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Lathouwers E, Radwan A, Blommaert J, Stas L, Tassignon B, Allard SD, De Ridder F, De Waele E, Hoornaert N, Lacor P, Mertens R, Naeyaert M, Raeymaekers H, Seyler L, Vanbinst AM, Van Liedekerke L, Van Schependom J, Van Schuerbeek P, Provyn S, Roelands B, Vandekerckhove M, Meeusen R, Sunaert S, Nagels G, De Mey J, De Pauw K. Author Correction: A cross-sectional case-control study on the structural connectome in recovered hospitalized COVID-19 patients. Sci Rep 2023; 13:19012. [PMID: 37923789 PMCID: PMC10624892 DOI: 10.1038/s41598-023-44726-y] [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: 11/06/2023] Open
Affiliation(s)
- Elke Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI , KU Leuven, Leuven, Belgium
| | | | - Lara Stas
- Core Facility‑Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel, Brussels, Belgium
- Biostatistics and Medical Informatics Research Group, Faculty of Medicine and Pharmacy, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sabine D Allard
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Filip De Ridder
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | | | - Nicole Hoornaert
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Patrick Lacor
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Rembert Mertens
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Maarten Naeyaert
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Lucie Seyler
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Anne-Marie Vanbinst
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Lien Van Liedekerke
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Jeroen Van Schependom
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
- Artifcial Intelligence and Modelling in Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Steven Provyn
- Department of Anatomical Research and Clinical Studies (ARCS), Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marie Vandekerckhove
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Arts and Philosophy, University of Ghent, Ghent, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program 'Exercise and the Brain in Health & Disease: The Added Value of Human‑Centered Robotics', Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI , KU Leuven, Leuven, Belgium
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | - Guy Nagels
- Artifcial Intelligence and Modelling in Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium.
- Strategic Research Program 'Exercise and the Brain in Health & Disease: The Added Value of Human‑Centered Robotics', Vrije Universiteit Brussel, Brussels, Belgium.
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Rose AM, Nicolay N, Sandonis Martín V, Mazagatos C, Petrović G, Baruch J, Denayer S, Seyler L, Domegan L, Launay O, Machado A, Burgui C, Vaikutyte R, Niessen FA, Loghin II, Husa P, Aouali N, Panagiotakopoulos G, Tolksdorf K, Horváth JK, Howard J, Pozo F, Gallardo V, Nonković D, Džiugytė A, Bossuyt N, Demuyser T, Duffy R, Luong Nguyen LB, Kislaya I, Martínez-Baz I, Gefenaite G, Knol MJ, Popescu C, Součková L, Simon M, Michelaki S, Reiche J, Ferenczi A, Delgado-Sanz C, Lovrić Makarić Z, Cauchi JP, Barbezange C, Van Nedervelde E, O'Donnell J, Durier C, Guiomar R, Castilla J, Jonikaite I, Bruijning-Verhagen PC, Lazar M, Demlová R, Wirtz G, Amerali M, Dürrwald R, Kunstár MP, Kissling E, Bacci S, Valenciano M. Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Omicron-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021 to 2022. Euro Surveill 2023; 28:2300187. [PMID: 37997665 PMCID: PMC10668256 DOI: 10.2807/1560-7917.es.2023.28.47.2300187] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 11/25/2023] Open
Abstract
IntroductionThe I-MOVE-COVID-19 and VEBIS hospital networks have been measuring COVID-19 vaccine effectiveness (VE) in participating European countries since early 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in patients ≥ 20 years hospitalised with severe acute respiratory infection (SARI) from December 2021 to July 2022 (Omicron-dominant period).MethodsIn both networks, 46 hospitals (13 countries) follow a similar test-negative case-control protocol. We defined complete primary series vaccination (PSV) and first booster dose vaccination as last dose of either vaccine received ≥ 14 days before symptom onset (stratifying first booster into received < 150 and ≥ 150 days after last PSV dose). We measured VE overall, by vaccine category/product, age group and time since first mRNA booster dose, adjusting by site as a fixed effect, and by swab date, age, sex, and presence/absence of at least one commonly collected chronic condition.ResultsWe included 2,779 cases and 2,362 controls. The VE of all vaccine products combined against hospitalisation for laboratory-confirmed SARS-CoV-2 was 43% (95% CI: 29-54) for complete PSV (with last dose received ≥ 150 days before onset), while it was 59% (95% CI: 51-66) after addition of one booster dose. The VE was 85% (95% CI: 78-89), 70% (95% CI: 61-77) and 36% (95% CI: 17-51) for those with onset 14-59 days, 60-119 days and 120-179 days after booster vaccination, respectively.ConclusionsOur results suggest that, during the Omicron period, observed VE against SARI hospitalisation improved with first mRNA booster dose, particularly for those having symptom onset < 120 days after first booster dose.
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Affiliation(s)
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Joaquin Baruch
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Odile Launay
- Inserm, CIC Cochin-Pasteur, Paris, France
- AP-HP, Hôpital Cochin, Paris, France
- Faculty of Medicine, University of Paris City, Paris, France
| | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - F Annabel Niessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Isabela I Loghin
- St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Petr Husa
- Faculty of Medicine, Masaryk University, Brno, Czechia
- University Hospital Brno, Brno, Czechia
| | | | | | | | - Judit Krisztina Horváth
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Virtudes Gallardo
- Dirección General de Salud Pública y Ordenación Farmacéutica, Junta de Andalucía, Spain
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Aušra Džiugytė
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | | | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Irina Kislaya
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Giedre Gefenaite
- Faculty of Medicine, Lund University, Lund, Sweden
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Marc Simon
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | | | - Annamária Ferenczi
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | - Concepción Delgado-Sanz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - John Paul Cauchi
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | | | | | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Raquel Guiomar
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Patricia Cjl Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Mihaela Lazar
- "Cantacuzino" National Military Medical Institute for Research-Development, Bucharest, Romania
| | | | - Gil Wirtz
- Centre Hospitalier de Luxembourg, Luxembourg
| | - Marina Amerali
- National Public Health Organisation (EODY), Athens, Greece
| | | | - Mihály Pál Kunstár
- National Laboratory for Health Security, Epidemiology and Surveillance Centre, Semmelweis University, Budapest, Hungary
| | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Rose AM, Nicolay N, Sandonis Martín V, Mazagatos C, Petrović G, Niessen FA, Machado A, Launay O, Denayer S, Seyler L, Baruch J, Burgui C, Loghin II, Domegan L, Vaikutytė R, Husa P, Panagiotakopoulos G, Aouali N, Dürrwald R, Howard J, Pozo F, Sastre-Palou B, Nonković D, Knol MJ, Kislaya I, Luong Nguyen LB, Bossuyt N, Demuyser T, Džiugytė A, Martínez-Baz I, Popescu C, Duffy R, Kuliešė M, Součková L, Michelaki S, Simon M, Reiche J, Otero-Barrós MT, Lovrić Makarić Z, Bruijning-Verhagen PC, Gomez V, Lesieur Z, Barbezange C, Van Nedervelde E, Borg ML, Castilla J, Lazar M, O'Donnell J, Jonikaitė I, Demlová R, Amerali M, Wirtz G, Tolksdorf K, Valenciano M, Bacci S, Kissling E. Vaccine effectiveness against COVID-19 hospitalisation in adults (≥ 20 years) during Alpha- and Delta-dominant circulation: I-MOVE-COVID-19 and VEBIS SARI VE networks, Europe, 2021. Euro Surveill 2023; 28:2300186. [PMID: 37997666 PMCID: PMC10668259 DOI: 10.2807/1560-7917.es.2023.28.47.2300186] [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: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 11/25/2023] Open
Abstract
IntroductionTwo large multicentre European hospital networks have estimated vaccine effectiveness (VE) against COVID-19 since 2021.AimWe aimed to measure VE against PCR-confirmed SARS-CoV-2 in hospitalised severe acute respiratory illness (SARI) patients ≥ 20 years, combining data from these networks during Alpha (March-June)- and Delta (June-December)-dominant periods, 2021.MethodsForty-six participating hospitals across 14 countries follow a similar generic protocol using the test-negative case-control design. We defined complete primary series vaccination (PSV) as two doses of a two-dose or one of a single-dose vaccine ≥ 14 days before onset.ResultsWe included 1,087 cases (538 controls) and 1,669 cases (1,442 controls) in the Alpha- and Delta-dominant periods, respectively. During the Alpha period, VE against hospitalisation with SARS-CoV2 for complete Comirnaty PSV was 85% (95% CI: 69-92) overall and 75% (95% CI: 42-90) in those aged ≥ 80 years. During the Delta period, among SARI patients ≥ 20 years with symptom onset ≥ 150 days from last PSV dose, VE for complete Comirnaty PSV was 54% (95% CI: 18-74). Among those receiving Comirnaty PSV and mRNA booster (any product) ≥ 150 days after last PSV dose, VE was 91% (95% CI: 57-98). In time-since-vaccination analysis, complete all-product PSV VE was > 90% in those with their last dose < 90 days before onset; ≥ 70% in those 90-179 days before onset.ConclusionsOur results from this EU multi-country hospital setting showed that VE for complete PSV alone was higher in the Alpha- than the Delta-dominant period, and addition of a first booster dose during the latter period increased VE to over 90%.
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Affiliation(s)
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Clara Mazagatos
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - F Annabel Niessen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Ausenda Machado
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | - Odile Launay
- Inserm, CIC Cochin-Pasteur, Paris, France
- AP-HP, Hôpital Cochin, Paris, France
- Faculty of Medicine, University of Paris City, Paris, France
| | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Joaquin Baruch
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Isabela I Loghin
- St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
- Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | - Petr Husa
- Faculty of Medicine, Masaryk University, Brno, Czechia
- University Hospital Brno, Brno, Czechia
| | | | | | | | | | - Francisco Pozo
- National Centre for Microbiology, Institute of Health Carlos III, Madrid, Spain
| | - Bartolomé Sastre-Palou
- Servicio de Medicina Preventiva Hospital Universitario Son Espases, Servicio de Epidemiología, Consellería de Salut, Palma, Spain
| | - Diana Nonković
- Teaching Public Health Institute of Split-Dalmatia County, Split, Croatia
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Irina Kislaya
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Aušra Džiugytė
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Iván Martínez-Baz
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Corneliu Popescu
- Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Róisín Duffy
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Monika Kuliešė
- Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Marc Simon
- Centre Hospitalier de Luxembourg, Luxembourg
| | | | - María Teresa Otero-Barrós
- Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad de Galicia, Santiago de Compostela, A Coruna, Spain
| | | | - Patricia Cjl Bruijning-Verhagen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Verónica Gomez
- National Institute of Health Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | | | - Maria-Louise Borg
- IDCU within Health promotion and disease prevention Directorate, G'mangia, Malta
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mihaela Lazar
- "Cantacuzino" National Military Medical Institute for Research-Development, Bucharest, Romania
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Marina Amerali
- National Public Health Organisation (EODY), Athens, Greece
| | - Gil Wirtz
- Luxembourg Institute of Health, Luxembourg
| | | | | | - Sabrina Bacci
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Denayer S, Dufrasne FE, Monsieurs B, van Eycken R, Houben S, Seyler L, Demuyser T, van Nedervelde E, Bourgeois M, Delaere B, Magerman K, Jouck D, Lissoir B, Sion C, Reynders M, Petit E, Dauby N, Hainaut M, Laenen L, Maes P, Baele G, Dellicour S, Cuypers L, André E, Couvreur S, Brondeel R, Barbezange C, Bossuyt N, van Gucht S. Genomic monitoring of SARS-CoV-2 variants using sentinel SARI hospital surveillance. Influenza Other Respir Viruses 2023; 17:e13202. [PMID: 37840842 PMCID: PMC10570899 DOI: 10.1111/irv.13202] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Background To support the COVID-19 pandemic response, many countries, including Belgium, implemented baseline genomic surveillance (BGS) programs aiming to early detect and characterize new SARS-CoV-2 variants. In parallel, Belgium maintained a sentinel network of six hospitals that samples patients with severe acute respiratory infections (SARI) and integrated SARS-CoV-2 detection within a broader range of respiratory pathogens. We evaluate the ability of the SARI surveillance to monitor general trends and early signals of viral genetic evolution of SARS-CoV-2 and compare it with the BGS as a reference model. Methods Nine-hundred twenty-five SARS-CoV-2 positive samples from patients fulfilling the Belgian SARI definition between January 2020 and December 2022 were sequenced using the ARTIC Network amplicon tiling approach on a MinION platform. Weekly variant of concern (VOC) proportions and types were compared to those that were circulating between 2021 and 2022, using 96,251 sequences of the BGS. Results SARI surveillance allowed timely detection of the Omicron (BA.1, BA.2, BA.4, and BA.5) and Delta (B.1.617.2) VOCs, with no to 2 weeks delay according to the start of their epidemic growth in the Belgian population. First detection of VOCs B.1.351 and P.1 took longer, but these remained minor in Belgium. Omicron BA.3 was never detected in SARI surveillance. Timeliness could not be evaluated for B.1.1.7, being already major at the start of the study period. Conclusions Genomic surveillance of SARS-CoV-2 using SARI sentinel surveillance has proven to accurately reflect VOCs detected in the population and provides a cost-effective solution for long-term genomic monitoring of circulating respiratory viruses.
