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Bhatia KS, Sritharan HP, Ciofani J, Chia J, Allahwala UK, Chui K, Nour D, Vasanthakumar S, Khandadai D, Jayadeva P, Bhagwandeen R, Brieger D, Choong C, Delaney A, Dwivedi G, Harris B, Hillis G, Hudson B, Javorski G, Jepson N, Kanagaratnam L, Kotsiou G, Lee A, Lo ST, MacIsaac AI, McQuillan B, Ranasinghe I, Walton A, Weaver J, Wilson W, Yong ASC, Zhu J, Van Gaal W, Kritharides L, Chow CK, Bhindi R. Association of hypertension with mortality in patients hospitalised with COVID-19. Open Heart 2021; 8:openhrt-2021-001853. [PMID: 34876491 PMCID: PMC8649882 DOI: 10.1136/openhrt-2021-001853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
Objective To assess whether hypertension is an independent risk factor for mortality among patients hospitalised with COVID-19, and to evaluate the impact of ACE inhibitor and angiotensin receptor blocker (ARB) use on mortality in patients with a background of hypertension. Method This observational cohort study included all index hospitalisations with laboratory-proven COVID-19 aged ≥18 years across 21 Australian hospitals. Patients with suspected, but not laboratory-proven COVID-19, were excluded. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs. Results 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (adjusted OR (aOR) 1.09, 95% CI 1.07 to 1.12, p<0.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13 to 6.53, p=0.026), chronic kidney disease (aOR 2.33, 95% CI 1.02 to 5.32, p=0.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06 to 4.85, p=0.035). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48 to 1.77, p=0.81). Among patients with hypertension, ACE inhibitor (aOR 1.37, 95% CI 0.61 to 3.08, p=0.61) and ARB (aOR 0.64, 95% CI 0.27 to 1.49, p=0.30) use was not associated with mortality. Conclusions In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.
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Affiliation(s)
- Kunwardeep S Bhatia
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hari P Sritharan
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jonathan Ciofani
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Justin Chia
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Usaid K Allahwala
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Karina Chui
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Daniel Nour
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | | | - Dhanvee Khandadai
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Pavithra Jayadeva
- Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rohan Bhagwandeen
- Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - David Brieger
- Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Christopher Choong
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Anthony Delaney
- Intensive Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Girish Dwivedi
- Cardiology, Harry Perkins Institute of Medical Research, Perth, Australian Capital Territory, Australia.,Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Benjamin Harris
- Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Bernard Hudson
- NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - George Javorski
- Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Nigel Jepson
- Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Logan Kanagaratnam
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - George Kotsiou
- Infectious Diseases and Microbiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Astin Lee
- Cardiology, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sidney T Lo
- Cardiology, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Andrew I MacIsaac
- Cardiology Department, St Vincent's Health Australia, Sydney, New South Wales, Australia
| | - Brendan McQuillan
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - Isuru Ranasinghe
- Cardiology, The University of Queensland, Saint Lucia, Queensland, Australia.,The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Antony Walton
- Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - James Weaver
- Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - William Wilson
- Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andy S C Yong
- Cardiology, Concord Hospital, Sydney, New South Wales, Australia
| | - John Zhu
- Cardiology, Lismore Base Hospital, Lismore, New South Wales, Australia
| | | | - Leonard Kritharides
- Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Clara K Chow
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Cardiology, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Ravinay Bhindi
- Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Ng PC, Li K, Wong RPO, Chui K, Wong E, Li G, Fok TF. Proinflammatory and anti-inflammatory cytokine responses in preterm infants with systemic infections. Arch Dis Child Fetal Neonatal Ed 2003; 88:F209-13. [PMID: 12719394 PMCID: PMC1721542 DOI: 10.1136/fn.88.3.f209] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [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] [Indexed: 01/22/2023]
Abstract
OBJECTIVE A prospective study to investigate the pattern of proinflammatory and anti-inflammatory cytokine responses in preterm infants with systemic infection. METHODS Very low birthweight infants in whom infection was suspected when they were > 72 hours of age were eligible. A full sepsis screen was performed in each episode. Key cytokines of both proinflammatory and anti-inflammatory pathways, including interleukin (IL) 2, IL4, IL5, IL6, IL10, interferon (IFN) gamma, and tumour necrosis factor (TNF) alpha, were measured at 0 (at the time of sepsis evaluation), 24, and 48 hours by flow cytometric analysis or immunoassay. RESULTS Thirty seven of the 127 episodes of suspected clinical sepsis were proven infection or necrotising enterocolitis. Both proinflammatory (IL2, IL6, IFNgamma, TNFalpha) and anti-inflammatory (IL4, IL10) cytokines were significantly increased in infected infants compared with non-infected infants. Significant correlations were observed between IL6 and TNFalpha or IL10 as well as IL10 and IFNgamma in infected infants. In the subgroup analysis, plasma IL6, IL10, and TNFalpha concentrations, and IL10/TNFalpha and IL6/IL10 ratios were significantly elevated in patients with disseminated intravascular coagulation compared with infected infants without. The IL10/TNFalpha ratios had decreased significantly 48 hours after the onset, whereas the IL6/IL10 ratio showed only a non-significant decreasing trend. Further, the IL6/IL10 ratio in the deceased infant was disproportionally increased at presentation and continued to increase despite treatment. CONCLUSION The results indicate that the counter-regulatory mechanism between the proinflammatory and anti-inflammatory cytokine pathways is probably operational in preterm infants of early gestation. High plasma IL6, IL10, and TNFalpha concentrations, and IL10/TNFalpha and IL6/IL10 ratios signify severe infection, but transiently elevated plasma IL10 concentration or IL10/TNFalpha ratio does not necessarily indicate a poor prognosis.
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Affiliation(s)
- P C Ng
- Department of Paediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong.
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