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Boylan S, Arsenault C, Barreto M, Bozza FA, Fonseca A, Forde E, Hookham L, Humphreys GS, Ichihara MY, Le Doare K, Liu XF, McNamara E, Mugunga JC, Oliveira JF, Ouma J, Postlethwaite N, Retford M, Reyes LF, Morris AD, Wozencraft A. Data challenges for international health emergencies: lessons learned from ten international COVID-19 driver projects. Lancet Digit Health 2024; 6:e354-e366. [PMID: 38670744 DOI: 10.1016/s2589-7500(24)00028-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/28/2024]
Abstract
The COVID-19 pandemic highlighted the importance of international data sharing and access to improve health outcomes for all. The International COVID-19 Data Alliance (ICODA) programme enabled 12 exemplar or driver projects to use existing health-related data to address major research questions relating to the pandemic, and developed data science approaches that helped each research team to overcome challenges, accelerate the data research cycle, and produce rapid insights and outputs. These approaches also sought to address inequity in data access and use, test approaches to ethical health data use, and make summary datasets and outputs accessible to a wider group of researchers. This Health Policy paper focuses on the challenges and lessons learned from ten of the ICODA driver projects, involving researchers from 19 countries and a range of health-related datasets. The ICODA programme reviewed the time taken for each project to complete stages of the health data research cycle and identified common challenges in areas such as data sharing agreements and data curation. Solutions included provision of standard data sharing templates, additional data curation expertise at an early stage, and a trusted research environment that facilitated data sharing across national boundaries and reduced risk. These approaches enabled the driver projects to rapidly produce research outputs, including publications, shared code, dashboards, and innovative resources, which can all be accessed and used by other research teams to address global health challenges.
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Affiliation(s)
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Marcos Barreto
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Fernando A Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Adalton Fonseca
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | | | | | | | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Kirsty Le Doare
- St George's, University of London, London, UK; Makerere University John's Hopkins University Research Collaboration, Kampala, Uganda
| | - Xiao Fan Liu
- Department of Media and Communication, City University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Jean Claude Mugunga
- Partners in Health, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Juliane F Oliveira
- Center for Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil; Department of Mathematics, Centre of Mathematics of the University of Porto, Porto, Portugal
| | - Joseph Ouma
- Makerere University John's Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Luis Felipe Reyes
- Nuffield School of Medicine, University of Oxford, Oxford, UK; Universidad de La Sabana, Chia, Colombia
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Bastos LSL, Hamacher S, Kurtz P, Ranzani OT, Zampieri FG, Soares M, Bozza FA, Salluh JIF. The Association Between Prepandemic ICU Performance and Mortality Variation in COVID-19: A Multicenter Cohort Study of 35,619 Critically Ill Patients. Chest 2024; 165:870-880. [PMID: 37838338 DOI: 10.1016/j.chest.2023.10.011] [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: 03/27/2023] [Revised: 09/20/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, ICUs remained under stress and observed elevated mortality rates and high variations of outcomes. A knowledge gap exists regarding whether an ICU performing best during nonpandemic times would still perform better when under high pressure compared with the least performing ICUs. RESEARCH QUESTION Does prepandemic ICU performance explain the risk-adjusted mortality variability for critically ill patients with COVID-19? STUDY DESIGN AND METHODS This study examined a cohort of adults with real-time polymerase chain reaction-confirmed COVID-19 admitted to 156 ICUs in 35 hospitals from February 16, 2020, through December 31, 2021, in Brazil. We evaluated crude and adjusted in-hospital mortality variability of patients with COVID-19 in the ICU during the pandemic. Association of baseline (prepandemic) ICU performance and in-hospital mortality was examined using a variable life-adjusted display (VLAD) during the pandemic and a multivariable mixed regression model adjusted by clinical characteristics, interaction of performance with the year of admission, and mechanical ventilation at admission. RESULTS Thirty-five thousand six hundred nineteen patients with confirmed COVID-19 were evaluated. The median age was 52 years, median Simplified Acute Physiology Score 3 was 42, and 18% underwent invasive mechanical ventilation. In-hospital mortality was 13% and 54% for those receiving invasive mechanical ventilation. Adjusted in-hospital mortality ranged from 3.6% to 63.2%. VLAD in the most efficient ICUs was higher than the overall median in 18% of weeks, whereas VLAD was 62% and 84% in the underachieving and least efficient groups, respectively. The least efficient baseline ICU performance group was associated independently with increased mortality (OR, 2.30; 95% CI, 1.45-3.62) after adjusting for patient characteristics, disease severity, and pandemic surge. INTERPRETATION ICUs caring for patients with COVID-19 presented substantial variation in risk-adjusted mortality. ICUs with better baseline (prepandemic) performance showed reduced mortality and less variability. Our findings suggest that achieving ICU efficiency by targeting improvement in organizational aspects of ICUs may impact outcomes, and therefore should be a part of the preparedness for future pandemics.
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Affiliation(s)
- Leonardo S L Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Kurtz
- Hospital Copa Star, Rio de Janeiro, Brazil; Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Otavio T Ranzani
- Pulmonary Division, Heart Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Barcelona Institute for Global Health, ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Fernando G Zampieri
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
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França ARM, Rocha E, Bastos LSL, Bozza FA, Kurtz P, Maccariello E, Lapa E Silva JR, Salluh JIF. Development and validation of a machine learning model to predict the use of renal replacement therapy in 14,374 patients with COVID-19. J Crit Care 2024; 80:154480. [PMID: 38016226 DOI: 10.1016/j.jcrc.2023.154480] [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: 03/25/2023] [Revised: 11/11/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To develop a model to predict the use of renal replacement therapy (RRT) in COVID-19 patients. MATERIALS AND METHODS Retrospective analysis of multicenter cohort of intensive care unit (ICU) admissions of Brazil involving COVID-19 critically adult patients, requiring ventilatory support, admitted to 126 Brazilian ICUs, from February 2020 to December 2021 (development) and January to May 2022 (validation). No interventions were performed. RESULTS Eight machine learning models' classifications were evaluated. Models were developed using an 80/20 testing/train split ratio and cross-validation. Thirteen candidate predictors were selected using the Recursive Feature Elimination (RFE) algorithm. Discrimination and calibration were assessed. Temporal validation was performed using data from 2022. Of 14,374 COVID-19 patients with initial respiratory support, 1924 (13%) required RRT. RRT patients were older (65 [53-75] vs. 55 [42-68]), had more comorbidities (Charlson's Comorbidity Index 1.0 [0.00-2.00] vs 0.0 [0.00-1.00]), had higher severity (SAPS-3 median: 61 [51-74] vs 48 [41-58]), and had higher in-hospital mortality (71% vs 22%) compared to non-RRT. Risk factors for RRT, such as Creatinine, Glasgow Coma Scale, Urea, Invasive Mechanical Ventilation, Age, Chronic Kidney Disease, Platelets count, Vasopressors, Noninvasive Ventilation, Hypertension, Diabetes, modified frailty index (mFI) and Gender, were identified. The best discrimination and calibration were found in the Random Forest (AUC [95%CI]: 0.78 [0.75-0.81] and Brier's Score: 0.09 [95%CI: 0.08-0.10]). The final model (Random Forest) showed comparable performance in the temporal validation (AUC [95%CI]: 0.79 [0.75-0.84] and Brier's Score, 0.08 [95%CI: 0.08-0.1]). CONCLUSIONS An early ML model using easily available clinical and laboratory data accurately predicted the use of RRT in critically ill patients with COVID-19. Our study demonstrates that using ML techniques is feasible to provide early prediction of use of RRT in COVID-19 patients.
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Affiliation(s)
- Allan R M França
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil.
| | - Eduardo Rocha
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil; Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Pedro Kurtz
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Hospital Copa Star, Rio de Janeiro, RJ, Brazil
| | - Elizabeth Maccariello
- Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - José Roberto Lapa E Silva
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | - Jorge I F Salluh
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil; Postgraduate Program, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
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Moll-Bernardes R, Ferreira JR, Sousa AS, Tortelly MB, Pimentel AL, Figueiredo ACBS, Schaustz EB, Secco JCP, Sales ARK, Terzi FVO, Xavier de Brito A, Sarmento RO, Noya-Rabelo MM, Fortier S, Matos E Silva FA, Vera N, Conde L, Cabral-Castro MJ, Albuquerque DC, Rosado de-Castro P, Camargo GC, Pinheiro MVT, Souza OF, Bozza FA, Luiz RR, Medei E. Impact of the immune profiles of hypertensive patients with and without obesity on COVID-19 severity. Int J Obes (Lond) 2024; 48:254-262. [PMID: 37932408 DOI: 10.1038/s41366-023-01407-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Comorbidities such as obesity, hypertension, and diabetes are associated with COVID-19 development and severity, probably due to immune dysregulation; however, the mechanisms underlying these associations are not clear. The immune signatures of hypertensive patients with obesity with COVID-19 may provide new insight into the mechanisms of immune dysregulation and progression to severe disease in these patients. METHODS Hypertensive patients were selected prospectively from a multicenter registry of adults hospitalized with COVID-19 and stratified according to obesity (BMI ≥ 30 kg/m²). Clinical data including baseline characteristics, complications, treatment, and 46 immune markers were compared between groups. Logistic regression was performed to identify variables associated with the risk of COVID-19 progression in each group. RESULTS The sample comprised 213 patients (89 with and 124 without obesity). The clinical profiles of patients with and without obesity differed, suggesting potential interactions with COVID-19 severity. Relative to patients without obesity, patients with obesity were younger and fewer had cardiac disease and myocardial injury. Patients with obesity had higher EGF, GCSF, GMCSF, interleukin (IL)-1ra, IL-5, IL-7, IL-8, IL-15, IL-1β, MCP 1, and VEGF levels, total lymphocyte counts, and CD8+ CD38+ mean fluorescence intensity (MFI), and lower NK-NKG2A MFI and percentage of CD8+ CD38+ T cells. Significant correlations between cytokine and immune cell expression were observed in both groups. Five variables best predicted progression to severe COVID-19 in patients with obesity: diabetes, the EGF, IL-10, and IL-13 levels, and the percentage of CD8+ HLA-DR+ CD38+ cells. Three variables were predictive for patients without obesity: myocardial injury and the percentages of B lymphocytes and HLA-DR+ CD38+ cells. CONCLUSION Our findings suggest that clinical and immune variables and obesity interact synergistically to increase the COVID-19 progression risk. The immune signatures of hypertensive patients with and without obesity severe COVID-19 highlight differences in immune dysregulation mechanisms, with potential therapeutic applications.
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Affiliation(s)
| | - Juliana R Ferreira
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
| | - Andréa Silvestre Sousa
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Mariana B Tortelly
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
| | - Adriana L Pimentel
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
| | - Ana Cristina B S Figueiredo
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
| | | | | | | | - Flavia V O Terzi
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
| | | | - Renée O Sarmento
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Internal Medicine Department, Rio de Janeiro Federal State University, Rio de Janeiro, Brazil
| | - Marcia M Noya-Rabelo
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
- Bahia School of Medicine and Public Health, Bahia, Brazil
| | - Sergio Fortier
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | | | - Narendra Vera
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Luciana Conde
- Bahia School of Medicine and Public Health, Bahia, Brazil
| | - Mauro Jorge Cabral-Castro
- Institute of Microbiology Paulo de Góes, UFRJ, Rio de Janeiro, Brazil
- Department of Pathology, Faculty of Medicine, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Denilson C Albuquerque
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | | | - Olga F Souza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, São Paulo, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronir R Luiz
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Institute for Studies in Public Health-IESC, UFRJ, Rio de Janeiro, Brazil
| | - Emiliano Medei
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
- National Center for Structural Biology and Bioimaging, UFRJ, Rio de Janeiro, Brazil.
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Teixeira L, Pereira-Dutra FS, Reis PA, Cunha-Fernandes T, Yoshinaga MY, Souza-Moreira L, Souza EK, Barreto EA, Silva TP, Espinheira-Silva H, Igreja T, Antunes MM, Bombaça ACS, Gonçalves-de-Albuquerque CF, Menezes GB, Hottz ED, Menna-Barreto RF, Maya-Monteiro CM, Bozza FA, Miyamoto S, Melo RC, Bozza PT. Prevention of lipid droplet accumulation by DGAT1 inhibition ameliorates sepsis-induced liver injury and inflammation. JHEP Rep 2024; 6:100984. [PMID: 38293685 PMCID: PMC10827501 DOI: 10.1016/j.jhepr.2023.100984] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 11/11/2023] [Accepted: 11/21/2023] [Indexed: 02/01/2024] Open
Abstract
Background & Aims Lipid droplet (LD) accumulation in cells and tissues is understood to be an evolutionarily conserved tissue tolerance mechanism to prevent lipotoxicity caused by excess lipids; however, the presence of excess LDs has been associated with numerous diseases. Sepsis triggers the reprogramming of lipid metabolism and LD accumulation in cells and tissues, including the liver. The functions and consequences of sepsis-triggered liver LD accumulation are not well known. Methods Experimental sepsis was induced by CLP (caecal ligation and puncture) in mice. Markers of hepatic steatosis, liver injury, hepatic oxidative stress, and inflammation were analysed using a combination of functional, imaging, lipidomic, protein expression and immune-enzymatic assays. To prevent LD formation, mice were treated orally with A922500, a pharmacological inhibitor of DGAT1. Results We identified that liver LD overload correlates with liver injury and sepsis severity. Moreover, the progression of steatosis from 24 h to 48 h post-CLP occurs in parallel with increased cytokine expression, inflammatory cell recruitment and oxidative stress. Lipidomic analysis of purified LDs demonstrated that sepsis leads LDs to harbour increased amounts of unsaturated fatty acids, mostly 18:1 and 18:2. An increased content of lipoperoxides within LDs was also observed. Conversely, the impairment of LD formation by inhibition of the DGAT1 enzyme reduces levels of hepatic inflammation and lipid peroxidation markers and ameliorates sepsis-induced liver injury. Conclusions Our results indicate that sepsis triggers lipid metabolism alterations that culminate in increased liver LD accumulation. Increased LDs are associated with disease severity and liver injury. Moreover, inhibition of LD accumulation decreased the production of inflammatory mediators and lipid peroxidation while improving tissue function, suggesting that LDs contribute to the pathogenesis of liver injury triggered by sepsis. Impact and Implications Sepsis is a complex life-threatening syndrome caused by dysregulated inflammatory and metabolic host responses to infection. The observation that lipid droplets may contribute to sepsis-associated organ injury by amplifying lipid peroxidation and inflammation provides a rationale for therapeutically targeting lipid droplets and lipid metabolism in sepsis.