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Affiliation(s)
- Sarah Denayer
- Viral Diseases, National Influenza Centre, Scientific Directorate of Infectious Diseases in HumansSciensanoUkkelBelgium
| | - François E. Dufrasne
- Viral Diseases, National Influenza Centre, Scientific Directorate of Infectious Diseases in HumansSciensanoUkkelBelgium
| | - Bert Monsieurs
- Viral Diseases, National Influenza Centre, Scientific Directorate of Infectious Diseases in HumansSciensanoUkkelBelgium
| | - Reinout van Eycken
- Viral Diseases, National Influenza Centre, Scientific Directorate of Infectious Diseases in HumansSciensanoUkkelBelgium
| | - Sarah Houben
- Observational Clinical Trials, Scientific Directorate of infectious Diseases in HumansSciensanoUkkelBelgium
| | - Lucie Seyler
- Department of Internal Medicine and Infectiology, Universitair Ziekenhuis Brussel (UZB)Vrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Thomas Demuyser
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel (UZB)Vrije Universiteit Brussel (VUB)BrusselsBelgium
- AIMS Lab, Center for Neurosciences, Faculty of Medicine and PharmacyVrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Els van Nedervelde
- Department of Internal Medicine and Infectiology, Universitair Ziekenhuis Brussel (UZB)Vrije Universiteit Brussel (VUB)BrusselsBelgium
| | | | | | - Koen Magerman
- Infection Control and Clinical LaboratoryJessa ZiekenhuisHasseltBelgium
- Department of Immunology and InfectionHasselt UniversityHasseltBelgium
| | - Door Jouck
- Infection ControlJessa ZiekenhuisHasseltBelgium
| | | | - Catherine Sion
- Laboratory Site St‐JosephGrand Hôpital de CharleroiGillyBelgium
| | | | - Evelyn Petit
- Laboratory MedicineAZ Sint‐Jan Brugge‐Oostende AVBrugesBelgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint‐PierreUniversité Libre de Bruxelles (ULB)BrusselsBelgium
- Institute for Medical Immunology, ULB Center for Research in Immunology (U‐CRI)Université Libre de Bruxelles (ULB)BrusselsBelgium
- School of Public HealthUniversité Libre de Bruxelles (ULB)BrusselsBelgium
| | - Marc Hainaut
- Pediatrics Department, CHU Saint‐PierreUniversité Libre de Bruxelles (ULB)BrusselsBelgium
| | - Lies Laenen
- National Reference Center for Respiratory Pathogens, UZ LeuvenUniversity Hospitals LeuvenLeuvenBelgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and TransplantationKU LeuvenLeuvenBelgium
| | - Piet Maes
- Department of Microbiology, Immunology and Transplantation, Rega InstituteKU LeuvenLeuvenBelgium
| | - Guy Baele
- Department of Microbiology, Immunology and Transplantation, Rega InstituteKU LeuvenLeuvenBelgium
| | - Simon Dellicour
- Department of Microbiology, Immunology and Transplantation, Rega InstituteKU LeuvenLeuvenBelgium
- Spatial Epidemiology Lab (SpELL)Université Libre de BruxellesBrusselsBelgium
| | - Lize Cuypers
- National Reference Center for Respiratory Pathogens, UZ LeuvenUniversity Hospitals LeuvenLeuvenBelgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and TransplantationKU LeuvenLeuvenBelgium
| | - Emmanuel André
- National Reference Center for Respiratory Pathogens, UZ LeuvenUniversity Hospitals LeuvenLeuvenBelgium
- Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and TransplantationKU LeuvenLeuvenBelgium
| | - Simon Couvreur
- Epidemiology and public Health, Epidemiology of Infectious DiseasesSciensanoBrusselsBelgium
| | - Ruben Brondeel
- Epidemiology and public Health, Epidemiology of Infectious DiseasesSciensanoBrusselsBelgium
| | - Cyril Barbezange
- Viral Diseases, National Influenza Centre, Scientific Directorate of Infectious Diseases in HumansSciensanoUkkelBelgium
| | - Nathalie Bossuyt
- Epidemiology and public Health, Epidemiology of Infectious DiseasesSciensanoBrusselsBelgium
| | - Steven van Gucht
- Viral Diseases, National Influenza Centre, Scientific Directorate of Infectious Diseases in HumansSciensanoUkkelBelgium
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5
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Lathouwers E, Radwan A, Blommaert J, Stas L, Tassignon B, Allard SD, De Ridder F, De Waele E, Hoornaert N, Lacor P, Mertens R, Naeyaert M, Raeymaekers H, Seyler L, Vanbinst AM, Van Liedekerke L, Van Schependom J, Van Schuerbeek P, Provyn S, Roelands B, Vandekerckhove M, Meeusen R, Sunaert S, Nagels G, De Mey J, De Pauw K. A cross-sectional case-control study on the structural connectome in recovered hospitalized COVID-19 patients. Sci Rep 2023; 13:15668. [PMID: 37735584 PMCID: PMC10514277 DOI: 10.1038/s41598-023-42429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
COVID-19 can induce neurological sequelae, negatively affecting the quality of life. Unravelling this illness's impact on structural brain connectivity, white-matter microstructure (WMM), and cognitive performance may help elucidate its implications. This cross-sectional study aimed to investigate differences in these factors between former hospitalised COVID-19 patients (COV) and healthy controls. Group differences in structural brain connectivity were explored using Welch-two sample t-tests and two-sample Mann-Whitney U tests. Multivariate linear models were constructed (one per region) to examine fixel-based group differences. Differences in cognitive performance between groups were investigated using Wilcoxon Rank Sum tests. Possible effects of bundle-specific FD measures on cognitive performance were explored using a two-group path model. No differences in whole-brain structural organisation were found. Bundle-specific metrics showed reduced fiber density (p = 0.012, Hedges' g = 0.884) and fiber density cross-section (p = 0.007, Hedges' g = 0.945) in the motor segment of the corpus callosum in COV compared to healthy controls. Cognitive performance on the motor praxis and digit symbol substitution tests was worse in COV than healthy controls (p < 0.001, r = 0.688; p = 0.013, r = 422, respectively). Associations between the cognitive performance and bundle-specific FD measures differed significantly between groups. WMM and cognitive performance differences were observed between COV and healthy controls.
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Affiliation(s)
- Elke Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ahmed Radwan
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | | | - Lara Stas
- Biostatistics and Medical Informatics Research Group, Faculty of Medicine and Pharmacy, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Core Facility-Support for Quantitative and Qualitative Research (SQUARE), Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sabine D Allard
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Filip De Ridder
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | | | - Nicole Hoornaert
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Patrick Lacor
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Rembert Mertens
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Maarten Naeyaert
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Hubert Raeymaekers
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Lucie Seyler
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - Anne-Marie Vanbinst
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Lien Van Liedekerke
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Jeroen Van Schependom
- Artificial Intelligence and Modelling in Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Steven Provyn
- Department of Anatomical Research and Clinical Studies (ARCS), Vrije Universiteit Brussel, Brussels, Belgium
| | - Bart Roelands
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Marie Vandekerckhove
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Faculty of Arts and Philosophy, University of Ghent, Ghent, Belgium
| | - Romain Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program 'Exercise and the Brain in Health & Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefan Sunaert
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | - Guy Nagels
- Artificial Intelligence and Modelling in Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology and Magnetic Resonance, UZ Brussel, Brussels, Belgium
| | - Kevin De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium.
- Strategic Research Program 'Exercise and the Brain in Health & Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, Brussels, Belgium.
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Van Laethem J, Wuyts S, Van Laere S, Koulalis J, Colman M, Moretti M, Seyler L, De Waele E, Pierard D, Lacor P, Allard SD. Correction to: Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers. Intern Emerg Med 2023; 18:1607-1608. [PMID: 37178243 PMCID: PMC10182755 DOI: 10.1007/s11739-023-03302-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- J Van Laethem
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | - S Wuyts
- Hospital Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Van Laere
- Interfaculty Centre Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Koulalis
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Colman
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Moretti
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - L Seyler
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - E De Waele
- Intensive Care Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - D Pierard
- Microbiology Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S D Allard
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
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De Brucker L, Seyler L, Leemans G, Gutermuth J, Grosber M. Acute generalized exanthematous pustulosis (AGEP) in a patient with COVID-19 infection. J Eur Acad Dermatol Venereol 2023. [PMID: 37060256 DOI: 10.1111/jdv.19119] [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] [Received: 12/13/2022] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Affiliation(s)
- L De Brucker
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - L Seyler
- Department of Infectious Diseases, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - G Leemans
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
- Department of Pathology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - J Gutermuth
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - M Grosber
- Department of Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
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8
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Tassignon B, Radwan A, Blommaert J, Stas L, Allard SD, De Ridder F, De Waele E, Bulnes LC, Hoornaert N, Lacor P, Lathouwers E, Mertens R, Naeyaert M, Raeymaekers H, Seyler L, Van Binst AM, Van Imschoot L, Van Liedekerke L, Van Schependom J, Van Schuerbeek P, Vandekerckhove M, Meeusen R, Sunaert S, Nagels G, De Mey J, De Pauw K. Longitudinal changes in global structural brain connectivity and cognitive performance in former hospitalized COVID-19 survivors: an exploratory study. Exp Brain Res 2023; 241:727-741. [PMID: 36708380 PMCID: PMC9883830 DOI: 10.1007/s00221-023-06545-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/06/2022] [Accepted: 01/02/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Long-term sequelae of COVID-19 can result in reduced functionality of the central nervous system and substandard quality of life. Gaining insight into the recovery trajectory of admitted COVID-19 patients on their cognitive performance and global structural brain connectivity may allow a better understanding of the diseases' relevance. OBJECTIVES To assess whole-brain structural connectivity in former non-intensive-care unit (ICU)- and ICU-admitted COVID-19 survivors over 2 months following hospital discharge and correlate structural connectivity measures to cognitive performance. METHODS Participants underwent Magnetic Resonance Imaging brain scans and a cognitive test battery after hospital discharge to evaluate structural connectivity and cognitive performance. Multilevel models were constructed for each graph measure and cognitive test, assessing the groups' influence, time since discharge, and interactions. Linear regression models estimated whether the graph measurements affected cognitive measures and whether they differed between ICU and non-ICU patients. RESULTS Six former ICU and six non-ICU patients completed the study. Across the various graph measures, the characteristic path length decreased over time (β = 0.97, p = 0.006). We detected no group-level effects (β = 1.07, p = 0.442) nor interaction effects (β = 1.02, p = 0.220). Cognitive performance improved for both non-ICU and ICU COVID-19 survivors on four out of seven cognitive tests 2 months later (p < 0.05). CONCLUSION Adverse effects of COVID-19 on brain functioning and structure abate over time. These results should be supported by future research including larger sample sizes, matched control groups of healthy non-infected individuals, and more extended follow-up periods.
