evolution. In this context, patients under NIS are a very high-risk group for developing PE without a clear strategy regarding thromboprophylaxis.
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Affiliation(s)
- Jose Gregorio González-García
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Sergi Pascual-Guardia
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | | | - Pilar Ausín Herrero
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Diana Badenes Bonet
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Oswaldo A Caguana Vélez
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Marisol Dominguez-Alvarez
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Joaquim Gea
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Nuria Grau
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Karys Khilzi
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain
| | - Juana Martínez-Llorens
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | - Mónica Sánchez Ortiz
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain
| | - Albert Sánchez-Font
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Sancho-Muñoz
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain
| | | | | | | | | | - Roberto Chalela
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; School of Health & Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain.
| | - Diego Rodríguez-Chiaradia
- Respiratory Medicine Department, Hospital del Mar (PSMAR) - IMIM. Barcelona, Spain; CIBER, Área de Enfermedades Respiratorias (CIBERES), ISCIII, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Fernández ME, Capparelli I, Bonet DB. Rehabilitación Respiratoria en pacientes EPID, una intervención integral. Open Respiratory Archives 2021. [PMID: 37497356 PMCID: PMC10369504 DOI: 10.1016/j.opresp.2021.100090] [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: 10/21/2022] Open
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