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Affiliation(s)
- Lívia Teixeira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Filipe S. Pereira-Dutra
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Research, Innovation and Surveillance in COVID-19 and Heath Emergencies, FIOCRUZ, Rio de Janeiro, Brazil
| | - Patrícia A. Reis
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Biochemistry Department, Roberto Alcântara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tamires Cunha-Fernandes
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Research, Innovation and Surveillance in COVID-19 and Heath Emergencies, FIOCRUZ, Rio de Janeiro, Brazil
| | - Marcos Y. Yoshinaga
- Laboratory of Modified Lipids, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Luciana Souza-Moreira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Ellen K. Souza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Ester A. Barreto
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Thiago P. Silva
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences (ICB), Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Hugo Espinheira-Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Research, Innovation and Surveillance in COVID-19 and Heath Emergencies, FIOCRUZ, Rio de Janeiro, Brazil
| | - Tathiany Igreja
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Maísa M. Antunes
- Center for Gastrointestinal Biology, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana Cristina S. Bombaça
- Laboratory of Cellular Biology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Laboratory of Parasitic Disease, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Cassiano F. Gonçalves-de-Albuquerque
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Laboratory of Immunopharmacology, Department of Physiology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gustavo B. Menezes
- Center for Gastrointestinal Biology, Department of Morphology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Eugênio D. Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | | | - Clarissa M. Maya-Monteiro
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Research, Innovation and Surveillance in COVID-19 and Heath Emergencies, FIOCRUZ, Rio de Janeiro, Brazil
| | - Fernando A. Bozza
- Center for Research, Innovation and Surveillance in COVID-19 and Heath Emergencies, FIOCRUZ, Rio de Janeiro, Brazil
- Intensive Care Medicine Laboratory, INI, FIOCRUZ, Rio de Janeiro, Brazil
- D'Or Institute Research and Education (IDOr), Rio de Janeiro, Brazil
| | - Sayuri Miyamoto
- Laboratory of Modified Lipids, Department of Biochemistry, University of São Paulo, São Paulo, Brazil
| | - Rossana C.N. Melo
- Laboratory of Cellular Biology, Department of Biology, Institute of Biological Sciences (ICB), Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Patrícia T. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Research, Innovation and Surveillance in COVID-19 and Heath Emergencies, FIOCRUZ, Rio de Janeiro, Brazil
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Rynkowski CB, Hegele V, Soares PHR, Tonello ML, Petterson L, Gomes FK, Rabinstein AA, Bastos LSL, Turon R, Gonçalves B, Righy C, Bozza FA, Kurtz P. Correction: Effects of Tranexamic Acid in Patients with Subarachnoid Hemorrhage in Brazil: A Prospective Observational Study with Propensity Score Analysis. Neurocrit Care 2023; 39:754. [PMID: 37821722 DOI: 10.1007/s12028-023-01866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Carla B Rynkowski
- Intensive Care Unit, Cristo Redentor Hospital, Porto Alegre, Brazil
- Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil
| | - Vanessa Hegele
- Pharmacy Department, Cristo Redentor Hospital, Porto Alegre, Brazil
| | | | | | | | | | | | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Ricardo Turon
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Bruno Gonçalves
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Cassia Righy
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
- D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Pedro Kurtz
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
- D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil.
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil.
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Moll-Bernardes R, Ferreira JR, Schaustz EB, Sousa AS, Mattos JD, Tortelly MB, Pimentel AL, Figueiredo ACBS, Noya-Rabelo MM, Fortier S, Matos E Silva FA, Vera N, Conde L, Cabral-Castro MJ, Albuquerque DC, Rosado-de-Castro PH, Camargo GC, Pinheiro MVT, Freitas DOL, Pittella AM, Araújo JAM, Marques AC, Gouvêa EP, Terzi FVO, Zukowski CN, Gismondi RAOC, Bandeira BS, Oliveira RS, Abufaiad BEJ, Miranda JSS, Miranda LG, Souza OF, Bozza FA, Luiz RR, Medei E. New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID-19. J Clin Immunol 2023; 43:1496-1505. [PMID: 37294518 PMCID: PMC10250847 DOI: 10.1007/s10875-023-01523-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated. METHODS All patients were selected prospectively from a multicenter registry of adults hospitalized with confirmed COVID-19. Cases had hypertension and myocardial injury, defined by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantified and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury. RESULTS The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fluorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38-cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR-CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated significantly with myocardial injury. CONCLUSION Our findings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.
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Affiliation(s)
- Renata Moll-Bernardes
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Juliana R Ferreira
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Eduardo B Schaustz
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Andréa S Sousa
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - João D Mattos
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Mariana B Tortelly
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Adriana L Pimentel
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Ana Cristina B S Figueiredo
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Marcia M Noya-Rabelo
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
- Bahia School of Medicine and Public Health, Bahia, Brazil
| | - Sergio Fortier
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Flavia A Matos E Silva
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Narendra Vera
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Luciana Conde
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mauro Jorge Cabral-Castro
- Institute of Microbiology Paulo de Góes, UFRJ, Rio de Janeiro, Brazil
- Department of Pathology, Faculty of Medicine, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Denilson C Albuquerque
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Gabriel C Camargo
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Martha V T Pinheiro
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Daniele O L Freitas
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - Ana M Pittella
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
| | - José Afonso M Araújo
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - André C Marques
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Elias P Gouvêa
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Flavia V O Terzi
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Cleverson N Zukowski
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Ronaldo A O C Gismondi
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Bruno S Bandeira
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Renée S Oliveira
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
- Internal Medicine Department, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Barbara E J Abufaiad
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Jacqueline S S Miranda
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Luiz Guilherme Miranda
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Olga F Souza
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Cardiology and Internal Medicine Department, Rede D'Or São Luiz, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronir R Luiz
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil
- Institute for Studies in Public Health-IESC, UFRJ, Rio de Janeiro, Brazil
| | - Emiliano Medei
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30, 22281100, Rio de Janeiro, Brazil.
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
- National Center for Structural Biology and Bioimaging, UFRJ, Rio de Janeiro, Brazil.
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8
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Rynkowski CB, Hegele V, Soares PHR, Tonello ML, Petterson L, Gomes FK, Rabinstein AA, Bastos LSL, Turon R, Gonçalves B, Righy C, Bozza FA, Kurtz P. Effects of Tranexamic Acid in Patients with Subarachnoid Hemorrhage in Brazil: A Prospective Observational Study with Propensity Score Analysis. Neurocrit Care 2023; 39:191-197. [PMID: 37131089 DOI: 10.1007/s12028-023-01732-2] [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: 09/27/2022] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Rebleeding from a ruptured aneurysm increases the risk of unfavorable outcomes after subarachnoid hemorrhage (SAH) and is prevented by early aneurysm occlusion. The role of antifibrinolytics before aneurysm obliteration remains controversial. We investigated the effects of tranexamic acid on long-term functional outcomes of patients with aneurysmal SAH (aSAH). METHODS This was a single-center, prospective, observational study conducted in a high-volume tertiary hospital in a middle-income country from December 2016 to February 2020. We included all consecutive patients with aSAH who either received or did not receive tranexamic acid (TXA) treatment. Multivariate logistic regression analysis using propensity score was used to evaluate the association of TXA use with long-term functional outcomes, measured by the modified Rankin Scale (mRS) at 6 months. RESULTS A total of 230 patients with aSAH were analyzed. The median (interquartile range) age was 55 (46-63) years, 72% were women, 75% presented with good clinical grade (World Federation of Neurological Surgeons grade 1-3), and 83% had a Fisher scale of 3 or 4. Around 80% of patients were admitted up to 72 h from ictus. The aneurysm occlusion method was surgical clipping in 80% of the patients. A total of 129 patients (56%) received TXA. In multivariable logistic regression using inverse probability treatment weighting, the long-term rate of unfavorable outcomes (modified Rankin scale 4-6) was the same in the TXA and non-TXA groups (61 [48%] in TXA group vs. 33 [33%] in non-TXA group; odds ratio [OR] 1.39, 95% confidence interval [CI] 0.67-2.92; p = 0.377). The TXA group had higher in-hospital mortality (33 vs. 11% in non-TXA group; OR 4.13, 95% CI 1.55-12.53, p = 0.007). There were no differences between the groups concerning intensive care unit length of stay (16 ± 11.22 days in TXA group vs. 14 ± 9.24 days in non-TXA group; p = 0.2) or hospital (23 ± 13.35 days in TXA group vs. 22 ± 13.36 days in non-TXA group; p = 0.9). There was no difference in the rates of rebleeding (7.8% in TXA group vs. 8.9% in non-TXA group; p = 0.31) or delayed cerebral ischemia (27% in TXA group vs. 19% in non-TXA group; p = 0.14). For the propensity-matched analysis, 128 individuals were selected (64 in TXA group and 64 in non-TXA group), and the rates of unfavorable outcomes at 6 months were also similar between groups (45% in TXA group and 36% in non-TXA group; OR 1.22, 95% CI 0.51-2.89; p = 0.655). CONCLUSIONS Our findings in a cohort with delayed aneurysm treatment reinforce previous data that TXA use before aneurysm occlusion does not improve functional outcomes in aSAH.
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Affiliation(s)
- Carla B Rynkowski
- Intensive Care Unit, Cristo Redentor Hospital, Porto Alegre, Brazil
- Intensive Care Unit, Ernesto Dornelles Hospital, Porto Alegre, Brazil
| | - Vanessa Hegele
- Pharmacy Department, Cristo Redentor Hospital, Porto Alegre, Brazil
| | | | | | | | | | | | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Ricardo Turon
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Bruno Gonçalves
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Cassia Righy
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
- D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Pedro Kurtz
- Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
- D ́Or Institute for Research and Education, Rua Diniz Cordeiro 30, Rio de Janeiro, RJ, 22281-100, Brazil.
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil.
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9
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Gama-Almeida MC, Pinto GDA, Teixeira L, Hottz ED, Ivens P, Ribeiro H, Garrett R, Torres AG, Carneiro TIA, Barbalho BDO, Ludwig C, Struchiner CJ, Assunção-Miranda I, Valente APC, Bozza FA, Bozza PT, Dos Santos GC, El-Bacha T. Integrated NMR and MS Analysis of the Plasma Metabolome Reveals Major Changes in One-Carbon, Lipid, and Amino Acid Metabolism in Severe and Fatal Cases of COVID-19. Metabolites 2023; 13:879. [PMID: 37512587 PMCID: PMC10384698 DOI: 10.3390/metabo13070879] [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: 06/12/2023] [Revised: 07/15/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Brazil has the second-highest COVID-19 death rate worldwide, and Rio de Janeiro is among the states with the highest rate in the country. Although vaccine coverage has been achieved, it is anticipated that COVID-19 will transition into an endemic disease. It is concerning that the molecular mechanisms underlying clinical evolution from mild to severe disease, as well as the mechanisms leading to long COVID-19, are not yet fully understood. NMR and MS-based metabolomics were used to identify metabolites associated with COVID-19 pathophysiology and disease outcome. Severe COVID-19 cases (n = 35) were enrolled in two reference centers in Rio de Janeiro within 72 h of ICU admission, alongside 12 non-infected control subjects. COVID-19 patients were grouped into survivors (n = 18) and non-survivors (n = 17). Choline-related metabolites, serine, glycine, and betaine, were reduced in severe COVID-19, indicating dysregulation in methyl donors. Non-survivors had higher levels of creatine/creatinine, 4-hydroxyproline, gluconic acid, and N-acetylserine, indicating liver and kidney dysfunction. Several changes were greater in women; thus, patients' sex should be considered in pandemic surveillance to achieve better disease stratification and improve outcomes. These metabolic alterations may be useful to monitor organ (dys) function and to understand the pathophysiology of acute and possibly post-acute COVID-19 syndromes.
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Affiliation(s)
- Marcos C Gama-Almeida
- LeBioME-Bioactives, Mitochondrial and Placental Metabolism Core, Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Gabriela D A Pinto
- LeBioME-Bioactives, Mitochondrial and Placental Metabolism Core, Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Lívia Teixeira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21041-361, Brazil
| | - Eugenio D Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora, Juiz de Fora 36936-900, Brazil
| | - Paula Ivens
- LabMeta, Metabolomics Laboratory, Institute of Chemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
| | - Hygor Ribeiro
- LabMeta, Metabolomics Laboratory, Institute of Chemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
- Lipid Biochemistry and Lipidomics Laboratory, Department of Chemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
| | - Rafael Garrett
- LabMeta, Metabolomics Laboratory, Institute of Chemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
| | - Alexandre G Torres
- LeBioME-Bioactives, Mitochondrial and Placental Metabolism Core, Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
- Lipid Biochemistry and Lipidomics Laboratory, Department of Chemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
| | - Talita I A Carneiro
- LeBioME-Bioactives, Mitochondrial and Placental Metabolism Core, Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Bianca de O Barbalho
- LeBioME-Bioactives, Mitochondrial and Placental Metabolism Core, Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Christian Ludwig
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2SQ, UK
| | - Claudio J Struchiner
- School of Applied Mathematics, Fundação Getúlio Vargas, Rio de Janeiro 22231-080, Brazil
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20550-013, Brazil
| | - Iranaia Assunção-Miranda
- LaRIV, Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Ana Paula C Valente
- National Center for Nuclear Magnetic Resonance-Jiri Jonas, Institute of Medical Biochemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Fernando A Bozza
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Patrícia T Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro 21041-361, Brazil
| | - Gilson C Dos Santos
- LabMet-Laboratory of Metabolomics, Instituto de Biologia Roberto Alcantara Gomes (IBRAG), Department of Genetics, State University of Rio de Janeiro, Rio de Janeiro 20551-030, Brazil
| | - Tatiana El-Bacha
- LeBioME-Bioactives, Mitochondrial and Placental Metabolism Core, Institute of Nutrition Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
- Lipid Biochemistry and Lipidomics Laboratory, Department of Chemistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-598, Brazil
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10
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Kurtz P, Bastos LSL, Ranzani OT, Soares M, Zampieri F, Hamacher S, Salluh J, Bozza FA. Variants of concern and clinical outcomes in critically ill COVID-19 patients. Intensive Care Med 2023; 49:697-699. [PMID: 37067557 PMCID: PMC10108805 DOI: 10.1007/s00134-023-07039-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
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11
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Hastenreiter Filho HN, Peres IT, Maddalena LG, Baião FA, Ranzani OT, Hamacher S, Maçaira PM, Bozza FA. What we talk about when we talk about COVID-19 vaccination campaign impact: a narrative review. Front Public Health 2023; 11:1126461. [PMID: 37250083 PMCID: PMC10211334 DOI: 10.3389/fpubh.2023.1126461] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/06/2023] [Indexed: 05/31/2023] Open
Abstract
Background The lack of precise definitions and terminological consensus about the impact studies of COVID-19 vaccination leads to confusing statements from the scientific community about what a vaccination impact study is. Objective The present work presents a narrative review, describing and discussing COVID-19 vaccination impact studies, mapping their relevant characteristics, such as study design, approaches and outcome variables, while analyzing their similarities, distinctions, and main insights. Methods The articles screening, regarding title, abstract, and full-text reading, included papers addressing perspectives about the impact of vaccines on population outcomes. The screening process included articles published before June 10, 2022, based on the initial papers' relevance to this study's research topics. The main inclusion criteria were data analyses and study designs based on statistical modelling or comparison of pre- and post-vaccination population. Results The review included 18 studies evaluating the vaccine impact in a total of 48 countries, including 32 high-income countries (United States, Israel, and 30 Western European countries) and 16 low- and middle-income countries (Brazil, Colombia, and 14 Eastern European countries). We summarize the main characteristics of the vaccination impact studies analyzed in this narrative review. Conclusion Although all studies claim to address the impact of a vaccination program, they differ significantly in their objectives since they adopt different definitions of impact, methodologies, and outcome variables. These and other differences are related to distinct data sources, designs, analysis methods, models, and approaches.