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Affiliation(s)
- B Tassignon
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Radwan
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
| | - J Blommaert
- Department of Oncology, KU Leuven, Leuven, Belgium
| | - L Stas
- Biostatistics and Medical Informatics Research Group, Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Interfaculty Center for Data Processing and Statistics, Core Facility Statistics and Methodology, Vrije Universiteit Brussel, Brussels, Belgium
| | - S D Allard
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - F De Ridder
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - E De Waele
- Intensive Care Unit, UZ Brussel, Jette, Belgium
| | - L C Bulnes
- Brain, Body and Cognition Research Group, Faculty of Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - N Hoornaert
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - P Lacor
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - E Lathouwers
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - R Mertens
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - M Naeyaert
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - H Raeymaekers
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - L Seyler
- Infectious Diseases Unit, Department of Internal Medicine, UZ Brussel, Jette, Belgium
| | - A M Van Binst
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - L Van Imschoot
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - L Van Liedekerke
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - J Van Schependom
- Artificial Intelligence and Modelling in Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium
| | - P Van Schuerbeek
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - M Vandekerckhove
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - R Meeusen
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium
- Strategic Research Program 'Exercise and the Brain in Health & Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, Brussels, Belgium
| | - S Sunaert
- Department of Imaging and Pathology, Translational MRI, KU Leuven, Leuven, Belgium
- Department of Radiology, UZ Leuven, Leuven, Belgium
| | - G Nagels
- Artificial Intelligence and Modelling in Clinical Science, Vrije Universiteit Brussel, Brussels, Belgium
| | - J De Mey
- Department of Radiology and Magnetic Resonance, UZ Brussel, Jette, Belgium
| | - K De Pauw
- Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
- BruBotics, Vrije Universiteit Brussel, Brussels, Belgium.
- Strategic Research Program 'Exercise and the Brain in Health & Disease: The Added Value of Human-Centered Robotics', Vrije Universiteit Brussel, Brussels, Belgium.
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9
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Trøseid M, Arribas JR, Assoumou L, Holten AR, Poissy J, Terzić V, Mazzaferri F, Baño JR, Eustace J, Hites M, Joannidis M, Paiva JA, Reuter J, Püntmann I, Patrick-Brown TDJH, Westerheim E, Nezvalova-Henriksen K, Beniguel L, Dahl TB, Bouscambert M, Halanova M, Péterfi Z, Tsiodras S, Rezek M, Briel M, Ünal S, Schlegel M, Ader F, Lacombe K, Amdal CD, Rodrigues S, Tonby K, Gaudet A, Heggelund L, Mootien J, Johannessen A, Møller JH, Pollan BD, Tveita AA, Kildal AB, Richard JC, Dalgard O, Simensen VC, Baldé A, de Gastines L, del Álamo M, Aydin B, Lund-Johansen F, Trabaud MA, Diallo A, Halvorsen B, Røttingen JA, Tacconelli E, Yazdanpanah Y, Olsen IC, Costagliola D, Dyrhol-Riise AM, Stiksrud B, Jenum S, MacPherson ME, Aarskog NR, Røstad K, Skeie LG, Dahl Å, Steen JK, Nur S, Segers F, Korsan KA, Sethupathy A, Sandstå AJ, Paulsen GJ, Ueland T, Michelsen A, Aukrust P, Berdal JE, Melkeraaen I, Tollefsen MM, Andreassen J, Dokken J, Müller KE, Woll BM, Opsand H, Bogen M, Rød LT, Steinsvik T, Åsheim-Hansen B, Bjerkreim RH, Berg Å, Moen S, Kvalheim S, Strand K, Gravrok B, Skogen V, Lorentzen EM, Schive SW, Rossvoll L, Hoel H, Engebråten S, Martinsson MS, Thallinger M, Ådnanes E, Hannula R, Bremnes N, Liyanarachi K, Ehrnström B, Kvalshaug M, Berge K, Bygdås M, Gustafsson L, AballiB S, Strand M, Andersen B, Aukrust P, Barratt-Due A, Henriksen KN, Kåsine T, Dyrhol-Riise AM, Berdal JE, Favory R, Nseir S, Preau S, Jourdain M, Ledoux G, Durand A, Houard M, Moreau AS, Rouzé A, Tortuyaux R, Degouy G, Levy C, Liu V, Dognon N, Mariller L, Delcourte C, Reguig Z, Cerf A, Cuvelliez M, Kipnis E, Boyer-Beysserre M, Bignon A, Parmentier L, Meddour D, Frade S, Timsit JF, Peiffer-Smadja N, Wicky PH, De Montmollin E, Bouadma L, Dessajan J, Sonneville R, Patrier J, Presente S, Sylia Z, Rioux C, Thy M, Collias L, Bouaraba Y, Dobremel N, Dureau AF, Oudeville P, Pointurier V, Rabouel Y, Stiel L, Alzina C, Ramstein C, Ait-Oufella H, Hamoudi F, Urbina T, Zerbib Y, Maizel J, Wilpotte C, Piroth L, Blot M, Sixt T, Moretto F, Charles C, Gohier S, Roux D, Le Breton C, Gernez C, Thiry I, Baboi L, Malvy D, Boyer A, Perreau P, Armellini M, De Luca G, Di Pietro OSMM, Romanin B, Brogi M, Castelli F, Amadasi S, Barchiesi F, Canovari B, Coppola N, Pisaturo M, Russo A, Occhiello L, Cataldo F, Rillo MM, Queiruga J, Seco E, Stewart S, Borobia AM, Moraga P, Prieto R, García I, Rivera C, Narro JL, Chacón N, de la Rosa S, Macías M, Barrera L, Serna A, Palomo V, Sánchez MIG, Gutiérrez D, Campos AS, Garfia MÁG, Toyos EB, Cabrera JS, Lucena MI, Lapique EL, Englert P, Khalil Z, Jacobs F, Malaise J, Mukangenzi O, Smissaert C, Hildebrand M, Martiny D, Vervacke A, Scarnière A, Yin N, Michel C, Seyler L, Allard S, Van Laethem J, Verschelden G, Meeuwissen A, De Waele A, Van Buggenhout V, Monteyne D, Noppe N, Belkhir L, Yombi JC, De Greef J, Mesland JB, De Ghellinck L, Kin V, D’Aoust C, Bouvier A, Dekeister AC, Hawia E, Gaillet A, Deshorme H, Halleux S, Galand V, Roncon-Albuquerque R, Santos LL, Vieira CB, Magalhaes R, Ferreira S, Bernardo M, Jackson A, Sadlier C, O’Connell S, Blair M, Manning E, Cusack F, Kelly N, Stephenson H, Keane R, Murphy A, Cunnane M, Keane F, O’Regan MC, de Barra E, Bellone AM, O’Regan S, Carey P, Harte J, Coakley P, Heeney A, Ryan D, Curley G, McConkey S, Sulaiman I, Costello R, McNally C, Foley C, Trainor S, Jacob B, Vengathodi S, Kent B, Bergin C, Townsend L, Kerr C, Panti N, Sanz AG, Benny B, Dea EO, Galvin N, Burke C, Galvin A, Aisiyabi S, Lobo D, Laffey J, McNicolas B, Cosgrave D, Sheehan JR, Nita C, Hanley C, Kelly C, Kernan M, Murray J, Staub T, Henin T, Damilot G, Bintener T, Colling J, Ferretti C, Werer C, Stammet P, Braquet P, Arendt V, Calvo E, Michaux C, Mediouni C, Znati A, Montanes G, Garcia L, Thomé C, Breitkopf R, Peer A, Lehner G, Bellman R, Ditlbacher A, Finkenstedt A, Zotter K, Hernandez CP, Rajsic S, Lanthaler B, Greil R, Tamás K, Kovácsné-Levang S, Sipos D, Kappéter A, Halda-Kiss B, Madarassi-Papp E, Hajdu E, Bende B, Konstantinos T, Moschopoulos C, Labrou E, Tsakona M, Grigoropoulos I, Kotanidou A, Fragkou P, Theodorakopoulou M, Pantazi E, Jahai E, Moukouli M, Siafakas D, Mühlbauer B, Dembinski R, Stich K, Schneider G, Nagy A, Grodová K, Kubelová M, Součková L, Švábová HK, Demlová R, Sonderlichová S, Unal S, Inkaya AC, de Bono S, Kartman CE, Adams DH, Crowe B, Yazdanapanah Y, Unal S, Schneider G, Mühlbauer B, Ødegård T, Bakkehøi G, Autran B, Bjørås M, Lambellerie XD, Mezzarri F, Guedj J, Esperou H, Lumbroso J, Welte T, Calmy A, Pischke S, Treweek S, Goetghebeur E, Doussau A, Weiss L, Hulstaert F, Botgros R, del Alamo M, Chung F, Lumbroso J, Zeitlinger M, Escalera BN, Csajka C, Williams C, Amstutz A, Rüegg CS, Burdet C, Massonnaud C, Belhadi D, Mentré F, Aroun M, Mentré F, Ehrmann S, Espoerou H, Burdet C, Falk RS, Bjordal K, Bakkehøi G, Ødegård T, Barratt-Due A. Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial. Crit Care 2023; 27:9. [PMID: 36627655 PMCID: PMC9830601 DOI: 10.1186/s13054-022-04205-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants. METHODS Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. RESULTS Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49-69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI - 0.1% [- 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (- 3.2% [- 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities. CONCLUSION This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu ( 2022-500385-99-00 ).