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Affiliation(s)
- Horácio N. Hastenreiter Filho
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- School of Management, Federal University of Bahia, Salvador, Brazil
| | - Igor T. Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucas G. Maddalena
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda A. Baião
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Otavio T. Ranzani
- Barcelona Institute for Global Health, Barcelona, Spain
- Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paula M. Maçaira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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12
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Gonçalves B, Rynkowski C, Turon R, Charris N, Miranda F, de Caro V, Prazeres M, Santos T, Greer DM, Sharshar T, Guillaume T, Bozza FA, Righy C, Kurtz P. Clinical Characteristics and Outcomes of Patients with Aneurysmal Subarachnoid Hemorrhage: A Prospective Multicenter Study in a Middle-Income Country. Neurocrit Care 2023; 38:378-387. [PMID: 36324005 DOI: 10.1007/s12028-022-01629-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/03/2022] [Indexed: 04/13/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality and long-term functional impairment. Data on clinical management and functional outcomes from developing countries are scarce. We aimed to define patient profiles and clinical practices and evaluate long-term outcomes after SAH in a middle-income country. METHODS This was a prospective study including consecutive adult patients admitted with SAH to two reference centers in Brazil from January 2016 to February 2020. The primary outcome was functional status at 6 months using the modified Rankin Scale. Mixed multivariable analysis was performed to determine the relationship between clinical variables and functional outcomes. RESULTS From 471patients analyzed, the median time from symptom onset to arrival at a study center was 4 days (interquartile range 0-9). Median age was 55 years (interquartile range 46-62) and 353 (75%) patients were women. A total of 426 patients (90%) were transferred from nonspecialized general hospitals, initial computed tomography revealed thick hemorrhage in 73% of patients (modified Fisher score of 3 or 4), and 136 (29%) had poor clinical grade (World Federation of Neurological Surgeons score of 4 or 5). A total of 312 (66%) patients underwent surgical clipping, and 119 (25%) underwent endovascular coiling. Only 34 patients (7%) underwent withdrawal or withholding of life-sustaining therapy during their hospital stay, and in-hospital mortality was 24%. A total of 187 (40%) patients had an unfavorable long-term functional outcome (modified Rankin Scale score of 4 to 6). Factors associated with unfavorable outcome were age (adjusted odds ratio [OR] 1.05, 95% confidence interval [CI] 1.03-1.08), hypertension (adjusted OR 1.81, 95% CI 1.04-3.16), poor clinical grade (adjusted OR 4.92, 95% CI 2.85-8.48), external ventricular drain (adjusted OR 3.8, 95% CI 2.31-6.24), postoperative deterioration (adjusted OR 2.33, 95% CI 1.32-4.13), cerebral infarction (adjusted OR 3.16, 95% CI 1.81-5.52), rebleeding (adjusted OR 2.95, 95% CI 1.13-7.69), and sepsis (adjusted OR 2.68, 95% CI 1.42-5.05). CONCLUSIONS Our study demonstrated that SAH management in a middle-income country diverges significantly from published cohorts and current guidelines, despite comparable clinical profiles on presentation and admission to high-volume referral centers. Earlier aneurysm occlusion and increased use of endovascular therapy could potentially reduce modifiable in-hospital complications and improve functional outcomes in Brazil.
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Affiliation(s)
- Bruno Gonçalves
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Carla Rynkowski
- Department of Intensive Care Medicine, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Ricardo Turon
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Nestor Charris
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Fabio Miranda
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil
| | - Vanessa de Caro
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Marco Prazeres
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Thayana Santos
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Tarek Sharshar
- Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
| | - Turc Guillaume
- GHU Paris Psychiatrie et Neurosciences, Paris, France
- Université Paris Cité, Paris, France
- INSERM, Paris, France
- FHU NeuroVasc, Paris, France
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, CEP 22281-100, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Cassia Righy
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil
- National Institute of Infectious Diseases, Fundação Osvaldo Cruz, Rio de Janeiro, Brazil
| | - Pedro Kurtz
- Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
- Department of Neurointensive Care, Hospital Copa Star, Rio de Janeiro, Brazil.
- D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, CEP 22281-100, Brazil.
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Dias SSG, Cunha-Fernandes T, Souza-Moreira L, Soares VC, Lima GB, Azevedo-Quintanilha IG, Santos J, Pereira-Dutra F, Freitas C, Reis PA, Rehen SK, Bozza FA, Souza TML, de Almeida CJG, Bozza PT. Metabolic reprogramming and lipid droplets are involved in Zika virus replication in neural cells. J Neuroinflammation 2023; 20:61. [PMID: 36882750 PMCID: PMC9992922 DOI: 10.1186/s12974-023-02736-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023] Open
Abstract
Zika virus (ZIKV) infection is a global public health concern linked to adult neurological disorders and congenital diseases in newborns. Host lipid metabolism, including lipid droplet (LD) biogenesis, has been associated with viral replication and pathogenesis of different viruses. However, the mechanisms of LD formation and their roles in ZIKV infection in neural cells are still unclear. Here, we demonstrate that ZIKV regulates the expression of pathways associated with lipid metabolism, including the upregulation and activation of lipogenesis-associated transcription factors and decreased expression of lipolysis-associated proteins, leading to significant LD accumulation in human neuroblastoma SH-SY5Y cells and in neural stem cells (NSCs). Pharmacological inhibition of DGAT-1 decreased LD accumulation and ZIKV replication in vitro in human cells and in an in vivo mouse model of infection. In accordance with the role of LDs in the regulation of inflammation and innate immunity, we show that blocking LD formation has major roles in inflammatory cytokine production in the brain. Moreover, we observed that inhibition of DGAT-1 inhibited the weight loss and mortality induced by ZIKV infection in vivo. Our results reveal that LD biogenesis triggered by ZIKV infection is a crucial step for ZIKV replication and pathogenesis in neural cells. Therefore, targeting lipid metabolism and LD biogenesis may represent potential strategies for anti-ZIKV treatment development.
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Affiliation(s)
- Suelen Silva Gomes Dias
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Tamires Cunha-Fernandes
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Luciana Souza-Moreira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Vinicius Cardoso Soares
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Programa de Imunologia e Inflamação, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giselle Barbosa Lima
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | | | - Julia Santos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Filipe Pereira-Dutra
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Caroline Freitas
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patricia A Reis
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Departamento de Bioquímica, Instituto de Biologia Roberto Alcântara Gomes, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stevens Kastrup Rehen
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.,Instituto de Biologia, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.,Instituto Nacional de Infectologia Evandro Chagas (INI), FIOCRUZ, Rio de Janeiro, Brazil
| | - Thiago M Lopes Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.,Instituto Nacional de Ciência e Tecnologia em Inovação em Doenças de Populações Negligenciadas (INCT/IDPN), Centro de Desenvolvimento Tecnológico em Saúde, (CDTS), FIOCRUZ, Rio de Janeiro, Brazil
| | - Cecilia J G de Almeida
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patricia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil.
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14
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Antunes BBP, Silva AAB, Nunes PHC, Martin-Loeches I, Kurtz P, Hamacher S, Bozza FA. Antimicrobial consumption and drug utilization patterns among COVID-19 and non-COVID-19 patients. J Antimicrob Chemother 2023; 78:840-849. [PMID: 36740939 DOI: 10.1093/jac/dkad025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/04/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To understand differences in antimicrobial use between COVID-19 and non-COVID-19 patients. To compare two metrics commonly used for antimicrobial use: Defined Daily Dose (DDD) and Days of Therapy (DOT). To analyse the order in which antimicrobials were prescribed to COVID-19 patients using process mining techniques. METHODS We analysed data regarding all ICU admissions from 1 January 2018 to 14 September 2020, in 17 Brazilian hospitals. Our main outcome was the antimicrobial use estimated by the DDD and DOT (Days of Therapy). We compared clinical characteristics and antimicrobial consumption between COVID-19 and non-COVID-19 patients. We used process mining to evaluate the order in which the antimicrobial schemes were prescribed to each COVID-19 patient. RESULTS We analysed 68 405 patients admitted before the pandemic, 12 319 non-COVID-19 patients and 3240 COVID-19 patients. Comparing those admitted during the pandemic, the COVID-19 patients required advanced respiratory support more often (42% versus 12%). They also had longer ICU length of stay (6 versus 3 days), higher ICU mortality (18% versus 5.4%) and greater use of antimicrobials (70% versus 39%). Most of the COVID-19 treatments started with penicillins with ß-lactamase inhibitors (30%), third-generation cephalosporins (22%), or macrolides in combination with penicillins (19%). CONCLUSIONS Antimicrobial prescription increased in Brazilian ICUs during the COVID-19 pandemic, especially during the first months of the epidemic. We identified greater use of broad-spectrum antimicrobials by COVID-19 patients. Overall, the DDD metric overestimated antimicrobial use compared with the DOT metric.
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Affiliation(s)
- Bianca B P Antunes
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Amanda A B Silva
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Patricia H C Nunes
- Laboratory of Clinical Research in Intensive Care Medicine, National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.,Intensive Care Department, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland.,Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Pedro Kurtz
- Intensive Care Department, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Intensive Care Department, Copa Star Hospital, Rio de Janeiro, RJ, Brazil.,Intensive Care Department, Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- Laboratory of Clinical Research in Intensive Care Medicine, National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.,Intensive Care Department, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
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15
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Kurtz P, Bastos LSL, Zampieri FG, de Freitas GR, Bozza FA, Soares M, Salluh JIF. Trends in Intensive Care Admissions and Outcomes of Stroke Patients Over 10 Years in Brazil: Impact of the COVID-19 Pandemic. Chest 2023; 163:543-553. [PMID: 36347322 PMCID: PMC9636603 DOI: 10.1016/j.chest.2022.10.033] [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: 04/15/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic affected stroke care worldwide. Data from low- and middle-income countries are limited. RESEARCH QUESTION What was the impact of the pandemic in ICU admissions and outcomes of patients with stroke, in comparison with trends over the last 10 years? STUDY DESIGN AND METHODS Retrospective cohort study including prospectively collected data from 165 ICUs in Brazil between 2011 and 2020. We analyzed clinical characteristics and mortality over a period of 10 years and evaluated the impact of the pandemic on stroke outcomes, using the following approach: analyses of admissions for ischemic and hemorrhagic strokes and trends in in-hospital mortality over 10 years; analysis of variable life-adjusted display (VLAD) during 2020; and a mixed-effects multivariable logistic regression model. RESULTS A total of 17,115 stroke admissions were analyzed, from which 13,634 were ischemic and 3,481 were hemorrhagic. In-hospital mortality was lower after ischemic stroke as compared with hemorrhagic (9% vs 24%, respectively). Changes in VLAD across epidemiological weeks of 2020 showed that the rise in COVID-19 cases was accompanied by increased mortality, mainly after ischemic stroke. In logistic regression mixed models, mortality was higher in 2020 compared with 2019, 2018, and 2017 in patients with ischemic stroke, namely, in those without altered mental status. In hemorrhagic stroke, the increased mortality in 2020 was observed in patients 50 years of age or younger, as compared with 2019. INTERPRETATION Hospital outcomes of stroke admissions worsened during the COVID-19 pandemic, interrupting a trend of improvements in survival rates over 10 years. This effect was more pronounced during the surge of COVID-19 ICU admissions affecting predominantly patients with ischemic stroke without coma, and young patients with hemorrhagic stroke.
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Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Hospital Copa Star, Rio de Janeiro, RJ, Brazil; Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil.
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando G Zampieri
- Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gabriel R de Freitas
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Department of Neurology, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcio Soares
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil; Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
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16
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A Batista-da-Silva A, T Ranzani O, M de Paulo D, L Braunstein M, R Bozza H, Fischer R, V Ramos G, M C Dias C, P da Silva E, E Arouca L, L S Bastos L, T Ranzani O, Hamacher S, A Bozza F. Maré cohort-profile: a prospective cohort study based in a socially vulnerable community during the COVID-19 pandemic in Rio de Janeiro, Brazil. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.14035.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Socially vulnerable populations were vastly affected by the COVID-19 pandemic. The pandemic significantly impacted Brazil, pressuring its healthcare system for several months, with high mortality rates, even among the youngest population. Cohort studies combining disease surveillance are essential for understanding virus circulation in the community, surrogates of protection, vaccine effectiveness, and demand for health resources. Methods: Here, we present the protocol for a community-based prospective cohort study in the largest complex of favelas (slums) in Rio de Janeiro, Brazil (Complexo da Maré). The study participants are residents initially recruited during a massive vaccination campaign in the community. Five waves of data collection at approximately six-month intervals were planned. The first two waves have been completed at the time of writing this study protocol, and the third is underway. The protocol comprises interviews, blood sampling, and records linkage with secondary data to enrich the profiles of cohort participants and community information. We will describe COVID-19 seroprevalence, socio-demographic characteristics, and the burden of COVID-19, followed by estimating the association of socioeconomic factors and the burden of disease with seroprevalence. Discussion: The primary aims of the study are to assess COVID-19 clinical, epidemiological and genomic profiles and outcomes in residents from Maré, including vaccine effectiveness, surrogates of immune protection, virus transmission in households, and the overall burden of the pandemic.
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17
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Ferreira AC, Sacramento CQ, Pereira-Dutra FS, Fintelman-Rodrigues N, Silva PP, Mattos M, de Freitas CS, Marttorelli A, de Melo GR, Campos MM, Azevedo-Quintanilha IG, Carlos AS, Emídio JV, Garcia CC, Bozza PT, Bozza FA, Souza TML. Severe influenza infection is associated with inflammatory programmed cell death in infected macrophages. Front Cell Infect Microbiol 2023; 13:1067285. [PMID: 36875528 PMCID: PMC9980436 DOI: 10.3389/fcimb.2023.1067285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Influenza A virus (IAV) is one of the leading causes of respiratory tract infections in humans, representing a major public health concern. The various types of cell death have a crucial role in IAV pathogenesis because this virus may trigger both apoptosis and necroptosis in airway epithelial cells in parallel. Macrophages play an important role in the clearance of virus particles, priming the adaptive immune response in influenza. However, the contribution of macrophage death to pathogenesis of IAV infection remains unclear. Methods In this work, we investigated IAV-induced macrophage death, along with potential therapeutic intervention. We conducted in vitro and in vivo experiments to evaluate the mechanism and the contribution of macrophages death to the inflammatory response induced by IAV infection. Results We found that IAV or its surface glycoprotein hemagglutinin (HA) triggers inflammatory programmed cell death in human and murine macrophages in a Toll-like receptor-4 (TLR4)- and TNF-dependent manner. Anti-TNF treatment in vivo with the clinically approved drug etanercept prevented the engagement of the necroptotic loop and mouse mortality. Etanercept impaired the IAV-induced proinflammatory cytokine storm and lung injury. Conclusion In summary, we demonstrated a positive feedback loop of events that led to necroptosis and exacerbated inflammation in IAV-infected macrophages. Our results highlight an additional mechanism involved in severe influenza that could be attenuated with clinically available therapies.
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Affiliation(s)
- André C. Ferreira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- Preclinical Research Laboratory, Universidade Iguaçu (UNIG), Nova Iguaçu, RJ, Brazil
| | - Carolina Q. Sacramento
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Filipe S. Pereira-Dutra
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Natália Fintelman-Rodrigues
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Priscila P. Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- Preclinical Research Laboratory, Universidade Iguaçu (UNIG), Nova Iguaçu, RJ, Brazil
| | - Mayara Mattos
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Caroline S. de Freitas
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Andressa Marttorelli
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Gabrielle R. de Melo
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Mariana M. Campos
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Aluana S. Carlos
- Preclinical Research Laboratory, Universidade Iguaçu (UNIG), Nova Iguaçu, RJ, Brazil
| | - João Vítor Emídio
- Preclinical Research Laboratory, Universidade Iguaçu (UNIG), Nova Iguaçu, RJ, Brazil
| | - Cristiana C. Garcia
- Respiratory and Measles Virus Laboratory, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Patrícia T. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute of Infectious Disease Evandro Chagas, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- Department of Critical Care, Instituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | - Thiago M. L. Souza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Fundação Oswado Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- *Correspondence: Thiago M. L. Souza,
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Pinheiro MBM, Rozini SV, Quirino-Teixeira AC, Barbosa-Lima G, Lopes JF, Sacramento CQ, Bozza FA, Bozza PT, Hottz ED. Dengue induces iNOS expression and nitric oxide synthesis in platelets through IL-1R. Front Immunol 2022; 13:1029213. [PMID: 36569864 PMCID: PMC9767985 DOI: 10.3389/fimmu.2022.1029213] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Dengue is an arthropod-born disease caused by dengue virus (DENV), that may manifest as a mild illness or severe form, characterized by hemorrhagic fever and shock. Nitric oxide (NO) is a vasodilator signaling molecule and an inhibitor of platelet aggregation known to be increased in platelets from dengue patients. However, the mechanisms underlying NO synthesis by platelets during dengue are not yet elucidated. IL-1β is a pro-inflammatory cytokine able to induce iNOS expression in leukocytes and present in dengue patients at high levels. Nevertheless, the role of IL-1β in platelet activation, especially regarding iNOS expression, are not clear. Methods We prospectively followed a cohort of 28 dengue-infected patients to study NO synthesis in platelets and its relationship with disease outcomes. We used in vitro infection and stimulation models to gain insights on the mechanisms. Results and Discussion We confirmed that platelets from dengue patients express iNOS and produce higher levels of NO during the acute phase compared to healthy volunteers, returning to normal levels after recovery. Platelet NO production during acute dengue infection was associated with the presence of warning signs, hypoalbuminemia and hemorrhagic manifestations, suggesting a role in dengue pathophysiology. By investigating the mechanisms, we evidenced increased iNOS expression in platelets stimulated with dengue patients´ plasma, indicating induction by circulating inflammatory mediators. We then investigated possible factors able to induce platelet iNOS expression and observed higher levels of IL-1β in plasma from patients with dengue, which were correlated with NO production by platelets. Since platelets can synthesize and respond to IL-1β, we investigated whether IL-1β induces iNOS expression and NO synthesis in platelets. We observed that recombinant human IL-1β enhanced iNOS expression and dose-dependently increased NO synthesis by platelets. Finally, platelet infection with DENV in vitro induced iNOS expression and NO production, besides the secretion of both IL-1α and IL-1β. Importantly, treatment with IL-1 receptor antagonist or a combination of anti-IL-1α and anti-IL-1β antibodies prevented DENV-induced iNOS expression and NO synthesis. Our data show that DENV induces iNOS expression and NO production in platelets through mechanisms depending on IL-1 receptor signaling.
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Affiliation(s)
- Mariana Brandi Mendonça Pinheiro
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Stephane Vicente Rozini
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Anna Cecíllia Quirino-Teixeira
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Giselle Barbosa-Lima
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Juliana F. Lopes
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Carolina Q. Sacramento
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil,D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Patrícia T. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Eugenio D. Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Brazil,Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil,*Correspondence: Eugenio D. Hottz,
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19
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Serafim RB, Dal-Pizzol F, Souza-Dantas V, Soares M, Bozza FA, Póvoa P, Luiz RR, Lapa e Silva JR, Salluh JIF. Impact of Subsyndromal Delirium Occurrence and Its Trajectory during ICU Stay. J Clin Med 2022; 11:jcm11226797. [PMID: 36431274 PMCID: PMC9692318 DOI: 10.3390/jcm11226797] [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: 10/21/2022] [Revised: 11/05/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Despite recent advances in the field, the association between subsyndromal delirium (SSD) in the ICU and poor outcomes is not entirely clear. We performed a retrospective multicentric observational study analyzing mental status during the first 72 h of ICU stay. Of the 681 patients included, SSD occurred in 22.7%. Considering the worst cognitive assessment during the first 72 h, 233 (34%) patients had normal mental status, 124 (18%) patients had SSD and 324 (48%) patients had delirium or coma. SSD was not independently associated with an increased risk of death when compared with normal mental status (OR 95%IC 1.0 vs. 1.35 [0.73−1.49], p = 0.340), but was associated with a longer ICU LOS (7.0 (4−12) vs. 4 (3−8) days, p < 0.001). SSD patients who deteriorated to delirium or coma (21%) had a longer ICU LOS in comparison with those who improved or maintained mental status (8 (5−11) vs. 6 (4−8) days, p = 0.025), but did not have an increase in mortality. The main factors associated with the progression from SSD to delirium or coma were the use of mechanical ventilation, the use of intravenous benzodiazepines and a baseline APACHE II score > 23 points. Our findings support the association of SSD with increased ICU LOS, but not with ICU mortality. Monitoring the trajectory of SSD early at ICU admission can help to identify patients with increased risk of conversion from SSD to delirium or coma.
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Affiliation(s)
- Rodrigo B. Serafim
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil
- Hospital Copa D’Or, Rio de Janeiro 22031-011, Brazil
- Hospital Universitário Clementino Fraga Filho/Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Correspondence:
| | - Felipe Dal-Pizzol
- Laboratório de Fisiopatologia experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | | | - Marcio Soares
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Fernando A. Bozza
- Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro 22281-100, Brazil
| | - Pedro Póvoa
- Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, 1150-199 Lisboa, Portugal
- NOVA Medical School, CEDOC, Universidade Nova de Lisboa, 1150-082 Lisboa, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, C 5000 Odense, Denmark
| | - Ronir Raggio Luiz
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Instituto de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-592, Brazil
| | - José R. Lapa e Silva
- Hospital Universitário Clementino Fraga Filho/Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Jorge I. F. Salluh
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro 22281-100, Brazil
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
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20
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Martins-Gonçalves R, Campos MM, Palhinha L, Azevedo-Quintanilha IG, Abud Mendes M, Ramos Temerozo J, Toledo-Mendes J, Rosado-de-Castro PH, Bozza FA, Souza Rodrigues R, Hottz ED, Bozza PT. Persisting Platelet Activation and Hyperactivity in COVID-19 Survivors. Circ Res 2022; 131:944-947. [PMID: 36268747 PMCID: PMC9645447 DOI: 10.1161/circresaha.122.321659] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Remy Martins-Gonçalves
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.).,Postgraduate Program in Immunology and Inflammation, Federal University of Rio de Janeiro (UFRJ), Brazil (R.M.-G., M.C.)
| | - Mariana M. Campos
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.).,Postgraduate Program in Immunology and Inflammation, Federal University of Rio de Janeiro (UFRJ), Brazil (R.M.-G., M.C.)
| | - Lohanna Palhinha
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.)
| | - Isaclaudia G. Azevedo-Quintanilha
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.)
| | - Mayara Abud Mendes
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil (M.A.M., P.H.R.d.C., F.A.B., R.S.R.)
| | - Jairo Ramos Temerozo
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.).,Center for Technological Development in Health (CDTS), FIOCRUZ, RJ, Brazil (J.R.T.).,Laboratory on Thymus Research, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil (J.R.T.).,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ, Brazil (J.R.T.)
| | - Júlia Toledo-Mendes
- Department of Radiology, Federal University of Rio de Janeiro, Brazil (J.d.T.M., P.H.R.d.C., R.S.R.)
| | - Paulo H. Rosado-de-Castro
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil (M.A.M., P.H.R.d.C., F.A.B., R.S.R.).,Department of Radiology, Federal University of Rio de Janeiro, Brazil (J.d.T.M., P.H.R.d.C., R.S.R.)
| | - Fernando A. Bozza
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil (M.A.M., P.H.R.d.C., F.A.B., R.S.R.).,National Institute of Infectious Disease Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil (F.A.B.)
| | - Rosana Souza Rodrigues
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil (M.A.M., P.H.R.d.C., F.A.B., R.S.R.).,Department of Radiology, Federal University of Rio de Janeiro, Brazil (J.d.T.M., P.H.R.d.C., R.S.R.)
| | - Eugenio D. Hottz
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.).,Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil (E.D.H.)
| | - Patricia T. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil (R.M.-G., M.C., L.P., I.G.A.-Q., J.R.T., E.D.H., P.T.B.)
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21
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Moll-Bernardes R, Mattos JD, Schaustz EB, Sousa AS, Ferreira JR, Tortelly MB, Pimentel AML, Figueiredo ACBS, Noya-Rabelo MM, Sales ARK, Albuquerque DC, Rosado-de-Castro PH, Camargo GC, Souza OF, Bozza FA, Medei E, Luiz RR. Troponin in COVID-19: To Measure or Not to Measure? Insights from a Prospective Cohort Study. J Clin Med 2022; 11:jcm11195951. [PMID: 36233816 PMCID: PMC9570932 DOI: 10.3390/jcm11195951] [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: 08/22/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Myocardial injury (MI), defined by troponin elevation, has been associated with increased mortality and adverse outcomes in patients with coronavirus disease 2019 (COVID-19), but the role of this biomarker as a risk predictor remains unclear. Data from adult patients hospitalized with COVID-19 were recorded prospectively. A multiple logistic regression model was used to quantify associations of all variables with in-hospital mortality, including the calculation of odds ratios (ORs) and confidence intervals (CI). Troponin measurement was performed in 1476 of 4628 included patients, and MI was detected in 353 patients, with a prevalence of 23.9%; [95% CI, 21.8–26.1%]. The total in-hospital mortality rate was 10.9% [95% CI, 9.8–12.0%]. The mortality was much higher among patients with MI than among those without MI, with a prevalence of 22.7% [95% CI, 18.5–27.3%] vs. 5.5% [95% CI, 4.3–7.0%] and increased with each troponin level. After adjustment for age and comorbidities, the model revealed that the mortality risk was greater for patients with MI [OR = 2.99; 95% CI, 2.06–4.36%], and for those who did not undergo troponin measurement [OR = 2.2; 95% CI, 1.62–2.97%], compared to those without MI. Our data support the role of troponin as an important risk predictor for these patients, capable of discriminating between those with a low or increased mortality rate. In addition, our findings suggest that this biomarker has a remarkable negative predictive value in COVID-19.
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Affiliation(s)
- Renata Moll-Bernardes
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Correspondence: ; Tel.: +55-21-38836000
| | - João D. Mattos
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | | | - Andréa S. Sousa
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Juliana R. Ferreira
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Copa D’Or Hospital, Rio de Janeiro 22031-011, Brazil
| | - Mariana B. Tortelly
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Niterói D’Or Hospital, Rio de Janeiro 24230-251, Brazil
| | - Adriana M. L. Pimentel
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Niterói D’Or Hospital, Rio de Janeiro 24230-251, Brazil
| | - Ana Cristina B. S. Figueiredo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Unit, Glória D’Or Hospital, Rio de Janeiro 22211-230, Brazil
| | - Marcia M. Noya-Rabelo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Department, Bahia School of Medicine and Public Health, Salvador 40290-000, Brazil
- Cardiology Unit, Aliança Hospital, Salvador 41920-180, Brazil
| | - Allan R. K. Sales
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Denilson C. Albuquerque
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Cardiology Department, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil
| | | | - Gabriel C. Camargo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Olga F. Souza
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
| | - Fernando A. Bozza
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Emiliano Medei
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Ronir R. Luiz
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil
- Institute for Studies in Public Health—IESC, Federal University of Rio de Janeiro, Rio de Janeiro 21941-592, Brazil
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22
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Nassar AP, Archanjo LV, Ranzani OT, Zampieri FG, Salluh JI, Cavalcanti GF, Moreira CE, Viana WN, Costa R, Melo UO, Roderjan CN, Correa TD, de Almeida SL, Azevedo LC, Maia MO, Cravo VS, Bozza FA, Caruso P, Soares M. Characteristics and outcomes of autologous hematopoietic stem cell transplant recipients admitted to intensive care units: A multicenter study. J Crit Care 2022; 71:154077. [DOI: 10.1016/j.jcrc.2022.154077] [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] [Received: 01/20/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 10/18/2022]
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23
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Gomes de Azevedo-Quintanilha I, Campos MM, Teixeira Monteiro AP, Dantas do Nascimento A, Calheiros AS, Oliveira DM, Dias SSG, Soares VC, Santos JDC, Tavares I, Lopes Souza TM, Hottz ED, Bozza FA, Bozza PT. Increased platelet activation and platelet-inflammasome engagement during chikungunya infection. Front Immunol 2022; 13:958820. [PMID: 36189282 PMCID: PMC9520464 DOI: 10.3389/fimmu.2022.958820] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Chikungunya fever is a viral disease transmitted by mosquitoes of the genus Aedes. The infection is usually symptomatic and most common symptoms are fever accompanied by joint pain and swelling. In most cases symptoms subside within a week. However, severe prolonged and disabling joint pain, that may persist for several months, even years, are reported. Although the pathogenesis of Chikungunya infection is not fully understood, the evolution to severe disease seems to be associated with the activation of immune mechanisms and the action of inflammatory mediators. Platelets are recognized as inflammatory cells with fundamental activities in the immune response, maintenance of vascular stability and pathogenicity of several inflammatory and infectious diseases. Although the involvement of platelets in the pathogenesis of viral diseases has gained attention in recent years, their activation in Chikungunya has not been explored. The aim of this study was to analyze platelet activation and the possible role of platelets in the amplification of the inflammatory response during Chikungunya infection. We prospectively included 132 patients attended at the Quinta D’Or hospital and 25 healthy volunteers during the 2016 epidemic in Rio de Janeiro, Brazil. We observed increased expression of CD62P on the surface of platelets, as well as increased plasma levels of CD62P and platelet-derived inflammatory mediators indicating that the Chikungunya infection leads to platelet activation. In addition, platelets from chikungunya patients exhibit increased expression of NLRP3, caspase 4, and cleaved IL-1β, suggestive of platelet-inflammasome engagement during chikungunya infection. In vitro experiments confirmed that the Chikungunya virus directly activates platelets. Moreover, we observed that platelet activation and soluble p-selectin at the onset of symptoms were associated with development of chronic forms of the disease. Collectively, our data suggest platelet involvement in the immune processes and inflammatory amplification triggered by the infection.
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Affiliation(s)
- Isaclaudia Gomes de Azevedo-Quintanilha
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- *Correspondence: Patricia T. Bozza, ; Isaclaudia Gomes de Azevedo-Quintanilha,
| | - Mariana Macedo Campos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Alessandra Dantas do Nascimento
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - Andrea Surrage Calheiros
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Douglas Mathias Oliveira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Suelen Silva Gomes Dias
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Vinicius Cardoso Soares
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Julia da Cunha Santos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Isabel Tavares
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - Thiago Moreno Lopes Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Centro de Desenvolvimento Tecnológico em Saúde (CDTS) and National Institute for Science and Technology on Innovation on Diseases of Neglected Populations (INCT/IDNP), FIOCRUZ, Rio de Janeiro, Brazil
| | - Eugenio D. Hottz
- Laboratório de Imunotrombose, Departamento de Bioquimica, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Fernando A. Bozza
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil
| | - Patricia T. Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- *Correspondence: Patricia T. Bozza, ; Isaclaudia Gomes de Azevedo-Quintanilha,
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24
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Bastos LS, Wortel SA, de Keizer NF, Bakhshi-Raiez F, Salluh JI, Dongelmans DA, Zampieri FG, Burghi G, Abu-Hanna A, Hamacher S, Bozza FA, Soares M. Comparing continuous versus categorical measures to assess and benchmark intensive care unit performance. J Crit Care 2022; 70:154063. [DOI: 10.1016/j.jcrc.2022.154063] [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] [Received: 02/23/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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25
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Moraes ECDS, Martins-Gonçalves R, da Silva LR, Mandacaru SC, Melo RM, Azevedo-Quintanilha I, Perales J, Bozza FA, Souza TML, Castro-Faria-Neto HC, Hottz ED, Bozza PT, Trugilho MRO. Proteomic Profile of Procoagulant Extracellular Vesicles Reflects Complement System Activation and Platelet Hyperreactivity of Patients with Severe COVID-19. Front Cell Infect Microbiol 2022; 12:926352. [PMID: 35937696 PMCID: PMC9354812 DOI: 10.3389/fcimb.2022.926352] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/20/2022] [Indexed: 01/08/2023] Open
Abstract
Background Extracellular vesicles (EVs) are a valuable source of biomarkers and display the pathophysiological status of various diseases. In COVID-19, EVs have been explored in several studies for their ability to reflect molecular changes caused by SARS-CoV-2. Here we provide insights into the roles of EVs in pathological processes associated with the progression and severity of COVID-19. Methods In this study, we used a label-free shotgun proteomic approach to identify and quantify alterations in EV protein abundance in severe COVID-19 patients. We isolated plasma extracellular vesicles from healthy donors and patients with severe COVID-19 by size exclusion chromatography (SEC). Then, flow cytometry was performed to assess the origin of EVs and to investigate the presence of circulating procoagulant EVs in COVID-19 patients. A total protein extraction was performed, and samples were analyzed by nLC-MS/MS in a Q-Exactive HF-X. Finally, computational analysis was applied to signify biological processes related to disease pathogenesis. Results We report significant changes in the proteome of EVs from patients with severe COVID-19. Flow cytometry experiments indicated an increase in total circulating EVs and with tissue factor (TF) dependent procoagulant activity. Differentially expressed proteins in the disease groups were associated with complement and coagulation cascades, platelet degranulation, and acute inflammatory response. Conclusions The proteomic data reinforce the changes in the proteome of extracellular vesicles from patients infected with SARS-CoV-2 and suggest a role for EVs in severe COVID-19.