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Affiliation(s)
- Marius Trøseid
- grid.55325.340000 0004 0389 8485Section for Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - José R. Arribas
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, IdiPAZ, Madrid, Spain ,grid.512890.7Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Lambert Assoumou
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Aleksander Rygh Holten
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
| | - Julien Poissy
- grid.503422.20000 0001 2242 6780Lille University, Lille, France/CHU Lille - Hôpital Roger Salengro, Lille, France ,grid.457369.aL’Institut National de La Santé Et de La Recherche Médicale (Inserm), Paris, France
| | - Vida Terzić
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Fulvia Mazzaferri
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jesús Rodríguez Baño
- grid.411375.50000 0004 1768 164XDepartment of Medicine, Virgen Macarena University Hospital, Seville, Spain ,grid.9224.d0000 0001 2168 1229University of Sevilla and Biomedicines Institute of Seville (IBiS)/CSIC, Seville, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Joe Eustace
- grid.7872.a0000000123318773University College Cork, Cork, Ireland
| | - Maya Hites
- grid.412157.40000 0000 8571 829XBrussels University Hospital-Erasme, Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Joannidis
- grid.5361.10000 0000 8853 2677Medical University Innsbruck, Innsbruck, Austria
| | - José-Artur Paiva
- grid.414556.70000 0000 9375 4688Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal ,grid.5808.50000 0001 1503 7226Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jean Reuter
- grid.418041.80000 0004 0578 0421Centre Hospitalier de Luxembourg, Service de Réanimation-Soins Intensifs, 1210 Luxembourg, Luxembourg
| | - Isabel Püntmann
- Institute of Pharmacology, Hospital Group Gesundheit Nord gGmbH, Bremen, Germany
| | - Thale D. J. H. Patrick-Brown
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Elin Westerheim
- grid.55325.340000 0004 0389 8485Section for Monitoring, Clinical Trial Unit (CTU), Oslo University Hospital, Oslo, Norway
| | - Katerina Nezvalova-Henriksen
- grid.55325.340000 0004 0389 8485Department of Haematology, Oslo University Hospital and Oslo Hospital Pharmacy, Oslo, Norway
| | - Lydie Beniguel
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Tuva Børresdatter Dahl
- grid.55325.340000 0004 0389 8485Research Institute for Internal Medicine, Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Maude Bouscambert
- grid.413852.90000 0001 2163 3825Laboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Des Infections Respiratoires France Sud, Hospices Civils de Lyon, 69317 Lyon, France
| | - Monika Halanova
- grid.11175.330000 0004 0576 0391Department of Epidemiology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovakia
| | - Zoltán Péterfi
- grid.9679.10000 0001 0663 94791St Department of Internal Medicine, Division of Infectology, University of Pécs, Pécs, Hungary
| | - Sotirios Tsiodras
- grid.5216.00000 0001 2155 0800National and Kapodistrian University of Athens, Athens, Greece ,grid.411449.d0000 0004 0622 4662University Hospital of Athens Attikon, Athens, Greece
| | - Michael Rezek
- grid.412554.30000 0004 0609 2751St. Anne University Hospital, Brno, Czech Republic
| | - Matthias Briel
- grid.410567.1Swiss Clinical Trial Organisation and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Serhat Ünal
- grid.411920.f0000 0004 0642 1084Hacettepe University Hospital, Ankara, Turkey
| | - Martin Schlegel
- grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care Medicine, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Florence Ader
- grid.413852.90000 0001 2163 3825Hospices Civils de Lyon, Département Des Maladies Infectieuses Et Tropicales, 69004 Lyon, France ,grid.15140.310000 0001 2175 9188Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, 69007 Lyon, France
| | - Karine Lacombe
- grid.7429.80000000121866389Sorbonne Université, Institut Pierre-Louis d’Épidemiologie Et de Santé Publique, INSERM, 75013 Paris, France ,grid.412370.30000 0004 1937 1100APHP, Hôpital Saint-Antoine, Service de Maladies Infectieuses Et Tropicales, 75012 Paris, France
| | - Cecilie Delphin Amdal
- grid.55325.340000 0004 0389 8485Research support service and Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Serge Rodrigues
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Kristian Tonby
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Deptartment of Infectious Diseases, Oslo University Hospital, Oslo, Norway
| | - Alexandre Gaudet
- grid.410463.40000 0004 0471 8845Critical Care Center, Department of Intensive Care Medicine, CHU Lille, 59000 Lille, France ,grid.503422.20000 0001 2242 6780Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d’Infection Et d’Immunité de Lille, 59000 Lille, France
| | - Lars Heggelund
- grid.459157.b0000 0004 0389 7802Medical Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Joy Mootien
- grid.414085.c0000 0000 9480 048XService, de Réanimation Médiale, GHRMSA Hopital Emile Muller, Mulhouse, France
| | - Asgeir Johannessen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.417292.b0000 0004 0627 3659Department of Infectious Diseases, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jannicke Horjen Møller
- grid.412835.90000 0004 0627 2891Department of Intensive Care Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Beatriz Diaz Pollan
- grid.81821.320000 0000 8970 9163Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain ,grid.81821.320000 0000 8970 9163Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), IdiPAZ, Madrid, Spain
| | - Anders Aune Tveita
- grid.414168.e0000 0004 0627 3595Department of Medicine, Bærum Hospital, Vestre Viken, Bærum, Norway
| | - Anders Benjamin Kildal
- grid.412244.50000 0004 4689 5540Department of Anesthesiology and Intensive Care, University Hospital of North Norway, Tromsø, Norway
| | - Jean-Christophe Richard
- grid.413306.30000 0004 4685 6736Service de Médecine Intensive-Réanimation, Hôpital de La Croix - Rousse - HCL, Lyon, France ,grid.7429.80000000121866389CREATIS INSERM U1206-CNRS UMR 5220, Lyon, France
| | - Olav Dalgard
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.411279.80000 0000 9637 455XAkershus University Hospital, Lørenskog, Norway
| | - Victoria Charlotte Simensen
- grid.418193.60000 0001 1541 4204Division of Health Services, Department of Global Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Aliou Baldé
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
| | - Lucie de Gastines
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | | | - Burç Aydin
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Fridtjof Lund-Johansen
- grid.55325.340000 0004 0389 8485Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Mary-Anne Trabaud
- grid.134996.00000 0004 0593 702XLaboratoire de Virologie, Institut Des Agents Infectieux de Lyon, Centre National de Reference Des Virus Respiratoires France Sud, 69317 Hospices Civils de LyonLyon, France
| | - Alpha Diallo
- Maladies Infectieuses Emergentes, 75015 Paris, France ,grid.7429.80000000121866389Institut National de La Santé Et de La Recherche Médicale, INSERM, 75013 Paris, France
| | - Bente Halvorsen
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - John-Arne Røttingen
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Oslo, Norway
| | - Evelina Tacconelli
- grid.5611.30000 0004 1763 1124Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy ,grid.411475.20000 0004 1756 948XVerona University Hospital, Verona, Italy
| | - Yazdan Yazdanpanah
- grid.512950.aUniversité de Paris, IAME, INSERM, 75018 Paris, France ,grid.411119.d0000 0000 8588 831XAP-HP, Hôpital Bichat, Service de Maladies Infectieuses Et Tropicales, 75018 Paris, France
| | - Inge C. Olsen
- grid.55325.340000 0004 0389 8485Department of Research Support for Clinical Trials, Oslo University Hospital, Oslo, Norway
| | - Dominique Costagliola
- grid.7429.80000000121866389Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie Et de Santé Publique (IPLESP), Paris, France
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Nevejan L, Ombelet S, Laenen L, Keyaerts E, Demuyser T, Seyler L, Soetens O, Van Nedervelde E, Naesens R, Geysels D, Verstrepen W, Cattoir L, Martens S, Michel C, Mathieu E, Reynders M, Evenepoel A, Hellemans J, Vanhee M, Magerman K, Maes J, Matheeussen V, Boogaerts H, Lagrou K, Cuypers L, André E. Severity of COVID-19 among Hospitalized Patients: Omicron Remains a Severe Threat for Immunocompromised Hosts. Viruses 2022; 14:v14122736. [PMID: 36560741 PMCID: PMC9783877 DOI: 10.3390/v14122736] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the general population in the context of a relatively high immunity gained through the early waves of coronavirus disease 19 (COVID-19), and vaccination campaigns. Despite this context, a significant number of patients were hospitalized, and identifying the risk factors associated with severe disease in the Omicron era is critical for targeting further preventive, and curative interventions. We retrospectively analyzed the individual medical records of 1501 SARS-CoV-2 positive hospitalized patients between 13 December 2021, and 13 February 2022, in Belgium, of which 187 (12.5%) were infected with Delta, and 1036 (69.0%) with Omicron. Unvaccinated adults showed an increased risk of moderate/severe/critical/fatal COVID-19 (crude OR 1.54; 95% CI 1.09-2.16) compared to vaccinated patients, whether infected with Omicron or Delta. In adults infected with Omicron and moderate/severe/critical/fatal COVID-19 (n = 323), immunocompromised patients showed an increased risk of in-hospital mortality related to COVID-19 (adjusted OR 2.42; 95% CI 1.39-4.22), compared to non-immunocompromised patients. The upcoming impact of the pandemic will be defined by evolving viral variants, and the immune system status of the population. The observations support that, in the context of an intrinsically less virulent variant, vaccination and underlying patient immunity remain the main drivers of severe disease.
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Affiliation(s)
- Louis Nevejan
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- Correspondence: (L.N.); (L.C.); (E.A.)
| | - Sien Ombelet
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Lies Laenen
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Els Keyaerts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Thomas Demuyser
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium
| | - Lucie Seyler
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
| | - Oriane Soetens
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
| | - Els Van Nedervelde
- Department of Internal Medicine and Infectious Diseases, Vrije Universiteit Brussel (VUB), UZ Brussel—University Hospitals Brussels, 1090 Brussels, Belgium
| | - Reinout Naesens
- Department of Medical Microbiology, Department of infection prevention and control, ZNA Middelheim, 2020 Antwerp, Belgium
| | - Dieter Geysels
- Department of Medical Microbiology, Department of infection prevention and control, ZNA Middelheim, 2020 Antwerp, Belgium
| | - Walter Verstrepen
- Department of Medical Microbiology, Department of infection prevention and control, ZNA Middelheim, 2020 Antwerp, Belgium
| | - Lien Cattoir
- Clinical Laboratory of Microbiology, OLV Hospital, 9300 Aalst, Belgium
| | - Steven Martens
- Clinical Laboratory of Microbiology, OLV Hospital, 9300 Aalst, Belgium
| | - Charlotte Michel
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Elise Mathieu
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Marijke Reynders
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Anton Evenepoel
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Jorn Hellemans
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Merijn Vanhee
- Department of Laboratory Medicine—Medical Microbiology, AZ Sint Jan Brugge-Oostende, 8000 Brugge, Belgium
| | - Koen Magerman
- Clinical Laboratory, Jessa Hospital, 3500 Hasselt, Belgium
| | - Justine Maes
- Clinical Laboratory, Jessa Hospital, 3500 Hasselt, Belgium
| | - Veerle Matheeussen
- Department of Microbiology, University Hospital Antwerp, 2650 Antwerp, Belgium
| | - Hélène Boogaerts
- Department of Microbiology, University Hospital Antwerp, 2650 Antwerp, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
| | - Lize Cuypers
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
- Correspondence: (L.N.); (L.C.); (E.A.)
| | - Emmanuel André
- Department of Laboratory Medicine, National Reference Center for Respiratory Pathogens, UZ Leuven—University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Microbiology, 3000 Leuven, Belgium
- Correspondence: (L.N.); (L.C.); (E.A.)
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11
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Demuyser T, Seyler L, Buttiens R, Soetens O, Van Nedervelde E, Caljon B, Praet J, Seyler T, Boeckmans J, Meert J, Vanstokstraeten R, Martini H, Crombé F, Piérard D, Allard SD, Wybo I. Healthcare-Associated COVID-19 across Five Pandemic Waves: Prediction Models and Genomic Analyses. Viruses 2022; 14:v14102292. [PMID: 36298847 PMCID: PMC9607632 DOI: 10.3390/v14102292] [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: 07/29/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Healthcare-associated SARS-CoV-2 infections need to be explored further. Our study is an analysis of hospital-acquired infections (HAIs) and ambulatory healthcare workers (aHCWs) with SARS-CoV-2 across the pandemic in a Belgian university hospital. Methods: We compared HAIs with community-associated infections (CAIs) to identify the factors associated with having an HAI. We then performed a genomic cluster analysis of HAIs and aHCWs. We used this alongside the European Centre for Disease Control (ECDC) case source classifications of an HAI. Results: Between March 2020 and March 2022, 269 patients had an HAI. A lower BMI, a worse frailty index, lower C-reactive protein (CRP), and a higher thrombocyte count as well as death and length of stay were significantly associated with having an HAI. Using those variables to predict HAIs versus CAIs, we obtained a positive predictive value (PPV) of 83.6% and a negative predictive value (NPV) of 82.2%; the area under the ROC was 0.89. Genomic cluster analyses and representations on epicurves and minimal spanning trees delivered further insights into HAI dynamics across different pandemic waves. The genomic data were also compared with the clinical ECDC definitions for HAIs; we found that 90.0% of the ‘definite’, 87.8% of the ‘probable’, and 70.3% of the ‘indeterminate’ HAIs belonged to one of the twenty-two COVID-19 genomic clusters we identified. Conclusions: We propose a novel prediction model for HAIs. In addition, we show that the management of nosocomial outbreaks will benefit from genome sequencing analyses.
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Affiliation(s)
- Thomas Demuyser
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Correspondence: (T.D.); (L.S.); Tel.: +32-2474-9648 (T.D.)
| | - Lucie Seyler
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
- Correspondence: (T.D.); (L.S.); Tel.: +32-2474-9648 (T.D.)
| | - Rhea Buttiens
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Oriane Soetens
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Els Van Nedervelde
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ben Caljon
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jessy Praet
- bioMérieux, Data Analytics, Keistraat 120, 9830 St-Martens-Latem, Belgium
| | | | - Joost Boeckmans
- Department of In Vitro Toxicology and Dermato-Cosmetology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Clinical Laboratory, Jessa Hospital, Stadsomvaart 11, 3500 Hasselt, Belgium
| | - Jessy Meert
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
- Center for Neurosciences, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Robin Vanstokstraeten
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Helena Martini
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Florence Crombé
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Denis Piérard
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sabine D. Allard
- Department of Internal Medicine and Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Wybo
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
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12
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Debaenst N, Seyler L, Putman K, Van Den Borre I, Vanlauwe J. Outpatient parenteral antibiotic therapy for the treatment of prosthetic knee and hip infections in Belgium, a cost minimization analysis. Acta Clin Belg 2022; 77:10-17. [PMID: 32484406 DOI: 10.1080/17843286.2020.1772572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Prosthetic joint infections (PJI) are treated with prolonged periods of intravenous (IV) antibiotics combined with one or more appropriate surgical procedures. In Belgium, patients receive their IV treatments as inpatients, whereas in other parts of the world similar IV antibiotics can be given as outpatient parenteral antibiotic therapy (OPAT), without jeopardising patient outcomes. The purpose of this paper was to analyse the financial feasibility of OPAT for PJI in Belgium. METHODS Patients with PJI treated with a two-stage revision between January 2013 and June 2016 were selected for analysis of in-hospital costs. An OPAT cost simulation was made for comparable lengths of stay, for the different antimicrobial regimens used. A cost minimization analysis comparing the non-OPAT costs and the OPAT cost simulation was performed, with a sensitivity analysis accounting for cost uncertainties. RESULTS Based on the financial data of 12 two-stage revisions and 4 different antibiotic regimens, the average simulated cost difference for OPAT was €2.402 surplus for the patient, €-25.950 for health care and €-23.548 in total. CONCLUSION Projected cost savings for OPAT-treatment of PJI are substantial. However, OPAT within the current Belgian system was significantly more expensive for the patients. This can be attributed to the Belgian health insurance system; its current reimbursement regulations prevent OPAT from truly making a breakthrough in Belgium.
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Affiliation(s)
- Niels Debaenst
- Department of Orthopaedics, University Hospital Brussels, Brussels, Belgium
| | - Lucie Seyler
- Department of Infectious Diseases, University Hospital Brussels, Brussels, Belgium
| | - Koen Putman
- Department of Health Economics, Vrije Universiteit Brussels (VUB), Brussels, Belgium
| | | | - Johan Vanlauwe
- Department of Orthopaedics, University Hospital Brussels, Brussels, Belgium
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13
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Vermeersch S, Demeester RP, Ausselet N, Callens S, De Munter P, Florence E, Goffard JC, Henrard S, Lacor P, Messiaen P, Libois A, Seyler L, Uurlings F, Vandecasteele SJ, Van Wijngaerden E, Yombi JC, Annemans L, De Wit S. A public health value-based healthcare paradigm for HIV. BMC Health Serv Res 2022; 22:13. [PMID: 34974833 PMCID: PMC8722062 DOI: 10.1186/s12913-021-07371-7] [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: 06/25/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background HIV patients face considerable acute and chronic healthcare needs and battling the HIV epidemic remains of the utmost importance. By focusing on health outcomes in relation to the cost of care, value-based healthcare (VBHC) proposes a strategy to optimize quality of care and cost-efficiency. Its implementation may provide an answer to the increasing pressure to optimize spending in healthcare while improving patient outcomes. This paper describes a pragmatic value-based healthcare framework for HIV care. Methods A value-based HIV healthcare framework was developed during a series of roundtable discussions bringing together 16 clinical stakeholder representatives from the Belgian HIV reference centers and 2 VBHC specialists. Each round of discussions was focused on a central question translating a concept or idea to the next level of practical implementation: 1) how can VBHC principles be translated into value-based HIV care drivers; 2) how can these value-based HIV care divers be translated into value-based care objectives and activities; and 3) how can value-based HIV care objectives and activities be translated into value-based care indicators. Value drivers were linked to concrete objectives and activities using a logical framework approach. Finally, specific, measurable, and acceptable structure, process and outcomes indicators were defined to complement the framework. Results Our framework identifies 4 core value areas where HIV care would benefit most from improvements: Prevention, improvement of the cascade of care, providing patient-centered HIV care and sustaining a state-of-the-art HIV disease management context. These 4 core value areas were translated into 12 actionable core value objectives. For each objective, example activities were proposed. Indicators are suggested for each level of the framework (outcome indicators for value areas and objectives, process indicators for suggested activities). Conclusions This framework approach outlines how to define a patient- and public health centered value-based HIV care paradigm. It proposes how to translate core value drivers to practical objectives and activities and suggests defining indicators that can be used to track and improve the framework’s implementation in practice.
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Affiliation(s)
| | - Rémy P Demeester
- HIV Reference Centre, University Hospital of Charleroi, Charleroi, Belgium
| | | | - Steven Callens
- Department General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Paul De Munter
- Department of Microbiology Immunology, Transplantation and HIV Reference Centre, University Hospital Leuven, Leuven, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jean-Christophe Goffard
- HIV Reference Centre, Internal Medicine, C.U.B. Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sophie Henrard
- HIV Reference Centre, Internal Medicine, C.U.B. Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Patrick Lacor
- HIV Reference Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Agnès Libois
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Lucie Seyler
- HIV Reference Centre, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Françoise Uurlings
- HIV Reference Centre, Infectious Diseases Department, Liège University Hospital, Liege, Belgium
| | - Stefaan J Vandecasteele
- Department of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge Oostende AV, Brugge, Belgium
| | - Eric Van Wijngaerden
- Department of Microbiology Immunology, Transplantation and HIV Reference Centre, University Hospital Leuven, Leuven, Belgium
| | - Jean-Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Stéphane De Wit
- Division of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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14
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Van Laethem J, Wuyts S, Van Laere S, Koulalis J, Colman M, Moretti M, Seyler L, De Waele E, Pierard D, Lacor P, Allard SD. Antibiotic prescriptions in the context of suspected bacterial respiratory tract superinfections in the COVID-19 era: a retrospective quantitative analysis of antibiotic consumption and identification of antibiotic prescription drivers. Intern Emerg Med 2022; 17:141-151. [PMID: 34185257 PMCID: PMC8239323 DOI: 10.1007/s11739-021-02790-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/05/2021] [Indexed: 11/24/2022]
Abstract
This study aims to quantify antibiotic consumption for suspected respiratory tract superinfections in COVID-19 patients, while investigating the associated drivers of antibiotic prescribing in light of the current signs of antibiotic overuse. Adult patients with a positive COVID-19 diagnosis admitted to a Belgian 721-bed university hospital were analyzed retrospectively (March 11th-May 4th, 2020), excluding short-term admissions (< 24 h). Antibiotic prescriptions were analyzed and quantified, using Defined Daily Doses (DDD) per admission and per 100 bed days. Possible drivers of antibiotic prescribing were identified by means of mixed effects logistic modelling analysis with backwards selection. Of all included admissions (n = 429), 39% (n = 171) were prescribed antibiotics for (presumed) respiratory tract superinfection (3.6 DDD/admission; 31.5 DDD/100 bed days). Consumption of beta-lactamase inhibitor-penicillin combinations was the highest (2.55 DDD/admission; 23.3 DDD/100 bed days). Four drivers were identified: fever on admission (OR 2.97; 95% CI 1.42-6.22), lower SpO2/FiO2 ratio on admission (OR 0.96; 95% CI 0.92-0.99), underlying pulmonary disease (OR 3.04; 95% CI 1.12-8.27) and longer hospital stay (OR 1.09; 95% CI 1.03-1.16). We present detailed quantitative antibiotic data for presumed respiratory tract superinfections in hospitalized COVID-19 patients. In addition to knowledge on antibiotic consumption, we hope antimicrobial stewardship programs will be able to use the drivers identified in this study to optimize their interventions in COVID-19 wards.
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Affiliation(s)
- J Van Laethem
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium.
| | - S Wuyts
- Hospital Pharmacy, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Research Group Clinical Pharmacology and Pharmacotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - S Van Laere
- Interfaculty Centre Data Processing and Statistics, Vrije Universiteit Brussel, Brussels, Belgium
| | - J Koulalis
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Colman
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - M Moretti
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - L Seyler
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - E De Waele
- Intensive Care Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - D Pierard
- Microbiology Department, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - P Lacor
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
| | - S D Allard
- Department of Internal Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, B-1090, Brussels, Belgium
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15
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Luchian ML, Motoc AI, Lochy S, Magne J, Roosens B, Belsack D, Van Den Bussche K, Von Kemp B, Galloo X, Francois CE, Seyler L, Van Laethem J, Weytjens C, Droogmans S, Cosyns B. Troponin T in COVID-19 hospitalized patients: kinetics matter. Eur Heart J 2021. [PMCID: PMC8767608 DOI: 10.1093/eurheartj/ehab724.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic continues to overwhelm healthcare systems worldwide, due to high numbers of critical cases over a short period of time (1,2). Elevated cardiac troponin (cTn), suggestive for myocardial damage, was associated with increased mortality of COVID-19 patients (3,4). However, data addressing the role of cTn in major adverse cardiovascular events (MACE) in COVID-19 patients is scarce. Objectives We aimed to assess the role of baseline cTnT and cTnT kinetics in the prediction of MACE and in - hospital mortality in COVID-19 patients. Furthermore, we assessed the association between cTnT kinetics and the need of cardiac imaging evaluation. Methods 310 patients were included prospectively (age 64.6±16.7 years, 180 (58.1%) males), between March 2020 and April 2020. Clinical data including demographics,medical history,comorbidities,clinical evaluation,laboratory exams,in-hospital treatment,complications and outcomes were collected at admission and during hospitalization by physicians in charge. Two hundred and two patients (65.1%) with at least two cTnT values assessed during hospitalization, at 24–48 hours interval were included in the final analysis. cTnT-values >0.011 micrograms/L were considered elevated, according to hospital laboratory cut-offs. Patients were divided into 3 groups according to cTnT kinetics profile: 1 – variable, 2 – descending and 3 – constant. cTnT slope was defined as the ratio of the cTnT change and the change in time. MACE were considered as the primary endpoint and were composed by all-cause mortality, acute heart failure, acute coronary syndrome, pericarditis, myocarditis, atrial fibrillation or flutter and pulmonary embolism. In-hospital mortality was considered as the secondary endpoint. Results Mean hospitalization was 13.9±0.9 days. MACE occurred in 60 patients (29.7%) and in-hospital mortality in 40 (19.8%) patients. Baseline cTnT independently predicted MACE, (p=0.047, HR 1.805, 95% CI 1.009–3.231) and in-hospital mortality (p=0.009, HR 2.322, 95% CI 1.234–4.369) (Figure 1A, 1B). An increased cTnT slope independently predicted in-hospital mortality (p=0.041, HR 1.006, 95% CI 1.000–1.011). Constant cTnT was associated with lower MACE and mortality rates (p=0,000, HR 3.080, 95% CI, 1.914–4.954, p=0.000, HR 2.851. 95% CI 1.828–4.447, respectively) (Figure 1C, 1D, 2). Cardiac imaging evaluation was performed in 8 (16%) patients with constant cTnT, 30 (60%) with variable cTnT, and 12 (24%) with descending cTnT.(p<0.001) Conclusions Increased baseline cTnT independently predicted MACE and in-hospital mortality in COVID-19 patients. The magnitude of cTnT increase over time was associated with in-hospital mortality. On the contrary, patients with constant cTnT had lower MACE and in-hospital mortality rates. These finding emphasize the additional role of cTnT testing in COVID-19 patients for risk stratification and improved diagnostic pathway and management Funding Acknowledgement Type of funding sources: None.