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Affiliation(s)
- Emilly Caroline dos Santos Moraes
- Laboratory of Toxinology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Remy Martins-Gonçalves
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Luana Rocha da Silva
- Laboratory of Toxinology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Samuel Coelho Mandacaru
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Reynaldo Magalhães Melo
- Laboratory Protein Chemistry and Biochemistry and Laboratory of Gene Biology, Department of Cell Biology, University of Brasília, Brasília, Brazil
| | | | - Jonas Perales
- Laboratory of Toxinology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Thiago Moreno Lopes Souza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Eugenio D. Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Patricia T. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- *Correspondence: Monique R. O. Trugilho, , ; Patricia T. Bozza, ,
| | - Monique R. O. Trugilho
- Laboratory of Toxinology, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Brazil
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- *Correspondence: Monique R. O. Trugilho, , ; Patricia T. Bozza, ,
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26
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Fischer R, Bozza B, Victorino C, Motta M, Arouca L, Bozza FA. What did you do to stay ‘sane’ during the pandemic? A qualitative study to identify self-care mental health strategies utilized in a socially vulnerable population. Gates Open Res 2022. [DOI: 10.12688/gatesopenres.13658.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Mental health has deteriorated during the COVID-19 pandemic. These impacts are likely to be more severe in socially vulnerable communities. Previous research has identified useful self-help strategies that individuals may use to maintain and improve mental health. However, these studies have typically ignored economically and socially marginalized communities and have used researcher pre-defined practices. Little is known what activities or actions members of poor urban communities from low and middle income countries may utilize to take care of their mental health. Methods During March and April 2021, we conducted open-ended interviews with 317 community members in Complexo de Favelas da Maré, Rio de Janeiro, Brazil, one of the largest slum areas in South America. Individuals were interviewed in selected public spaces to provide a representative sample of the wider area. Our sample consisted of 178 (56.1%) cis women, 133 (41.9%) cis men, 3 (0.9%) trans men, and 3 (0.9%) classified themselves as other. The majority of participants had incomplete middle school or less (54.2%) and were between 30 and 60 years (54.1%). Results Using thematic analysis, we identified eight major themes in the responses. The most common themes that emerged were work, leisure activities (including watching TV & physical exercise) and religion/prayer. These findings did not clearly align with previous mental health recommendations. Some results were noteworthy by their absence, e.g., cost-effective mental health practices such as yoga, meditation or mindfulness were not mentioned. Only 4 individuals reported consulting mental health professionals during the pandemic. Conclusions Our findings highlight the need for better public health campaigns that disseminate information for effective mental health practices during acute crises, especially for communities that are most vulnerable during public health crises.
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27
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Moll-Bernardes R, Fortier SC, Sousa AS, Lopes RD, Vera N, Conde L, Feldman A, Arruda G, Cabral-Castro M, Albuquerque DC, Paula TC, Furquim T, Loures VA, Giusti K, Oliveira N, Macedo A, Barros e Silva P, De Luca F, Kotsugai M, Domiciano R, Silva FA, Santos MF, Souza OF, Bozza FA, Luiz RR, Medei E. NKG2A Expression among CD8 Cells Is Associated with COVID-19 Progression in Hypertensive Patients: Insights from the BRACE CORONA Randomized Trial. J Clin Med 2022; 11:jcm11133713. [PMID: 35806995 PMCID: PMC9267446 DOI: 10.3390/jcm11133713] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular comorbidities and immune-response dysregulation are associated with COVID-19 severity. We aimed to explore the key immune cell profile and understand its association with disease progression in 156 patients with hypertension that were hospitalized due to COVID-19. The primary outcome was progression to severe disease. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and immune cell subsets associated with the primary outcome. Obesity; diabetes; oxygen saturation; lung involvement on computed tomography (CT) examination; the C-reactive protein concentration; total lymphocyte count; proportions of CD4+ and CD8+ T cells; CD4/CD8 ratio; CD8+ HLA-DR MFI; and CD8+ NKG2A MFI on admission were all associated with progression to severe COVID-19. This study demonstrated that increased CD8+ NKG2A MFI at hospital admission, in combination with some clinical variables, is associated with a high risk of COVID-19 progression in hypertensive patients. These findings reinforce the hypothesis of the functional exhaustion of T cells with the increased expression of NKG2A in patients with severe COVID-19, elucidating how severe acute respiratory syndrome coronavirus 2 infection may break down the innate antiviral immune response at an early stage of the disease, with future potential therapeutic implications.
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Affiliation(s)
- Renata Moll-Bernardes
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
| | - Sérgio C. Fortier
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Pathological Anatomy Laboratory, Rede D’Or São Luiz, São Paulo 04321-120, Brazil
| | - Andréa S. Sousa
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Renato D. Lopes
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA
- Brazilian Clinical Research Institute, São Paulo 01404-000, Brazil;
| | - Narendra Vera
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-170, Brazil; (N.V.); (L.C.)
| | - Luciana Conde
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-170, Brazil; (N.V.); (L.C.)
| | - André Feldman
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Anália Franco Hospital, São Paulo 03313-001, Brazil
| | - Guilherme Arruda
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz São Caetano Hospital, São Caetano do Sul 09531-205, Brazil
| | - Mauro Cabral-Castro
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil;
| | - Denílson C. Albuquerque
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Cardiology Department, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil
| | - Thiago C. Paula
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Jabaquara Hospital, São Paulo 04321-120, Brazil
| | - Thyago Furquim
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Sino Brasileiro Hospital, Osasco 06016-050, Brazil
| | - Vitor A. Loures
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Anália Franco Hospital, São Paulo 03313-001, Brazil
| | - Karla Giusti
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Villa Lobos Hospital, São Paulo 03184-020, Brazil
| | - Nathália Oliveira
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Villa Lobos Hospital, São Paulo 03184-020, Brazil
| | - Ariane Macedo
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Jabaquara Hospital, São Paulo 04321-120, Brazil
- Santa Casa of São Paulo, São Paulo 01221-010, Brazil
| | | | - Fábio De Luca
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Morumbi Hospital, São Paulo 05605-050, Brazil
| | - Marisol Kotsugai
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Morumbi Hospital, São Paulo 05605-050, Brazil
| | - Rafael Domiciano
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- São Luiz Anália Franco Hospital, São Paulo 03313-001, Brazil
| | - Flávia A. Silva
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Pathological Anatomy Laboratory, Rede D’Or São Luiz, São Paulo 04321-120, Brazil
| | - Mayara F. Santos
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
| | - Olga F. Souza
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Copa Star Hospital, Rio de Janeiro 22031-012, Brazil
| | - Fernando A. Bozza
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro 21040-360, Brazil
| | - Ronir R. Luiz
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Public Health Studies Institute—IESC, Federal University of Rio de Janeiro, Rio de Janeiro 21941-592, Brazil
| | - Emiliano Medei
- D’Or Institute for Research and Education, Rio de Janeiro 22281-100, Brazil; (R.M.-B.); (S.C.F.); (A.S.S.); (R.D.L.); (A.F.); (G.A.); (D.C.A.); (T.C.P.); (T.F.); (V.A.L.); (K.G.); (N.O.); (A.M.); (F.D.L.); (M.K.); (R.D.); (F.A.S.); (M.F.S.); (O.F.S.); (F.A.B.); (R.R.L.)
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-170, Brazil; (N.V.); (L.C.)
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
- Correspondence: ; Tel.: +55-21-3938-0370
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Bourhy L, Mazeraud A, Bozza FA, Turc G, Lledo PM, Sharshar T. Neuro-Inflammatory Response and Brain-Peripheral Crosstalk in Sepsis and Stroke. Front Immunol 2022; 13:834649. [PMID: 35464410 PMCID: PMC9022190 DOI: 10.3389/fimmu.2022.834649] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 12/18/2022] Open
Abstract
Despite recent therapeutic advances, ischemic stroke is still a leading cause of death and disability. There is renewed attention on peripheral inflammatory signaling as a way of modulating the post-ischemic neuro-inflammatory process. The immune-brain crosstalk has long been the focus for understanding the mechanisms of sickness behavior, which is an adaptive autonomic, neuroendocrine, and behavioral response to a peripheral inflammation. It is mediated by humoral and neural pathways that mainly involve the circumventricular organs and vagal nerve, respectively. In this review we address the question of how sepsis and stroke can dysregulate this adaptive response, notably by impairing the central integration of peripheral signaling, but also by efferent control of the immune response. We highlight the potential role of gut–brain and brain–spleen signaling in stroke.
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Affiliation(s)
- Lena Bourhy
- Institut Pasteur, Université de Paris, Centre National de Recherche Scientifique, Unité Mixte de Recherche (CNRS UMR) 3571, Perception and Memory Unit, Paris, France
| | - Aurélien Mazeraud
- Institut Pasteur, Université de Paris, Centre National de Recherche Scientifique, Unité Mixte de Recherche (CNRS UMR) 3571, Perception and Memory Unit, Paris, France.,Neuro-Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| | - Fernando A Bozza
- National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Université de Paris, Centre National de Recherche Scientifique, Unité Mixte de Recherche (CNRS UMR) 3571, Perception and Memory Unit, Paris, France
| | - Tarek Sharshar
- Neuro-Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Universitaire (GHU) Paris Psychiatrie et Neurosciences, Université de Paris, Paris, France
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Salluh JIF, Kurtz P, Bastos LSL, Quintairos A, Zampieri FG, Bozza FA. The resilient intensive care unit. Ann Intensive Care 2022; 12:37. [PMID: 35471746 PMCID: PMC9038989 DOI: 10.1186/s13613-022-01011-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic tested the capacity of intensive care units (ICU) to respond to a crisis and demonstrated their fragility. Unsurprisingly, higher than usual mortality rates, lengths of stay (LOS), and ICU-acquired complications occurred during the pandemic. However, worse outcomes were not universal nor constant across ICUs and significant variation in outcomes was reported, demonstrating that some ICUs could adequately manage the surge of COVID-19. Methods In the present editorial, we discuss the concept of a resilient Intensive Care Unit, including which metrics can be used to address the capacity to respond, sustain results and incorporate new practices that lead to improvement. Results We believe that a resiliency analysis adds a component of preparedness to the usual ICU performance evaluation and outcomes metrics to be used during the crisis and in regular times. Conclusions The COVID-19 pandemic demonstrated the need for a resilient health system. Although this concept has been discussed for health systems, it was not tested in intensive care. Future studies should evaluate this concept to improve ICU organization for standard and pandemic times.
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Affiliation(s)
- Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, Brazil.,Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, Brazil.,Hospital Copa Star, Rio de Janeiro, RJ, Brazil.,Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Amanda Quintairos
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, Brazil. .,Department of Critical and Intensive Care Medicine, Academic Hospital Fundación Santa Fe de Bogota, Bogota, Colombia.
| | - Fernando G Zampieri
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, Brazil.,HCor Research Institute, Sao Paulo, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, Brazil.,National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
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30
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Temerozo JR, Fintelman-Rodrigues N, Dos Santos MC, Hottz ED, Sacramento CQ, de Paula Dias da Silva A, Mandacaru SC, Dos Santos Moraes EC, Trugilho MRO, Gesto JSM, Ferreira MA, Saraiva FB, Palhinha L, Martins-Gonçalves R, Azevedo-Quintanilha IG, Abrantes JL, Righy C, Kurtz P, Jiang H, Tan H, Morel C, Bou-Habib DC, Bozza FA, Bozza PT, Souza TML. Human endogenous retrovirus K in the respiratory tract is associated with COVID-19 physiopathology. Microbiome 2022; 10:65. [PMID: 35459226 PMCID: PMC9024070 DOI: 10.1186/s40168-022-01260-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/15/2022] [Indexed: 05/04/2023]
Abstract
BACKGROUND Critically ill 2019 coronavirus disease (COVID-19) patients under invasive mechanical ventilation (IMV) are 10 to 40 times more likely to die than the general population. Although progression from mild to severe COVID-19 has been associated with hypoxia, uncontrolled inflammation, and coagulopathy, the mechanisms involved in the progression to severity are poorly understood. METHODS The virome of tracheal aspirates (TA) from 25 COVID-19 patients under IMV was assessed through unbiased RNA sequencing (RNA-seq), and correlation analyses were conducted using available clinical data. Unbiased sequences from nasopharyngeal swabs (NS) from mild cases and TA from non-COVID patients were included in our study for further comparisons. RESULTS We found higher levels and differential expression of human endogenous retrovirus K (HERV-K) genes in TA from critically ill and deceased patients when comparing nasopharyngeal swabs from mild cases to TA from non-COVID patients. In critically ill patients, higher HERV-K levels were associated with early mortality (within 14 days of diagnosis) in the intensive care unit. Increased HERV-K expression in deceased patients was associated with IL-17-related inflammation, monocyte activation, and an increased consumption of clotting/fibrinolysis factors. Moreover, increased HERV-K expression was detected in human primary monocytes from healthy donors after experimental SARS-CoV-2 infection in vitro. CONCLUSION Our data implicate the levels of HERV-K transcripts in the physiopathology of COVID-19 in the respiratory tract of patients under invasive mechanical ventilation. Video abstract.
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Affiliation(s)
- Jairo R Temerozo
- Laboratory on Thymus Research, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Neuroimmunomodulation (INCT/NIM), Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Natalia Fintelman-Rodrigues
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Monique Cristina Dos Santos
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eugenio D Hottz
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Carolina Q Sacramento
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Aline de Paula Dias da Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Samuel Coelho Mandacaru
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Laboratory of Toxinology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Emilly Caroline Dos Santos Moraes
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Laboratory of Toxinology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Monique R O Trugilho
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- Laboratory of Toxinology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - João S M Gesto
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Marcelo Alves Ferreira
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Felipe Betoni Saraiva
- Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Lohanna Palhinha
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Remy Martins-Gonçalves
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Juliana L Abrantes
- Instituto de Ciências Biomédicas, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Cássia Righy
- Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Pedro Kurtz
- Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Hui Jiang
- MGI Tech Co. Ltd, Building No.11, Beishan Industrial Zone, Yantian District, Shenzhen, 518083, China
| | - Hongdong Tan
- MGI Tech Co. Ltd, Building No.11, Beishan Industrial Zone, Yantian District, Shenzhen, 518083, China
| | - Carlos Morel
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Dumith Chequer Bou-Habib
- Laboratory on Thymus Research, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Neuroimmunomodulation (INCT/NIM), Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
- D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Patrícia T Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Moreno L Souza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute (IOC), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.