Figure 1. Kaplan Meier for MACE and mortality ![]() Figure 2. Troponin kinetics as MACE predictors ![]()
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Affiliation(s)
- M L Luchian
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - A I Motoc
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - S Lochy
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - J Magne
- Dupuytren University Hospital Centre Limoges, Limoges, France
| | - B Roosens
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - D Belsack
- University Hospital (UZ) Brussels, Brussels, Belgium
| | | | - B Von Kemp
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - X Galloo
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - C E Francois
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - L Seyler
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - J Van Laethem
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - C Weytjens
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - S Droogmans
- University Hospital (UZ) Brussels, Brussels, Belgium
| | - B Cosyns
- University Hospital (UZ) Brussels, Brussels, Belgium
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16
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Luchian ML, Motoc AI, Lochy S, Magne J, Roosens B, Belsack D, Van den Bussche K, von Kemp B, Galloo X, François C, Scheirlynck E, Boeckstaens S, De Potter T, Seyler L, van Laethem J, Hennebicq S, Weytjens C, Droogmans S, Cosyns B. Troponin T in COVID-19 hospitalized patients: Kinetics matter. Cardiol J 2021; 28:807-815. [PMID: 34581431 PMCID: PMC8747831 DOI: 10.5603/cj.a2021.0104] [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: 06/18/2021] [Revised: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) emerged as a worldwide health crisis, overwhelming healthcare systems. Elevated cardiac troponin T (cTn T) at admission was associated with increased in-hospital mortality. However, data addressing the role of cTn T in major adverse cardiovascular events (MACE) in COVID-19 are scarce. Therefore, we assessed the role of baseline cTn T and cTn T kinetics for MACE and in-hospital mortality prediction in COVID-19. METHODS Three hundred and ten patients were included prospectively. One hundred and eight patients were excluded due to incomplete records. Patients were divided into three groups according to cTn T kinetics: ascending, descending, and constant. The cTn T slope was defined as the ratio of the cTn T change over time. The primary and secondary endpoints were MACE and in-hospital mortality. RESULTS Two hundred and two patients were included in the analysis (mean age 64.4 ± 16.7 years, 119 [58.9%] males). Mean duration of hospitalization was 14.0 ± 12.3 days. Sixty (29.7%) patients had MACE, and 40 (19.8%) patients died. Baseline cTn T predicted both endpoints (p = 0.047, hazard ratio [HR] 1.805, 95% confidence interval [CI] 1.009-3.231; p = 0.009, HR 2.322, 95% CI 1.234-4.369). Increased cTn T slope predicted mortality (p = 0.041, HR 1.006, 95% CI 1.000-1.011). Constant cTn T was associated with lower MACE and mortality (p = 0.000, HR 3.080, 95% CI 1.914-4.954, p = 0.000, HR 2.851, 95% CI 1.828-4.447). CONCLUSIONS The present study emphasizes the additional role of cTn T testing in COVID-19 patients for risk stratification and improved diagnostic pathway and management.
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Affiliation(s)
| | | | - Stijn Lochy
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Julien Magne
- b. CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, France
| | - Bram Roosens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Dries Belsack
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | | | - Berlinde von Kemp
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Xavier Galloo
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Clara François
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Esther Scheirlynck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Sven Boeckstaens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Tom De Potter
- Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, 1090 Brussel, Belgium
| | - Lucie Seyler
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Johan van Laethem
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | | | - Caroline Weytjens
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Steven Droogmans
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
| | - Bernard Cosyns
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Belgium
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17
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Devos T, Van Thillo Q, Compernolle V, Najdovski T, Romano M, Dauby N, Jadot L, Leys M, Maillart E, Loof S, Seyler L, Moonen M, Moutschen M, Van Regenmortel N, Ariën KK, Barbezange C, Betrains A, Garigliany M, Engelen MM, Gyselinck I, Maes P, Schauwvlieghe A, Liesenborghs L, Belmans A, Verhamme P, Meyfroidt G. Early high antibody-titre convalescent plasma for hospitalised COVID-19 patients: DAWn-plasma. Eur Respir J 2021; 59:13993003.01724-2021. [PMID: 34446469 PMCID: PMC8576805 DOI: 10.1183/13993003.01724-2021] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 06/17/2021] [Accepted: 07/24/2021] [Indexed: 12/15/2022]
Abstract
Background Several randomised clinical trials have studied convalescent plasma for coronavirus disease 2019 (COVID-19) using different protocols, with different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralising antibody titres, at different time-points and severities of illness. Methods In the prospective multicentre DAWn-plasma trial, adult patients hospitalised with COVID-19 were randomised to 4 units of open-label convalescent plasma combined with standard of care (intervention group) or standard of care alone (control group). Plasma from donors with neutralising antibody titres (50% neutralisation titre (NT50)) ≥1/320 was the product of choice for the study. Results Between 2 May 2020 and 26 January 2021, 320 patients were randomised to convalescent plasma and 163 patients to the control group according to a 2:1 allocation scheme. A median (interquartile range) volume of 884 (806–906) mL) convalescent plasma was administered and 80.68% of the units came from donors with neutralising antibody titres (NT50) ≥1/320. Median time from onset of symptoms to randomisation was 7 days. The proportion of patients alive and free of mechanical ventilation on day 15 was not different between both groups (convalescent plasma 83.74% (n=267) versus control 84.05% (n=137)) (OR 0.99, 95% CI 0.59–1.66; p=0.9772). The intervention did not change the natural course of antibody titres. The number of serious or severe adverse events was similar in both study arms and transfusion-related side-effects were reported in 19 out of 320 patients in the intervention group (5.94%). Conclusions Transfusion of 4 units of convalescent plasma with high neutralising antibody titres early in hospitalised COVID-19 patients did not result in a significant improvement of clinical status or reduced mortality. Early transfusion of 4 units of high neutralising antibody titre convalescent plasma in hospitalised COVID-19 patients does not reduce mortality or the need for mechanical ventilationhttps://bit.ly/3fiRY2I
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Affiliation(s)
- Timothy Devos
- Department of Hematology, University Hospitals Leuven and Department of Microbiology and Immunology, Laboratory of Molecular Immunology (Rega Institute), KU Leuven, Leuven, Belgium
| | - Quentin Van Thillo
- Center for Cancer Biology, Vlaams Instituut voor Biotechnologie (VIB), Leuven and Center for Human Genetics, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Belgian Red Cross, Blood Services, Mechelen, Belgium. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Marta Romano
- Immune Response Service; Infectious Diseases in Humans Scientific Directorate, Sciensano, Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Universite Libre de Bruxelles (ULB), School of Public Health, Universite Libre de Bruxelles (ULB), Institute for Medical Immunology, Universite Libre de Bruxelles (ULB), Belgium
| | - Laurent Jadot
- Department of Anesthesiology and Intensive Care Medicine, and Department of Infectious diseases, CHC Mont Legia, Liege, Belgium
| | - Mathias Leys
- Department of Pulmonary Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Evelyne Maillart
- Department of Infectious Diseases, Brugmann University Hospital, Brussels, Belgium
| | - Sarah Loof
- Department of Respiratory Medicine, AZ Maria Middelares Gent, Ghent, Belgium. Department of Respiratory Medicine, AZ Sint-Vincentius Deinze, Deinze, Belgium
| | - Lucie Seyler
- Department of Infectious Diseases and Internal Medicine, UZ Brussel Hospital, Brussels, Belgium
| | - Martial Moonen
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Regional (CHR), Liege, Belgium
| | - Michel Moutschen
- Infectious Diseases and General Internal Medicine, CHU de Liege, ULiege, Belgium
| | - Niels Van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Antwerp, Belgium
| | - Kevin K Ariën
- Virology Unit, Institute of Tropical Medicine Antwerp, Antwerp and Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, Leuven and Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Mutien Garigliany
- University of Liege, Faculty of Veterinary Medicine, Animal Pathology, Liege, Belgium
| | | | - Iwein Gyselinck
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Respiratory Diseases UZ Leuven, Leuven, Belgium
| | - Piet Maes
- KU Leuven, Rega Institute for Medical Research, Clinical and Epidemiological Virology, Leuven, Belgium
| | | | - Laurens Liesenborghs
- Laboratory of Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ann Belmans
- I-BioStat, KU Leuven, Leuven, Belgium and University Hasselt, Hasselt, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, UZ and KU Leuven, Belgium
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, and Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
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18
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Devos T, Geukens T, Schauwvlieghe A, Ariën KK, Barbezange C, Cleeren M, Compernolle V, Dauby N, Desmecht D, Grimaldi D, Lambrecht BN, Luyten A, Maes P, Moutschen M, Romano M, Seyler L, Nevessignsky MT, Vandenberghe K, van Griensven J, Verbeke G, Vlieghe E, Yombi JC, Liesenborghs L, Verhamme P, Meyfroidt G. Correction to: A randomized, multicentre, open-label phase II proof-of-concept trial investigating the clinical efficacy and safety of the addition of convalescent plasma to the standard of care in patients hospitalized with COVID-19: the Donated Antibodies Working against nCoV (DAWn-Plasma) trial. Trials 2020; 21:1024. [PMID: 33317581 PMCID: PMC7734912 DOI: 10.1186/s13063-020-04947-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Timothy Devos
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium. .,Catholic University of Leuven (KU Leuven), Leuven, Belgium.
| | - Tatjana Geukens
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium.,Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | | | - Kevin K Ariën
- Instituut voor Tropische Geneeskunde, Antwerp, Belgium
| | | | - Myriam Cleeren
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium
| | | | - Nicolas Dauby
- Universite Libre de Bruxelles Institut d 'Immunologie Medicale, Bruxelles, Belgium
| | | | | | | | | | - Piet Maes
- Katholieke Universiteit Leuven Rega Institute for Medical Research, Leuven, Belgium
| | | | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Bruxelles, Belgium
| | | | | | | | - Geert Verbeke
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Leuven, Belgium
| | - Erika Vlieghe
- Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Jean Cyr Yombi
- Cliniques Universitaires Saint-Luc, Sint-Lambrechts-Woluwe, Belgium
| | - Laurens Liesenborghs
- Katholieke Universiteit Leuven Rega Institute for Medical Research, Leuven, Belgium
| | - Peter Verhamme
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium
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19
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Devos T, Geukens T, Schauwvlieghe A, Ariën KK, Barbezange C, Cleeren M, Compernolle V, Dauby N, Desmecht D, Grimaldi D, Lambrecht BN, Luyten A, Maes P, Moutschen M, Romano M, Seyler L, Nevessignsky MT, Vandenberghe K, van Griensven J, Verbeke G, Vlieghe E, Yombi JC, Liesenborghs L, Verhamme P, Meyfroidt G. A randomized, multicentre, open-label phase II proof-of-concept trial investigating the clinical efficacy and safety of the addition of convalescent plasma to the standard of care in patients hospitalized with COVID-19: the Donated Antibodies Working against nCoV (DAWn-Plasma) trial. Trials 2020; 21:981. [PMID: 33246499 PMCID: PMC7691949 DOI: 10.1186/s13063-020-04876-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has imposed an enormous burden on health care systems around the world. In the past, the administration of convalescent plasma of patients having recovered from SARS and severe influenza to patients actively having the disease showed promising effects on mortality and appeared safe. Whether or not this also holds true for the novel SARS-CoV-2 virus is currently unknown. METHODS DAWn-Plasma is a multicentre nation-wide, randomized, open-label, phase II proof-of-concept clinical trial, evaluating the clinical efficacy and safety of the addition of convalescent plasma to the standard of care in patients hospitalized with COVID-19 in Belgium. Patients hospitalized with a confirmed diagnosis of COVID-19 are eligible when they are symptomatic (i.e. clinical or radiological signs) and have been diagnosed with COVID-19 in the 72 h before study inclusion through a PCR (nasal/nasopharyngeal swab or bronchoalveolar lavage) or a chest-CT scan showing features compatible with COVID-19 in the absence of an alternative diagnosis. Patients are randomized in a 2:1 ratio to either standard of care and convalescent plasma (active treatment group) or standard of care only. The active treatment group receives 2 units of 200 to 250 mL of convalescent plasma within 12 h after randomization, with a second administration of 2 units 24 to 36 h after ending the first administration. The trial aims to include 483 patients and will recruit from 25 centres across Belgium. The primary endpoint is the proportion of patients that require mechanical ventilation or have died at day 15. The main secondary endpoints are clinical status on day 15 and day 30 after randomization, as defined by the WHO Progression 10-point ordinal scale, and safety of the administration of convalescent plasma. DISCUSSION This trial will either provide support or discourage the use of convalescent plasma as an early intervention for the treatment of hospitalized patients with COVID-19 infection. TRIAL REGISTRATION ClinicalTrials.gov NCT04429854 . Registered on 12 June 2020 - Retrospectively registered.