- Center for Technological Development in Health (CDTS), National Institute for Science and Technology on Innovation on Disease Of Neglected Poppulations (INCT/IDPN), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ, Brazil.
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Kurtz P, Peres IT, Soares M, Salluh JIF, Bozza FA. Hospital Length of Stay and 30-Day Mortality Prediction in Stroke: A Machine Learning Analysis of 17,000 ICU Admissions in Brazil. Neurocrit Care 2022; 37:313-321. [PMID: 35381967 DOI: 10.1007/s12028-022-01486-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/03/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hospital length of stay and mortality are associated with resource use and clinical severity, respectively, in patients admitted to the intensive care unit (ICU) with acute stroke. We proposed a structured data-driven methodology to develop length of stay and 30-day mortality prediction models in a large multicenter Brazilian ICU cohort. METHODS We analyzed data from 130 ICUs from 43 Brazilian hospitals. All consecutive adult patients admitted with stroke (ischemic or nontraumatic hemorrhagic) to the ICU from January 2011 to December 2020 were included. Demographic data, comorbidities, acute disease characteristics, organ support, and laboratory data were retrospectively analyzed by a data-driven methodology, which included seven different types of machine learning models applied to training and test sets of data. The best performing models, based on discrimination and calibration measures, are reported as the main results. Outcomes were hospital length of stay and 30-day in-hospital mortality. RESULTS Of 17,115 ICU admissions for stroke, 16,592 adult patients (13,258 ischemic and 3334 hemorrhagic) were analyzed; 4298 (26%) patients had a prolonged hospital length of stay (> 14 days), and 30-day mortality was 8% (n = 1392). Prolonged hospital length of stay was best predicted by the random forests model (Brier score = 0.17, area under the curve = 0.73, positive predictive value = 0.61, negative predictive value = 0.78). Mortality prediction also yielded the best discrimination and calibration through random forests (Brier score = 0.05, area under the curve = 0.90, positive predictive value = 0.66, negative predictive value = 0.94). Among the 20 strongest contributor variables in both models were (1) premorbid conditions (e.g., functional impairment), (2) multiple organ dysfunction parameters (e.g., hypotension, mechanical ventilation), and (3) acute neurological aspects of stroke (e.g., Glasgow coma scale score on admission, stroke type). CONCLUSIONS Hospital length of stay and 30-day mortality of patients admitted to the ICU with stroke were accurately predicted through machine learning methods, even in the absence of stroke-specific data, such as the National Institutes of Health Stroke Scale score or neuroimaging findings. The proposed methods using general intensive care databases may be used for resource use allocation planning and performance assessment of ICUs treating stroke. More detailed acute neurological and management data, as well as long-term functional outcomes, may improve the accuracy and applicability of future machine-learning-based prediction algorithms.
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Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Hospital Copa Star, Rio de Janeiro, Brazil.,Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil
| | - Igor Tona Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil. .,National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Ranzani OT, Bozza FA. ‘Vaccine effectiveness of ChAdOx1 nCoV-19 against COVID-19 in a socially vulnerable community in Rio de Janeiro, Brazil' – Author’s reply. Clin Microbiol Infect 2022; 28:1166-1167. [PMID: 35398310 PMCID: PMC8983482 DOI: 10.1016/j.cmi.2022.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 03/17/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública, Barcelona, Spain; Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.
| | - Fernando A Bozza
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (INI-FIOCRUZ), Rio de Janeiro, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
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Temerozo JR, Sacramento CQ, Fintelman-Rodrigues N, Pão CRR, de Freitas CS, Dias SSG, Ferreira AC, Mattos M, Soares VC, Teixeira L, Azevedo-Quintanilha IG, Hottz ED, Kurtz P, Bozza FA, Bozza PT, Souza TML, Bou-Habib DC. VIP plasma levels associate with survival in severe COVID-19 patients, correlating with protective effects in SARS-CoV-2-infected cells. J Leukoc Biol 2022; 111:1107-1121. [PMID: 35322471 PMCID: PMC9088587 DOI: 10.1002/jlb.5cova1121-626r] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 12/11/2022] Open
Abstract
Infection by SARS‐CoV‐2 may elicit uncontrolled and damaging inflammatory responses. Thus, it is critical to identify compounds able to inhibit virus replication and thwart the inflammatory reaction. Here, we show that the plasma levels of the immunoregulatory neuropeptide VIP are elevated in patients with severe COVID‐19, correlating with reduced inflammatory mediators and with survival on those patients. In vitro, vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase‐activating polypeptide (PACAP), highly similar neuropeptides, decreased the SARS‐CoV‐2 RNA content in human monocytes and viral production in lung epithelial cells, also reducing cell death. Both neuropeptides inhibited the production of proinflammatory mediators in lung epithelial cells and in monocytes. VIP and PACAP prevented in monocytes the SARS‐CoV‐2‐induced activation of NF‐kB and SREBP1 and SREBP2, transcriptions factors involved in proinflammatory reactions and lipid metabolism, respectively. They also promoted CREB activation, a transcription factor with antiapoptotic activity and negative regulator of NF‐kB. Specific inhibition of NF‐kB and SREBP1/2 reproduced the anti‐inflammatory, antiviral, and cell death protection effects of VIP and PACAP. Our results support further clinical investigations of these neuropeptides against COVID‐19.
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Affiliation(s)
- Jairo R Temerozo
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Carolina Q Sacramento
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Natalia Fintelman-Rodrigues
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Camila R R Pão
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Caroline S de Freitas
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Suelen Silva Gomes Dias
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - André C Ferreira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil.,Iguaçu University, Nova Iguaçu, RJ, Brazil
| | - Mayara Mattos
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Vinicius Cardoso Soares
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,Program of Immunology and Inflammation, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Lívia Teixeira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | | | - Eugenio D Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Pedro Kurtz
- Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil.,D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.,Evandro Chagas National Institute of Infectious Diseases, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Patrícia T Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Thiago Moreno L Souza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Dumith Chequer Bou-Habib
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
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Teixeira L, Temerozo JR, Pereira-Dutra FS, Ferreira AC, Mattos M, Gonçalves BS, Sacramento CQ, Palhinha L, Cunha-Fernandes T, Dias SSG, Soares VC, Barreto EA, Cesar-Silva D, Fintelman-Rodrigues N, Pão CRR, de Freitas CS, Reis PA, Hottz ED, Bozza FA, Bou-Habib DC, Saraiva EM, de Almeida CJG, Viola JPB, Souza TML, Bozza PT. Simvastatin Downregulates the SARS-CoV-2-Induced Inflammatory Response and Impairs Viral Infection Through Disruption of Lipid Rafts. Front Immunol 2022; 13:820131. [PMID: 35251001 PMCID: PMC8895251 DOI: 10.3389/fimmu.2022.820131] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/25/2022] [Indexed: 12/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is currently a worldwide emergency caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In observational clinical studies, statins have been identified as beneficial to hospitalized patients with COVID-19. However, experimental evidence of underlying statins protection against SARS-CoV-2 remains elusive. Here we reported for the first-time experimental evidence of the protective effects of simvastatin treatment both in vitro and in vivo. We found that treatment with simvastatin significantly reduced the viral replication and lung damage in vivo, delaying SARS-CoV-2-associated physiopathology and mortality in the K18-hACE2-transgenic mice model. Moreover, simvastatin also downregulated the inflammation triggered by SARS-CoV-2 infection in pulmonary tissue and in human neutrophils, peripheral blood monocytes, and lung epithelial Calu-3 cells in vitro, showing its potential to modulate the inflammatory response both at the site of infection and systemically. Additionally, we also observed that simvastatin affected the course of SARS-CoV-2 infection through displacing ACE2 on cell membrane lipid rafts. In conclusion, our results show that simvastatin exhibits early protective effects on SARS-CoV-2 infection by inhibiting virus cell entry and inflammatory cytokine production, through mechanisms at least in part dependent on lipid rafts disruption.
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Affiliation(s)
- Lívia Teixeira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Jairo R. Temerozo
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Filipe S. Pereira-Dutra
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - André Costa Ferreira
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Preclinical Research Laboratory, Universidade Iguaçu (UNIG), Nova Iguaçu, Brazil
| | - Mayara Mattos
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Barbara Simonson Gonçalves
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Carolina Q. Sacramento
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Lohanna Palhinha
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Tamires Cunha-Fernandes
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Suelen S. G. Dias
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Vinicius Cardoso Soares
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Program of Immunology and Inflammation, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Ester A. Barreto
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Daniella Cesar-Silva
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Natalia Fintelman-Rodrigues
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Camila R. R. Pão
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Caroline S. de Freitas
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patrícia A. Reis
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Biochemistry Department, Roberto Alcântara Gomes Biology Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eugenio D. Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Federal University of Juiz de Fora (UFJF), Minas Gerais, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Dumith C. Bou-Habib
- Laboratory on Thymus Research, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Elvira M. Saraiva
- Laboratory of Immunobiology of Leishmaniasis, Department of Immunology, Paulo de Goes Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cecília J. G. de Almeida
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - João P. B. Viola
- Program of Immunology and Tumor Biology, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Thiago Moreno L. Souza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- National Institute for Science and Technology on Innovation on Neglected Diseases (INCT/IDN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Patricia T. Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- *Correspondence: Patrícia T. Bozza, ;
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Bourhy L, Mazeraud A, Costa LHA, Levy J, Rei D, Hecquet E, Gabanyi I, Bozza FA, Chrétien F, Lledo PM, Sharshar T, Lepousez G. OUP accepted manuscript. Brain 2022; 145:1391-1409. [PMID: 35441215 PMCID: PMC9128826 DOI: 10.1093/brain/awab475] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lena Bourhy
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Université Paris Cité, Collège doctoral, F-75005 Paris, France
| | - Aurélien Mazeraud
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Université Paris Cité, Collège doctoral, F-75005 Paris, France
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuro-anesthésie réanimation, Paris, France
| | - Luis H. A. Costa
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Department of Basic and Oral Biology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jarod Levy
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Damien Rei
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Estéban Hecquet
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Ilana Gabanyi
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Institut Pasteur, Université Paris Cité, Microenvironment and Immunity Unit, F-75015 Paris, France
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas (INI), OswaldoCruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Fabrice Chrétien
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuropathologie, Paris, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Correspondence may also be addressed to: Pierre-Marie Lledo E-mail:
| | - Tarek Sharshar
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuro-anesthésie réanimation, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM UMR 1266, F-75014 Paris, France
| | - Gabriel Lepousez
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Correspondence to: Gabriel Lepousez Laboratory for Perception and Memory Institut Pasteur 25 rue du Docteur Roux, 75724 Paris Cedex 15, France E-mail:
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Antunes BBP, Bastos LSL, Hamacher S, Bozza FA. Using data envelopment analysis to perform benchmarking in intensive care units. PLoS One 2021; 16:e0260025. [PMID: 34793542 PMCID: PMC8601512 DOI: 10.1371/journal.pone.0260025] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Studies using Data Envelopment Analysis to benchmark Intensive Care Units (ICUs) are scarce. Previous studies have focused on comparing efficiency using only performance metrics, without accounting for resources. Hence, we aimed to perform a benchmarking analysis of ICUs using data envelopment analysis. METHODS We performed a retrospective analysis on observational data of patients admitted to ICUs in Brazil (ORCHESTRA Study). The outputs in our data envelopment analysis model were the performance metrics: Standardized Mortality Ratio (SMR) and Standardized Resource Use (SRU); whereas the inputs consisted of three groups of variables that represented staffing patterns, structure, and strain, thus resulting in three models. We compared efficient and non-efficient units for each model. In addition, we compared our results to the efficiency matrix method and presented targets to each non-efficient unit. RESULTS We performed benchmarking in 93 ICUs and 129,680 patients. The median age was 64 years old, and mortality was 12%. Median SMR was 1.00 [interquartile range (IQR): 0.79-1.21] and SRU was 1.15 [IQR: 0.95-1.56]. Efficient units presented lower median physicians per bed ratio (1.44 [IQR: 1.18-1.88] vs. 1.7 [IQR: 1.36-2.00]) and nursing workload (168 hours [IQR: 168-291] vs 396 hours [IQR: 336-672]) but higher nurses per bed ratio (2.02 [1.16-2.48] vs. 1.71 [1.43-2.36]) compared to non-efficient units. Units from for-profit hospitals and specialized ICUs presented the best efficiency scores. Our results were mostly in line with the efficiency matrix method: the efficiency units in our models were mostly in the "most efficient" quadrant. CONCLUSION Data envelopment analysis provides managers the information needed to identify not only the outcomes to be achieved but what are the levels of resources needed to provide efficient care. Different perspectives can be achieved depending on the chosen variables. Its use jointly with the efficiency matrix can provide deeper understanding of ICU performance and efficiency.
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Affiliation(s)
- Bianca B. P. Antunes
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Leonardo S. L. Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
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Moll-Bernardes R, de Sousa AS, Macedo AVS, Lopes RD, Vera N, Maia LCR, Feldman A, Arruda GDAS, Castro MJC, Pimentel-Coelho PM, de Albuquerque DC, de Paula TC, Furquim TAB, Loures VA, Giusti KGD, de Oliveira NM, De Luca FA, Kotsugai MDM, Domiciano RAM, Santos MF, de Souza OF, Bozza FA, Luiz RR, Medei E. IL-10 and IL-12 (P70) Levels Predict the Risk of Covid-19 Progression in Hypertensive Patients: Insights From the BRACE-CORONA Trial. Front Cardiovasc Med 2021; 8:702507. [PMID: 34386533 PMCID: PMC8353079 DOI: 10.3389/fcvm.2021.702507] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 04/29/2021] [Accepted: 07/02/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Cardiovascular comorbidities such as hypertension and inflammatory response dysregulation are associated with worse COVID-19 prognoses. Different cytokines have been proposed to play vital pathophysiological roles in COVID-19 progression, but appropriate prognostic biomarkers remain lacking. We hypothesized that the combination of immunological and clinical variables at admission could predict the clinical progression of COVID-19 in hypertensive patients. Methods: The levels of biomarkers, including C-reactive protein, lymphocytes, monocytes, and a panel of 29 cytokines, were measured in blood samples from 167 hypertensive patients included in the BRACE-CORONA trial. The primary outcome was the highest score during hospitalization on the modified WHO Ordinal Scale for Clinical Improvement. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and biomarkers associated significantly with the primary outcome. Results: During hospitalization, 13 (7.8%) patients showed progression to more severe forms of COVID-19, including three deaths. Obesity, diabetes, oxygen saturation, lung involvement on computed tomography examination, the C-reactive protein level, levels of 15 cytokines, and lymphopenia on admission were associated with progression to severe COVID-19. Elevated levels of interleukin-10 and interleukin-12 (p70) combined with two or three of the abovementioned clinical comorbidities were associated strongly with progression to severe COVID-19. The risk of progression to severe disease reached 97.5% in the presence of the five variables included in our model. Conclusions: This study demonstrated that interleukin-10 and interleukin-12 (p70) levels, in combination with clinical variables, at hospital admission are key biomarkers associated with an increased risk of disease progression in hypertensive patients with COVID-19.
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Affiliation(s)
| | - Andrea Silvestre de Sousa
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ariane V S Macedo
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Hospital São Luiz Jabaquara, São Paulo, Brazil.,Santa Casa de São Paulo, São Paulo, Brazil
| | - Renato D Lopes
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States.,Brazilian Clinical Research Institute, São Paulo, Brazil
| | - Narendra Vera
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana C R Maia
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - André Feldman
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Hospital São Luiz Anália Franco, São Paulo, Brazil
| | | | - Mauro J C Castro
- Instituto de Microbiologia Paulo de Góes, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro M Pimentel-Coelho
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denílson C de Albuquerque
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Cardiology Department, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | - Olga Ferreira de Souza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Hospital Copa Star, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Institute for Studies in Public Health-IESC, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Emiliano Medei
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Mendes-de-Almeida DP, Martins-Gonçalves R, Morato-Santos R, De Carvalho GAC, Martins SA, Palhinha L, Sandim V, Avvad-Portari E, Bozza FA, Monteiro RQ, Bozza PT, Kurtz P. Intracerebral hemorrhage associated with vaccine-induced thrombotic thrombocytopenia following ChAdOx1 nCOVID-19 vaccine in a pregnant woman. Haematologica 2021; 106:3025-3028. [PMID: 34261297 PMCID: PMC8561298 DOI: 10.3324/haematol.2021.279407] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/14/2021] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Daniela P Mendes-de-Almeida
- Department of Hematology, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Division of Molecular Carcinogenesis, Research Center, Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil; Division of Epidemiology, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Remy Martins-Gonçalves
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro
| | - Renata Morato-Santos
- Department of Obstetrics, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro
| | - Gustavo Adolpho C De Carvalho
- Neurosurgical Deptartment, Hospital Sao Lucas, Rio de Janeiro, Brazil; Neurosurgical Deptartment, Hospital Adventista Silvestre, Rio de Janeiro
| | - Silas A Martins
- Neurosurgical Deptartment, Hospital Sao Lucas, Rio de Janeiro, Brazil; Neurosurgical Deptartment, Hospital Adventista Silvestre, Rio de Janeiro
| | - Lohanna Palhinha
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro
| | - Vanessa Sandim
- Institute of Medical Biochemistry Leopoldo de Meis, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro
| | - Elyzabeth Avvad-Portari
- Department of Pathologic Anatomy, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; Department of Pathologic Anatomy, Histology, and Embryology, Medical Sciences Faculty, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro
| | - Fernando A Bozza
- Laboratory of Intensive Care, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro
| | - Robson Q Monteiro
- Institute of Medical Biochemistry Leopoldo de Meis, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro
| | - Patrícia T Bozza
- Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro
| | - Pedro Kurtz
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Department of Neurointensive Care, Instituto Estadual do Cérebro Paulo Niemeyer (IECPN), Rio de Janeiro, Brazil; Department of Intensive Care Medicine, Hospital Copa Star, Rio de Janeiro.
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Bastos LS, Ranzani OT, Souza TML, Hamacher S, Bozza FA. COVID-19 hospital admissions: Brazil's first and second waves compared. Lancet Respir Med 2021; 9:e82-e83. [PMID: 34273268 PMCID: PMC8279962 DOI: 10.1016/s2213-2600(21)00287-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Leonardo Sl Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain; Pulmonary Division, Heart Institute, Faculty of Medicine, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Moreno L Souza
- National Institute for Science and Technology on Innovation on Diseases of Neglected Populations, Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- Critical Care Lab, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, RJ 21040-900, Brazil.
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40
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Hottz ED, Quirino-Teixeira AC, Merij LB, Pinheiro MBM, Rozini SV, Bozza FA, Bozza PT. Platelet-leukocyte interactions in the pathogenesis of viral infections. Platelets 2021; 33:200-207. [PMID: 34260328 DOI: 10.1080/09537104.2021.1952179] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/14/2022]
Abstract
Evolving evidence demonstrates that platelets have major roles in viral syndromes through previously unrecognized viral sensing and effector functions. Activated platelets and increased platelet-leukocyte aggregates are observed in clinical and experimental viral infections. The mechanisms and outcomes of platelet-leukocyte interactions depend on the interacting leukocyte as well as on the pathogen and pathological conditions. In this review, we discuss the mechanisms involved in platelet interactions with leukocytes and its functions during viral infections. We focus on the contributions of human platelet-leukocyte interactions to pathophysiological and protective responses during viral infections of major global health relevance, including acquired immunodeficiency syndrome (AIDS), dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS), influenza pneumonia, and COVID-19.
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Affiliation(s)
- Eugenio D Hottz
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil.,Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Anna Cecíllia Quirino-Teixeira
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Laura Botelho Merij
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Mariana Brandi Mendonça Pinheiro
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Stephane Vicente Rozini
- Laboratory of Immunothrombosis, Department of Biochemistry, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Fernando A Bozza
- Laboratory of Clinical Research in Intensive Care Medicine, National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro , Brazil.,Intensive Care Medicine, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
| | - Patrícia T Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Kurtz P, Bastos LSL, Salluh JIF, Bozza FA, Soares M. SAPS-3 performance for hospital mortality prediction in 30,571 patients with COVID-19 admitted to ICUs in Brazil. Intensive Care Med 2021; 47:1047-1049. [PMID: 34244829 PMCID: PMC8270768 DOI: 10.1007/s00134-021-06474-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Hospital Copa Star, Rio de Janeiro, RJ, Brazil.,Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Marcio Soares
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
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42
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Sacramento CQ, Fintelman-Rodrigues N, Temerozo JR, Da Silva ADPD, Dias SDSG, da Silva CDS, Ferreira AC, Mattos M, Pão CRR, de Freitas CS, Soares VC, Hoelz LVB, Fernandes TVA, Branco FSC, Bastos MM, Boechat N, Saraiva FB, Ferreira MA, Jockusch S, Wang X, Tao C, Chien M, Xie W, Patel D, Garzia A, Tuschl T, Russo JJ, Rajoli RKR, Pedrosa CSG, Vitória G, Souza LRQ, Goto-Silva L, Guimarães MZ, Rehen SK, Owen A, Bozza FA, Bou-Habib DC, Ju J, Bozza PT, Souza TML. In vitro antiviral activity of the anti-HCV drugs daclatasvir and sofosbuvir against SARS-CoV-2, the aetiological agent of COVID-19. J Antimicrob Chemother 2021; 76:1874-1885. [PMID: 33880524 PMCID: PMC8083231 DOI: 10.1093/jac/dkab072] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current approaches of drug repurposing against COVID-19 have not proven overwhelmingly successful and the SARS-CoV-2 pandemic continues to cause major global mortality. SARS-CoV-2 nsp12, its RNA polymerase, shares homology in the nucleotide uptake channel with the HCV orthologue enzyme NS5B. Besides, HCV enzyme NS5A has pleiotropic activities, such as RNA binding, that are shared with various SARS-CoV-2 proteins. Thus, anti-HCV NS5B and NS5A inhibitors, like sofosbuvir and daclatasvir, respectively, could be endowed with anti-SARS-CoV-2 activity. METHODS SARS-CoV-2-infected Vero cells, HuH-7 cells, Calu-3 cells, neural stem cells and monocytes were used to investigate the effects of daclatasvir and sofosbuvir. In silico and cell-free based assays were performed with SARS-CoV-2 RNA and nsp12 to better comprehend the mechanism of inhibition of the investigated compounds. A physiologically based pharmacokinetic model was generated to estimate daclatasvir's dose and schedule to maximize the probability of success for COVID-19. RESULTS Daclatasvir inhibited SARS-CoV-2 replication in Vero, HuH-7 and Calu-3 cells, with potencies of 0.8, 0.6 and 1.1 μM, respectively. Although less potent than daclatasvir, sofosbuvir alone and combined with daclatasvir inhibited replication in Calu-3 cells. Sofosbuvir and daclatasvir prevented virus-induced neuronal apoptosis and release of cytokine storm-related inflammatory mediators, respectively. Sofosbuvir inhibited RNA synthesis by chain termination and daclatasvir targeted the folding of secondary RNA structures in the SARS-CoV-2 genome. Concentrations required for partial daclatasvir in vitro activity are achieved in plasma at Cmax after administration of the approved dose to humans. CONCLUSIONS Daclatasvir, alone or in combination with sofosbuvir, at higher doses than used against HCV, may be further fostered as an anti-COVID-19 therapy.
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Affiliation(s)
- Carolina Q Sacramento
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Natalia Fintelman-Rodrigues
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Jairo R Temerozo
- Laboratório de Pesquisas sobre o Timo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Neuroimmunomodulation (INCT/NIM), IOC, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Aline de Paula Dias Da Silva
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Suelen da Silva Gomes Dias
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Carine Dos Santos da Silva
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - André C Ferreira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
- Universidade Iguaçu, Nova Iguaçu, RJ, Brazil
| | - Mayara Mattos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Camila R R Pão
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Caroline S de Freitas
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Vinicius Cardoso Soares
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Tácio Vinício Amorim Fernandes
- Instituto de Tecnologia de Fármacos (Farmanguinhos), Fiocruz, Rio de Janeiro, RJ, Brazil
- Laboratório de Macromoléculas, Diretoria de Metrologia Aplicada às Ciências da Vida, Instituto Nacional de Metrologia, Qualidade e Tecnologia-INMETRO, Duque de Caxias, RJ 25250-020, Brazil
| | | | - Mônica Macedo Bastos
- Instituto de Tecnologia de Fármacos (Farmanguinhos), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Núbia Boechat
- Instituto de Tecnologia de Fármacos (Farmanguinhos), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Felipe B Saraiva
- Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Marcelo Alves Ferreira
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
- Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Steffen Jockusch
- Center for Genome Technology and Biomolecular Engineering, Columbia University, New York, NY 10027, USA
- Department of Chemistry, Columbia University, New York, NY 10027, USA
| | - Xuanting Wang
- Center for Genome Technology and Biomolecular Engineering, Columbia University, New York, NY 10027, USA
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
| | - Chuanjuan Tao
- Center for Genome Technology and Biomolecular Engineering, Columbia University, New York, NY 10027, USA
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
| | - Minchen Chien
- Center for Genome Technology and Biomolecular Engineering, Columbia University, New York, NY 10027, USA
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
| | - Wei Xie
- Laboratory of Structural Biology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Dinshaw Patel
- Laboratory of Structural Biology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Aitor Garzia
- Laboratory of RNA Molecular Biology, Rockefeller University, New York, NY 10065, USA
| | - Thomas Tuschl
- Laboratory of RNA Molecular Biology, Rockefeller University, New York, NY 10065, USA
| | - James J Russo
- Center for Genome Technology and Biomolecular Engineering, Columbia University, New York, NY 10027, USA
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
| | - Rajith K R Rajoli
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 3NY, UK
| | | | | | | | | | - Marilia Zaluar Guimarães
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Stevens K Rehen
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
- Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L7 3NY, UK
| | - Fernando A Bozza
- Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Dumith Chequer Bou-Habib
- Laboratório de Pesquisas sobre o Timo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Neuroimmunomodulation (INCT/NIM), IOC, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Jingyue Ju
- Center for Genome Technology and Biomolecular Engineering, Columbia University, New York, NY 10027, USA
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
- Department of Molecular Pharmacology and Therapeutics, Columbia University, New York, NY, 10032, USA
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Moreno L Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
- National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
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Ferreira AC, Soares VC, de Azevedo-Quintanilha IG, Dias SDSG, Fintelman-Rodrigues N, Sacramento CQ, Mattos M, de Freitas CS, Temerozo JR, Teixeira L, Hottz ED, Barreto EA, Pão CRR, Palhinha L, Miranda M, Bou-Habib DC, Bozza FA, Bozza PT, Souza TML. Correction: SARS-CoV-2 engages inflammasome and pyroptosis in human primary monocytes. Cell Death Discov 2021; 7:116. [PMID: 34011951 PMCID: PMC8131489 DOI: 10.1038/s41420-021-00477-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- André C Ferreira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,Laboratório de Pesquisa Pré-clínica-Universidade Iguaçu - UNIG, Nova Iguaçu, RJ, Brazil. .,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil.
| | - Vinicius Cardoso Soares
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Program of Immunology and Inflammation, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Suelen da Silva Gomes Dias
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Natalia Fintelman-Rodrigues
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Carolina Q Sacramento
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Mayara Mattos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Caroline S de Freitas
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Jairo R Temerozo
- Laboratório de Pesquisas sobre o Timo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Lívia Teixeira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eugenio Damaceno Hottz
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Laboratório de Imunotrombose, Departamento de Bioquímica, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Ester A Barreto
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Camila R R Pão
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Lohanna Palhinha
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Milene Miranda
- Laboratório de Vírus Respiratório e do Sarampo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Dumith Chequer Bou-Habib
- Laboratório de Pesquisas sobre o Timo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil.,Instituto D'or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Moreno L Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil.
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Kurtz P, Bastos LSL, Dantas LF, Zampieri FG, Soares M, Hamacher S, Salluh JIF, Bozza FA. Evolving changes in mortality of 13,301 critically ill adult patients with COVID-19 over 8 months. Intensive Care Med 2021; 47:538-548. [PMID: 33852032 PMCID: PMC8044656 DOI: 10.1007/s00134-021-06388-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/18/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Clinical characteristics and management of COVID-19 patients have evolved during the pandemic, potentially changing their outcomes. We analyzed the associations of changes in mortality rates with clinical profiles and respiratory support strategies in COVID-19 critically ill patients. METHODS A multicenter cohort of RT-PCR-confirmed COVID-19 patients admitted at 126 Brazilian intensive care units between February 27th and October 28th, 2020. Assessing temporal changes in deaths, we identified distinct time periods. We evaluated the association of characteristics and respiratory support strategies with 60-day in-hospital mortality using random-effects multivariable Cox regression with inverse probability weighting. RESULTS Among the 13,301 confirmed-COVID-19 patients, 60-day in-hospital mortality was 13%. Across four time periods identified, younger patients were progressively more common, non-invasive respiratory support was increasingly used, and the 60-day in-hospital mortality decreased in the last two periods. 4188 patients received advanced respiratory support (non-invasive or invasive), from which 42% underwent only invasive mechanical ventilation, 37% only non-invasive respiratory support and 21% failed non-invasive support and were intubated. After adjusting for organ dysfunction scores and premorbid conditions, we found that younger age, absence of frailty and the use of non-invasive respiratory support (NIRS) as first support strategy were independently associated with improved survival (hazard ratio for NIRS first [95% confidence interval], 0.59 [0.54-0.65], p < 0.001). CONCLUSION Age and mortality rates have declined over the first 8 months of the pandemic. The use of NIRS as the first respiratory support measure was associated with survival, but causal inference is limited by the observational nature of our data.
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Affiliation(s)
- Pedro Kurtz
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Hospital Copa Star, Rio de Janeiro, RJ, Brazil.,Paulo Niemeyer State Brain Institute (IECPN), Rio de Janeiro, RJ, Brazil
| | - Leonardo S L Bastos
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Leila F Dantas
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Fernando G Zampieri
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Research Institute, Hospital Do Coração (HCor), São Paulo, Brazil.,Center for Epidemiological Research, Southern Denmark University, Odense, Denmark
| | - Marcio Soares
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering (DEI), Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, RJ, Brazil
| | - Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.,Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, UFRJ, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil. .,National Institute of Infectious Disease Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
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45
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Fintelman-Rodrigues N, da Silva APD, Dos Santos MC, Saraiva FB, Ferreira MA, Gesto J, Rodrigues DAS, Vale AM, de Azevedo IG, Soares VC, Jiang H, Tan H, Tschoeke DA, Sacramento CQ, Bozza FA, Morel CM, Bozza PT, Souza TML. Genetic Evidence and Host Immune Response in Persons Reinfected with SARS-CoV-2, Brazil. Emerg Infect Dis 2021; 27:1446-1453. [PMID: 33797393 PMCID: PMC8084520 DOI: 10.3201/eid2705.204912] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The dynamics underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection remain poorly understood. We identified a small cluster of patients in Brazil who experienced 2 episodes of coronavirus disease (COVID-19) in March and late May 2020. In the first episode, patients manifested an enhanced innate response compared with healthy persons, but neutralizing humoral immunity was not fully achieved. The second episode was associated with different SARS-CoV-2 strains, higher viral loads, and clinical symptoms. Our finding that persons with mild COVID-19 may have controlled SARS-CoV-2 replication without developing detectable humoral immunity suggests that reinfection is more frequent than supposed, but this hypothesis is not well documented.