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Affiliation(s)
- Timothy Devos
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium.
- Catholic University of Leuven (KU Leuven), Leuven, Belgium.
| | - Tatjana Geukens
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium
- Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | | | - Kevin K Ariën
- Instituut voor Tropische Geneeskunde, Antwerp, Belgium
| | | | - Myriam Cleeren
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium
| | | | - Nicolas Dauby
- Universite Libre de Bruxelles Institut d'Immunologie Medicale, Bruxelles, Belgium
| | | | | | | | | | - Piet Maes
- Katholieke Universiteit Leuven Rega Institute for Medical Research, Leuven, Belgium
| | | | | | - Lucie Seyler
- Universitair Ziekenhuis Brussel, Bruxelles, Belgium
| | | | | | | | - Geert Verbeke
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Leuven, Belgium
| | - Erika Vlieghe
- Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Jean Cyr Yombi
- Cliniques Universitaires Saint-Luc, Sint-Lambrechts-Woluwe, Belgium
| | - Laurens Liesenborghs
- Katholieke Universiteit Leuven Rega Institute for Medical Research, Leuven, Belgium
| | - Peter Verhamme
- University Hospitals Leuven (UZ Leuven), Leuven, Belgium
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Bendinger A, Seyler L, Saager M, Debus C, Peschke P, Komljenovic D, Debus J, Peter J, Floca R, Karger C, Glowa C. PH-0476: Impact of single dose photon or 12C-ion irradiation on rat prostate tumors assessed by DCE-MRI. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00498-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
In this review of the current challenges in the fight against HIV, we describe the state of the HIV epidemic and the framework put in place using the 90-90-90 objectives to try and curb the epidemic worldwide. There are numerous effective and evidence-based prevention measures against the spread of HIV, but the biggest challenges lie in the lack of political commitment, reluctance to address issues of sexuality and reproduction, and criminalization of key populations that are at the highest risk of HIV. Access to HIV treatment and continued care without stigmatization should be as easy and cheap as possible for those who are tested and diagnosed with HIV to achieve the best results worldwide. Regarding the treatment of HIV, the last decades have been very successful in dramatically improving the quality of life of people living with HIV, reducing the transmission rate and decreasing HIV-associated morbidity and mortality. It could even be argued that the next milestone will be a strategy that allows individuals to stop combination antiretroviral therapy safely before a cure is discovered. Despite great progress, people with HIV have shorter life expectancy than those without the virus, and the underlying causes are probably multifactorial, including premature aging, drug toxicities, and comorbidities. Even if challenges remain, hope should too, with the ultimate goal to end the HIV epidemic.
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Seyler L, Henrard S, Goffard JC. [HIV-associated haematological complications]. Rev Med Brux 2018; 39:307-311. [PMID: 30320993] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite recent advances in combined anti- retroviral therapy that have profoundly changed the prognosis of HIV infection, HIV-associated haematological complications remains frequent whatever the stage of the disease. Some types of lymphoma observed a dramatic reduction in their incidences but others such as diffuse B-cell lymphoma and Hodkin lymphoma remain as frequent as before the CART era. Treatments for lymphoma are nowadays not different for people living with HIV than for others. Other non- neoplastic diseases such as immune thrombo- penic purpura, thrombotic microangiopathies and hemophagocytic lymphohistiocytosis are still associated with HIV infection and will be discussed.
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Affiliation(s)
- L Seyler
- Interne Geneeskunde, UZ Brussels
| | - S Henrard
- Service de Médecine interne, Hôpital Erasme, ULB
| | - J C Goffard
- Service de Médecine interne, Hôpital Erasme, ULB
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Yombi JC, Seyler L, Cornu O, Barbier O, Libouton X, Rodriguez-Villalobos H, Thienpont E. Difficult to treat osteoarticulars infections : Focus on Mycobacterial and Fungal infection. Acta Orthop Belg 2017; 83:110-123. [PMID: 29322903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Bone and joint infections are rare but often devastating. While bacteria are most commonly encountered organisms, mycobacteria and fungi are less frequent. Management of the latter is often more complex, especially in the presence of foreign material. We will increasingly be faced with mycobacterial and fungal bone infections, as medical conditions and newer therapeutics lead to more immunosuppression. In this article, we will review osteomyelitis, septic arthritis and peri-prosthetic joint infections related to mycobacteria and fungi.
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Carlier M, Taccone FS, Beumier M, Seyler L, Cotton F, Jacobs F, Roberts JA. Population pharmacokinetics and dosing simulations of cefepime in septic shock patients receiving continuous renal replacement therapy. Int J Antimicrob Agents 2015. [PMID: 26208469 DOI: 10.1016/j.ijantimicag.2015.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The aim of this study was to describe the population pharmacokinetics of cefepime in septic shock patients requiring continuous renal replacement therapy and to determine whether current or alternative dosing regimens can achieve PK/PD targets. In this observational PK study, 62 samples from 13 patients were analysed using non-linear mixed-effects modelling. Different dosing regimens were evaluated using Monte Carlo simulations with ultrafiltration flow rates (UFRs) of 1000, 1500 and 2000 mL/h. The probability of target attainment was calculated against a conservative (60% T(>MIC)) and a higher PK/PD target (100% T(>MIC)) against an MIC of 8 mg/L, the clinical susceptibility breakpoint for Pseudomonas aeruginosa. A one-compartment model with between-subject variability (BSV) on clearance and volume of distribution (V(d)) described the data adequately. UFR was supported as a covariate on both parameters. Typical values for clearance and V(d) were 4.4L/h (BSV 37%) and 40.9L (BSV 20%), respectively. Dosing simulations showed failure to achieve both a conservative and a higher PK/PD target using a dose of 1g q12h for patients treated with a high UFR (≥1500 mL/h). The dose of 2g q8h or 1g q6h leads to optimal target attainment for high UFR. One gram q8h is optimal for low UFR (≤1000 mL/h). We found important variability in PK parameters. Dosing simulations show that a dose of 2g q8h or 1g q6h is needed to ensure rapid achievement of adequate levels if the UFR is ≥1500 mL/h and 1g q8h for low UFR (≤1000 mL/h).
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Affiliation(s)
- Mieke Carlier
- Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium; Department of Critical Care, Ghent University, Ghent, Belgium.
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Majorie Beumier
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lucie Seyler
- Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Frédéric Cotton
- Department of Clinical Chemistry, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Frédérique Jacobs
- Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jason A Roberts
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Herston, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland, Australia; Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Mertens R, Allard S, Seyler L, Jochmans K, Lacor P. Haemophagocytic Syndrome in a 19-Year-Old Male with Plasmodium falciparum Malaria. Eur J Case Rep Intern Med 2014. [DOI: 10.12890/2014_000073] [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: 11/05/2022] Open
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Beumier M, Casu GS, Hites M, Seyler L, Cotton F, Vincent JL, Jacobs F, Taccone FS. β-lactam antibiotic concentrations during continuous renal replacement therapy. Crit Care 2014; 18:R105. [PMID: 24886826 PMCID: PMC4075122 DOI: 10.1186/cc13886] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 05/07/2014] [Indexed: 01/05/2023]
Abstract
Introduction The use of standard doses of β-lactam antibiotics during continuous renal replacement therapy (CRRT) may result in inadequate serum concentrations. The aim of this study was to evaluate the adequacy of unadjusted drug regimens (i.e., similar to those used in patients with normal renal function) in patients treated with CRRT and the influence of CRRT intensity on drug clearance. Methods We reviewed data from 50 consecutive adult patients admitted to our Department of Intensive Care in whom routine therapeutic drug monitoring (TDM) of broad-spectrum β-lactam antibiotics (ceftazidime or cefepime, CEF; piperacillin/tazobactam; TZP; meropenem, MEM) was performed using unadjusted β-lactam antibiotics regimens (CEF = 2 g q8h; TZP = 4 g q6h; MEM = 1 g q8h). Serum drug concentrations were measured twice during the elimination phase by high-performance liquid chromatography (HPLC-UV). We considered therapy was adequate when serum drug concentrations were between 4 and 8 times the minimal inhibitory concentration (MIC) of Pseudomonas aeruginosa during optimal periods of time for each drug (≥70% for CEF; ≥ 50% for TZP; ≥ 40% for MEM). Therapy was considered as early (ET) or late (LT) phase if TDM was performed within 48 hours of antibiotic initiation or later on, respectively. Results We collected 73 serum samples from 50 patients (age 58 ± 13 years; Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission 21 (17–25)), 35 during ET and 38 during LT. Drug concentrations were above 4 times the MIC in 63 (90%), but above 8 times the MIC in 39 (53%) samples. The proportions of patients with adequate drug concentrations during ET and LT were quite similar. We found a weak but significant correlation between β-lactam antibiotics clearance and CRRT intensity. Conclusions In septic patients undergoing CRRT, doses of β-lactam antibiotics similar to those given to patients with normal renal function achieved drug levels above the target threshold in 90% of samples. Nevertheless, 53% of samples were associated with very high drug levels and daily drug regimens may need to be adapted accordingly.
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Bäuerle T, Seyler L, Münter M, Jensen A, Brand K, Fritzsche K, Kopp-Schneider A, Schüssler M, Schlemmer HP, Stieltjes B, Ganten M. Korrelation zwischen Parametern der diffusionsgewichteten Bildgebung des Rektumkarzinoms und der Histologie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bäuerle T, Seyler L, Alt V, Cao L, Schnettler R, Semmler W, Liu Y. Erfassung von Osteogenese und Angiogenese während der Knochendefektheilung in einem Rattenmodell der Osteoporose mittels VCT und MRT. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Van Beckhoven D, Buvé A, Ruelle J, Seyler L, Sasse A. A national cohort of HIV-infected patients in Belgium: design and main characteristics. Acta Clin Belg 2013. [PMID: 23189540 DOI: 10.2143/acb.67.5.2062686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In Belgium, individual laboratory and treatment data of all HIV-infected patients seen in the 9 AIDS Reference Centres and 7 AIDS Reference Laboratories are collected prospectively since 2006. We present here an analysis of patients recorded in the cohort database between 1st of January 2006 and 31st of December 2008. During that period, 11982 patients were under medical follow-up in Belgium. Sixty-one percent of the patients were male and the median age was 39.8 at the time of first recorded viral load. Among the patients whose nationality or probable mode of transmission was recorded, nearly half (48.0%) were Belgian and 38.3% originated from Sub-Saharan Africa; heterosexual contacts were reported in the majority of cases (56.0%) followed by homosexual contacts (35.3%). A total of 145 deaths were reported. Around three quarters of the patients were on ART. The median CD4 cell count rose from 470 cells/mm3 in 2006 to 501 cells/mm3 in 2008. This cohort enabled us to obtain comprehensive information on the numbers and characteristics of HIV-infected patients currently being followed up in Belgium, and on trends in antiretroviral therapy and biological results. This will serve for planning purposes, evaluation of access to care and as a source of information for further studies.