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46
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Dantas LF, Peres IT, Bastos LSL, Marchesi JF, de Souza GFG, Gelli JGM, Baião FA, Maçaira P, Hamacher S, Bozza FA. App-based symptom tracking to optimize SARS-CoV-2 testing strategy using machine learning. PLoS One 2021; 16:e0248920. [PMID: 33765050 PMCID: PMC7993758 DOI: 10.1371/journal.pone.0248920] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/08/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tests are scarce resources, especially in low and middle-income countries, and the optimization of testing programs during a pandemic is critical for the effectiveness of the disease control. Hence, we aim to use the combination of symptoms to build a predictive model as a screening tool to identify people and areas with a higher risk of SARS-CoV-2 infection to be prioritized for testing. MATERIALS AND METHODS We performed a retrospective analysis of individuals registered in "Dados do Bem," a Brazilian app-based symptom tracker. We applied machine learning techniques and provided a SARS-CoV-2 infection risk map of Rio de Janeiro city. RESULTS From April 28 to July 16, 2020, 337,435 individuals registered their symptoms through the app. Of these, 49,721 participants were tested for SARS-CoV-2 infection, being 5,888 (11.8%) positive. Among self-reported symptoms, loss of smell (OR[95%CI]: 4.6 [4.4-4.9]), fever (2.6 [2.5-2.8]), and shortness of breath (2.1 [1.6-2.7]) were independently associated with SARS-CoV-2 infection. Our final model obtained a competitive performance, with only 7% of false-negative users predicted as negatives (NPV = 0.93). The model was incorporated by the "Dados do Bem" app aiming to prioritize users for testing. We developed an external validation in the city of Rio de Janeiro. We found that the proportion of positive results increased significantly from 14.9% (before using our model) to 18.1% (after the model). CONCLUSIONS Our results showed that the combination of symptoms might predict SARS-Cov-2 infection and, therefore, can be used as a tool by decision-makers to refine testing and disease control strategies.
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Affiliation(s)
- Leila F. Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Igor T. Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Leonardo S. L. Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Janaina F. Marchesi
- Instituto Tecgraf, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Guilherme F. G. de Souza
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - João Gabriel M. Gelli
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernanda A. Baião
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Paula Maçaira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
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47
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Ten-Caten F, Gonzalez-Dias P, Castro Í, Ogava RLT, Giddaluru J, Silva JCS, Martins F, Gonçalves ANA, Costa-Martins AG, Araujo JD, Viegas AC, Cunha FQ, Farsky S, Bozza FA, Levin AS, Pannaraj PS, de Silva TI, Minoprio P, Pinheiro da Silva F, Andrade BB, Nakaya HI. In-depth analysis of laboratory parameters reveals the interplay between sex, age, and systemic inflammation in individuals with COVID-19. Int J Infect Dis 2021; 105:579-587. [PMID: 33713813 PMCID: PMC7944763 DOI: 10.1016/j.ijid.2021.03.016] [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: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The progression and severity of COVID-19 vary significantly in the population. While the hallmarks of SARS-CoV-2 and severe COVID-19 within routine laboratory parameters are emerging, the impact of sex and age on these profiles is still unknown. METHODS A multidimensional analysis was performed involving millions of records of laboratory parameters and diagnostic tests for 178 887 individuals from Brazil, of whom 33 266 tested positive for SARS-CoV-2. Analyzed data included those relating to complete blood cell count, electrolytes, metabolites, arterial blood gases, enzymes, hormones, cancer biomarkers, and others. FINDINGS COVID-19 induced similar alterations in laboratory parameters in males and females. CRP and ferritin were increased, especially in older men with COVID-19, whereas abnormal liver function tests were common across several age groups, except for young women. Low peripheral blood basophils and eosinophils were more common in the elderly with COVID-19. Both male and female COVID-19 patients admitted to intensive care units displayed alterations in the coagulation system, and higher values for neutrophils, CRP, and lactate dehydrogenase. CONCLUSIONS Our study uncovered the laboratory profiles of a large cohort of COVID-19 patients, which formed the basis of discrepancies influenced by aging and biological sex. These profiles directly linked COVID-19 disease presentation to an intricate interplay between sex, age, and immune activation.
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Affiliation(s)
- Felipe Ten-Caten
- Department of Infectious and Parasitic Diseases, University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
| | - Patrícia Gonzalez-Dias
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ícaro Castro
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodrigo L T Ogava
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Jeevan Giddaluru
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Juan Carlo S Silva
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Felipe Martins
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - André N A Gonçalves
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - André G Costa-Martins
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - José D Araujo
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Viegas
- Division of Nephrology, Medicine Department, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Fernando Q Cunha
- Center of Research in Inflammatory Diseases (CRID), University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Sandra Farsky
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Anna S Levin
- Department of Infectious Diseases, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Pia S Pannaraj
- Division of Infectious Diseases, Children's Hospital Los Angeles and Department of Pediatrics, Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Thushan I de Silva
- The Florey Institute for Host-Pathogen Interactions and Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Paola Minoprio
- Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil
| | - Fabiano Pinheiro da Silva
- Departamento de Emergências Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno B Andrade
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil.
| | - Helder I Nakaya
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil; Scientific Platform Pasteur-University of São Paulo, São Paulo, Brazil; Center of Research in Inflammatory Diseases (CRID), University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
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48
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Ferreira AC, Soares VC, de Azevedo-Quintanilha IG, Dias SDSG, Fintelman-Rodrigues N, Sacramento CQ, Mattos M, de Freitas CS, Temerozo JR, Teixeira L, Damaceno Hottz E, Barreto EA, Pão CRR, Palhinha L, Miranda M, Bou-Habib DC, Bozza FA, Bozza PT, Souza TML. SARS-CoV-2 engages inflammasome and pyroptosis in human primary monocytes. Cell Death Discov 2021; 7:43. [PMID: 33649297 PMCID: PMC7919254 DOI: 10.1038/s41420-021-00428-w] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [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: 12/07/2020] [Revised: 01/15/2021] [Accepted: 02/03/2021] [Indexed: 02/08/2023] Open
Abstract
Infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been associated with leukopenia and uncontrolled inflammatory response in critically ill patients. A better comprehension of SARS-CoV-2-induced monocyte death is essential for the identification of therapies capable to control the hyper-inflammation and reduce viral replication in patients with 2019 coronavirus disease (COVID-19). Here, we show that SARS-CoV-2 engages inflammasome and triggers pyroptosis in human monocytes, experimentally infected, and from patients under intensive care. Pyroptosis associated with caspase-1 activation, IL-1ß production, gasdermin D cleavage, and enhanced pro-inflammatory cytokine levels in human primary monocytes. At least in part, our results originally describe mechanisms by which monocytes, a central cellular component recruited from peripheral blood to respiratory tract, succumb to control severe COVID-19.
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Affiliation(s)
- André C Ferreira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,Laboratório de Pesquisa Pré-clínica-Universidade Iguaçu - UNIG, Nova Iguaçu, RJ, Brazil. .,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil.
| | - Vinicius Cardoso Soares
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Program of Immunology and Inflammation, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | | | - Suelen da Silva Gomes Dias
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Natalia Fintelman-Rodrigues
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Carolina Q Sacramento
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Mayara Mattos
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Caroline S de Freitas
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Jairo R Temerozo
- Laboratório de Pesquisas sobre o Timo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Lívia Teixeira
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eugenio Damaceno Hottz
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Laboratório de Imunotrombose, Departamento de Bioquímica, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Ester A Barreto
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Camila R R Pão
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Lohanna Palhinha
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Milene Miranda
- Laboratório de Vírus Respiratório e do Sarampo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Dumith Chequer Bou-Habib
- Laboratório de Pesquisas sobre o Timo, IOC, Fiocruz, Rio de Janeiro, RJ, Brazil.,National Institute for Science and Technology on Neuroimmunomodulation, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Fernando A Bozza
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil.,Instituto D'or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
| | - Patrícia T Bozza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Thiago Moreno L Souza
- Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil. .,National Institute for Science and Technology on Innovation in Diseases of Neglected Populations (INCT/IDPN), Center for Technological Development in Health (CDTS), Fiocruz, Rio de Janeiro, RJ, Brazil.
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49
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Peres IT, Bastos LSL, Gelli JGM, Marchesi JF, Dantas LF, Antunes BBP, Maçaira PM, Baião FA, Hamacher S, Bozza FA. Sociodemographic factors associated with COVID-19 in-hospital mortality in Brazil. Public Health 2021; 192:15-20. [PMID: 33607516 PMCID: PMC7836512 DOI: 10.1016/j.puhe.2021.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/15/2020] [Accepted: 01/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has highlighted inequalities in access to healthcare systems, increasing racial disparities and worsening health outcomes in these populations. This study analysed the association between sociodemographic characteristics and COVID-19 in-hospital mortality in Brazil. STUDY DESIGN A retrospective analysis was conducted on quantitative reverse transcription polymerase chain reaction-confirmed hospitalised adult patients with COVID-19 with a defined outcome (i.e. hospital discharge or death) in Brazil. Data were retrieved from the national surveillance system database (SIVEP-Gripe) between February 16 and August 8, 2020. METHODS Clinical characteristics, sociodemographic variables, use of hospital resources and outcomes of hospitalised adult patients with COVID-19, stratified by self-reported race, were investigated. The primary outcome was in-hospital mortality. The association between self-reported race and in-hospital mortality, after adjusting for clinical characteristics and comorbidities, was evaluated using a logistic regression model. RESULTS During the study period, Brazil had 3,018,397 confirmed COVID-19 cases and 100,648 deaths. The study population included 228,196 COVID-19-positive adult in-hospital patients with a defined outcome; the median age was 61 years, 57% were men, 35% (79,914) self-reported as Black/Brown and 35.4% (80,853) self-reported as White. The total in-hospital mortality was 37% (85,171/228,196). Black/Brown patients showed higher in-hospital mortality than White patients (42% vs 37%, respectively), were admitted less frequently to the intensive care unit (ICU) (32% vs 36%, respectively) and used more invasive mechanical ventilation (21% vs 19%, respectively), especially outside the ICU (17% vs 11%, respectively). Black/Brown race was independently associated with high in-hospital mortality after adjusting for sex, age, level of education, region of residence and comorbidities (odds ratio = 1.15; 95% confidence interval = 1.09-1.22). CONCLUSIONS Among hospitalised Brazilian adults with COVID-19, Black/Brown patients showed higher in-hospital mortality, less frequently used hospital resources and had potentially more severe conditions than White patients. Racial disparities in health outcomes and access to health care highlight the need to actively implement strategies to reduce inequities caused by the wider health determinants, ultimately leading to a sustainable change in the health system.
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Affiliation(s)
- I T Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - L S L Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - J G M Gelli
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - J F Marchesi
- Instituto Tecgraf, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - L F Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - B B P Antunes
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - P M Maçaira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - F A Baião
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - S Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - F A Bozza
- National Institute of Infectious Diseases Evandro Chagas (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
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50
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Kurtz P, Righy C, Gadelha M, Bozza FA, Bozza PT, Gonçalves B, Bastos LSL, Vale AM, Higa LM, Castilho L, Monteiro FL, Charris N, Fialho F, Turon R, Guterres A, Lyra Miranda R, de Azeredo Lima CH, de Caro V, Prazeres MA, Ventura N, Gaspari C, Miranda F, Jose da Mata P, Pêcego M, Mateos S, Lopes ME, Castilho S, Oliveira Á, Boquimpani C, Rabello A, Lopes J, Neto OC, Ferreira ODC, Tanuri A, Filho PN, Amorim L. Effect of Convalescent Plasma in Critically Ill Patients With COVID-19: An Observational Study. Front Med (Lausanne) 2021; 8:630982. [PMID: 33585529 PMCID: PMC7876445 DOI: 10.3389/fmed.2021.630982] [Citation(s) in RCA: 9] [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: 11/18/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Convalescent plasma is a potential therapeutic option for critically ill patients with coronavirus disease 19 (COVID-19), yet its efficacy remains to be determined. The aim was to investigate the effects of convalescent plasma (CP) in critically ill patients with COVID-19. Methods: This was a single-center prospective observational study conducted in Rio de Janeiro, Brazil, from March 17th to May 30th, with final follow-up on June 30th. We included 113 laboratory-confirmed COVID-19 patients with respiratory failure. Primary outcomes were time to clinical improvement and survival within 28 days. Secondary outcomes included behavior of biomarkers and viral loads. Kaplan–Meier analyses and Cox proportional-hazards regression using propensity score with inverse-probability weighing were performed. Results: 41 patients received CP and 72 received standard of care (SOC). Median age was 61 years (IQR 48–68), disease duration was 10 days (IQR 6–13), and 86% were mechanically ventilated. At least 29 out of 41CP-recipients had baseline IgG titers ≥ 1:1,080. Clinical improvement within 28 days occurred in 19 (46%) CP-treated patients, as compared to 23 (32%) in the SOC group [adjusted hazard ratio (aHR) 0.91 (0.49–1.69)]. There was no significant change in 28-day mortality (CP 49% vs. SOC 56%; aHR 0.90 [0.52–1.57]). Biomarker assessment revealed reduced inflammatory activity and increased lymphocyte count after CP. Conclusions: In this study, CP was not associated with clinical improvement or increase in 28-day survival. However, our study may have been underpowered and included patients with high IgG titers and life-threatening disease. Clinical Trial Registration: The study protocol was retrospectively registered at the Brazilian Registry of Clinical Trials (ReBEC) with the identification RBR-4vm3yy (http://www.ensaiosclinicos.gov.br).
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Affiliation(s)
- Pedro Kurtz
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Cassia Righy
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Monica Gadelha
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Fernando A Bozza
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil.,National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Patricia T Bozza
- Laboratory of Immunopharmacology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Bruno Gonçalves
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Leonardo S L Bastos
- Industrial Engineering Department, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
| | - Andre M Vale
- Laboratory of Lymphocyte Biology, Program in Immunobiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Luiza M Higa
- Laboratory of Molecular Virology, Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leda Castilho
- Laboratory of Cell Culture Engineering, COPPE, Chemical Engineering Program, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Fabio L Monteiro
- Laboratory of Molecular Virology, Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nestor Charris
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Fernanda Fialho
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Ricardo Turon
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | | | | | | | - Vanessa de Caro
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | | | - Nina Ventura
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Clara Gaspari
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Fabio Miranda
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | | | - Margarida Pêcego
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Sheila Mateos
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Maria Esther Lopes
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Shirley Castilho
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Álvaro Oliveira
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Carla Boquimpani
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Andréa Rabello
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Josiane Lopes
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Orlando Conceição Neto
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
| | - Orlando da C Ferreira
- Laboratory of Molecular Virology, Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amilcar Tanuri
- Laboratory of Molecular Virology, Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luiz Amorim
- Instituto Estadual de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO), Rio de Janeiro, Brazil
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