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Affiliation(s)
- D Van Beckhoven
- O.D. Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.
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Bäuerle T, Seyler L, Münter M, Jensen A, Brand K, Fritzsche KH, Kopp-Schneider A, Schüssler M, Schlemmer HP, Stieltjes B, Ganten M. Diffusion-weighted imaging in rectal carcinoma patients without and after chemoradiotherapy: a comparative study with histology. Eur J Radiol 2012; 82:444-52. [PMID: 23219191 DOI: 10.1016/j.ejrad.2012.10.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/16/2012] [Accepted: 10/22/2012] [Indexed: 02/07/2023]
Abstract
Diffusion-weighted imaging (DWI) can be used to quantitatively assess functional parameters in rectal carcinoma that are relevant for prognosis and treatment response assessment. However, there is no consensus on the histopathological background underlying the findings derived from DWI. The aim of this study was to perform a comparison of DWI and histologic parameters in two groups of rectal carcinoma patients without (n=12) and after (n=9) neoadjuvant chemoradiotherapy (CRT). The intravoxel incoherent motion (IVIM) model was used to calculate the diffusion coefficient D and the perfusion fraction f in rectal carcinoma, the adjacent rectum and fat in the two patient groups. Immunohistological analysis was performed to assess the cellularity, vascular area fraction and vessel diameter for comparison and correlation. Out of 36 correlations between parameters from DWI and histology, four were found to be significant. In rectal carcinoma of patients without CRT, the diffusion D and the perfusion f correlated with the vascular area fraction, respectively, which could not be found in the group of patients who received CRT. Further correlations were found for the rectum and fat. Histological evaluation revealed significant differences between the tissues on the microscopic level concerning the cellular and vascular environment that influence diffusion and perfusion. In conclusion, DWI produces valuable biomarkers for diffusion and perfusion in rectal carcinoma and adjacent tissues that are highly dependent of the underlying cellular microenvironment influenced by structural and functional changes as well as the administered treatment, and consequently can be beyond histological ascertainability.
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Affiliation(s)
- T Bäuerle
- Department of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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Wolff F, Deprez G, Seyler L, Taccone F, Hites M, Gulbis B, Vincent JL, Jacobs F, Cotton F. Rapid quantification of six β-lactams to optimize dosage regimens in severely septic patients. Talanta 2012. [PMID: 23200371 DOI: 10.1016/j.talanta.2012.10.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A fast analytical procedure was developed for the simultaneous quantification of cefepime (CEF), meropenem (MEM), ceftazidime (CZA), cefuroxime (CFX), aztreonam (AZT), and piperacillin (PIP) in serum of intensive care patients. The β-lactam pharmacokinetic parameters can be altered in severe sepsis due to changes in the distribution, the metabolism and the elimination process. Therapeutic drug monitoring (TDM) of β-lactams is therefore recommended in critically ill patients. The plasma samples were spiked with cefoperazone as internal standard and proteins were precipitated with methanol. The different β-lactams were separated with high performance liquid chromatography within 18 min, and quantified by UV spectrophotometry with a diode array detector. The method was validated by means of the accuracy profile approach based on β expectation tolerance intervals. The acceptance limits were settled at ± 30% according to the regulatory requirements. Assay validation demonstrated good performance for all β-lactams analyzed in terms of trueness, repeatability, linearity and intermediate precision over the range of 2-200 μg/mL. The simple extraction procedure provides respective absolute and relative recoveries ranging from 70% to 86% and from 66% to 89% for all the β-lactams analyzed. Few interferences were observed and the method was easily applicable to TDM in intensive care patients. The quantification of β-lactams should allow for antibiotic regimen adjustment in critically ill patients.
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Affiliation(s)
- Fleur Wolff
- Laboratory of Clinical Chemistry, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
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Abstract
Community associated methicillin resistant Staphylococcus aureus (CA-MRSA) is an emergent infectious pathogen that might become an important public-health problem. Indeed, unique strains of S. aureus that combine specific virulence factors with resistance against frequently used antibiotics have been associated with severe community acquired infections in otherwise healthy and often younger people. This is especially the case in the USA, were these strains now represent a major part of staphylococcal infections in the outpatient setting. But, severe infections with CA-MRSA strains have already been reported in Belgium as well. This article summarizes the current knowledge on CA-MRSA as an emergent pathogen and discusses its clinical management.
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Affiliation(s)
- R Mertens
- Department of Internal Medicine, Infectious Diseases Unit, UZ Brussel, Belgium
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Dauby N, Fink W, Seyler L, Luce S, Nouwynck C, Tas S, Jacobs F. Probable hypersensitivity reaction to vancomycin associating rash, fever and neutropenia. Acta Clin Belg 2012; 67:226-228. [PMID: 22897075 DOI: 10.2143/acb.67.3.2062662] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We describe the case of a 54-year old woman with breast cancer who was treated by vancomycin for febrile neutropenia due to a methicillin-resistant Staphyloccocus epidermidis infection of a surgically implanted catheter. She developed an hypersensitivity reaction to vancomycin associating neutropenia, fever, skin rash and elevated liver enzymes following re-challenge with vancomycin after having been misdiagnosed with septic thrombophlebitis. Following this re-challenge, neutrophils count fell dramatically but promptly resolved after cessation of vancomycin.
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Affiliation(s)
- N Dauby
- Oncology Clinic,Erasme University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Liu Y, Seyler L, Heiss C, Schnettler R, Schlewitz G, Semmler W, Bäuerle T. Quantitative Erfassung von Mikrozirkulation und Diffusion mittels DCE-MRT und DWI im Knochenmark osteoporotischer Ratten. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Seyler L, Cotton F, Taccone FS, De Backer D, Macours P, Vincent JL, Jacobs F. Recommended β-lactam regimens are inadequate in septic patients treated with continuous renal replacement therapy. Crit Care 2011; 15:R137. [PMID: 21649882 PMCID: PMC3219006 DOI: 10.1186/cc10257] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/01/2011] [Accepted: 06/06/2011] [Indexed: 12/25/2022]
Abstract
Introduction Sepsis is responsible for important alterations in the pharmacokinetics of antibiotics. Continuous renal replacement therapy (CRRT), which is commonly used in septic patients, may further contribute to pharmacokinetic changes. Current recommendations for antibiotic doses during CRRT combine data obtained from heterogeneous patient populations in which different CRRT devices and techniques have been used. We studied whether these recommendations met optimal pharmacokinetic criteria for broad-spectrum antibiotic levels in septic shock patients undergoing CRRT. Methods This open, prospective study enrolled consecutive patients treated with CRRT and receiving either meropenem (MEM), piperacillin-tazobactam (TZP), cefepime (FEP) or ceftazidime (CAZ). Serum concentrations of these antibiotics were determined by high-performance liquid chromatography from samples taken before (t = 0) and 1, 2, 5, and 6 or 12 hours (depending on the β-lactam regimen) after the administration of each antibiotic. Series of measurements were separated into those taken during the early phase (< 48 hours from the first dose) of therapy and those taken later (> 48 hours). Results A total of 69 series of serum samples were obtained in 53 patients (MEM, n = 17; TZP, n = 16; FEP, n = 8; CAZ, n = 12). Serum concentrations remained above four times the minimal inhibitory concentration for Pseudomonas spp. for the recommended time in 81% of patients treated with MEM, in 71% with TZP, in 53% with CAZ and in 0% with FEP. Accumulation after 48 hours of treatment was significant only for MEM. Conclusions In septic patients receiving CRRT, recommended doses of β-lactams for Pseudomonas aeruginosa are adequate for MEM but not for TZP, FEP and CAZ; for these latter drugs, higher doses and/or extended infusions should be used to optimise serum concentrations.
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Affiliation(s)
- Lucie Seyler
- Department of Infectious Diseases, Erasme Hospital, Université Libre de Bruxelles, route de Lennik 808, Brussels, Belgium
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Seyler L, Lalvani A, Collins L, Goddard L, Bowler ICJW. Safety and cost savings of an improved three-day rule for stool culture in hospitalised children and adults. J Hosp Infect 2007; 67:121-6. [PMID: 17900758 DOI: 10.1016/j.jhin.2007.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 08/14/2006] [Accepted: 07/13/2007] [Indexed: 11/22/2022]
Abstract
Stools sent for culture from patients after three days of hospitalisation have a low yield (<1%) for bacterial enteric pathogens (BEP), excluding Clostridium difficile, and are expensive to process. A 'three-day rule' for rejection of specimens has previously been validated in adults. We evaluated a three-day rule for paediatric stool samples by retrospective review of all stool culture results from 1995 to 2002. Excluding C. difficile, yield for BEP in samples sent within three days following admission was 97/3751 (2.59%) compared with 3/1511 (0.2%) in samples sent more than three days after admission. The criteria for culture would have been met if the rule had been applied for these three samples. We prospectively evaluated potential savings if the rule were applied for both children and adults over a two-month period in 2000. Savings were greater for adults than for children. Of 490 stools from children, 38 (7.8%) samples did not meet the criteria for culture and of 206 stools from adult patients, 64 (31%) did not meet the criteria for culture. We implemented the rule between 1 March 2003 and 31 March 2006. A total of 14 439 stool samples were received from inpatients requesting culture for BEP, excluding C. difficile. Of these, 5744 (39.8%) were rejected because the criteria for culture were not met. This was estimated as an annual saving of 11,848 pounds to the Trust laboratory. If extrapolated to all NHS Trusts, the potential savings could be in the order of 1.18 million pounds annually.
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Affiliation(s)
- L Seyler
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
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Basilio CM, Seyler L, Bernstein J, Castro de la Mata R. Isolation and characterization of an utero-active compound from Agave americana. P R Health Sci J 1989; 8:295-9. [PMID: 2640501] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Crude extracts of Agave americana contain two utero-active compounds. One of these, tentatively named "Fraction B", has been purified to chromatographic homogeneity. Its pharmacological actions are similar to those of acetylcholine. However its chromatographic and electrophoretic mobilities are different. Some chemical properties of fraction B are compatible with the structure of an acyl derivative of choline different from acetylcholine.
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Affiliation(s)
- C M Basilio
- University of Puerto Rico, School of Medicine, Department of Biochemistry, San Juan 00936
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Rieber M, Seyler L. Growth inhibition of mouse mammary tumor cells by dexamethasone concurrent with enhanced endogenous protein phosphorylation: effects of retinoic acid. Cell Biol Int Rep 1980; 4:1075-9. [PMID: 7460021 DOI: 10.1016/0309-1651(80)90044-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Exposure of Mm 5mt mouse mammary tumor cells to either dexamethasone, retinoic acid or both drugs, results in growth inhibition of the cultures, as compared with controls. Endogenous protein phosphorylation using gamma-32P ATP revealed prominent labelling mainly in the 58K region in extracts from retinoic acid-treated and control cultures. Extracts from dexamethasone-treated cultures showed phosphorylation in the 58K, 53K, 47K and 27K regions. Exposure to both drugs gave extracts showing labelling in the 60K and 65K regions in addition to the bands phosphorylated in extracts exposed only to the steroid, concurrent with an even more marked inhibition of growth.
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