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Hasselbalch RB, Schultz M, Schytz PA, Kristensen JH, Strandkjær N, Pries-Heje M, Carlson N, Schou M, Bundgaard H, Torp-Pedersen C, Iversen KK. Predictive and prognostic value of different cardiac troponin assays: a nationwide register-based cohort study. Eur Heart J Qual Care Clin Outcomes 2023; 9:592-599. [PMID: 36264293 DOI: 10.1093/ehjqcco/qcac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/03/2022] [Accepted: 10/17/2022] [Indexed: 09/13/2023]
Abstract
AIMS Guidelines do not differentiate between the available assays of cardiac troponin (cTn). We compared the prognostic and predictive ability of cTn assays. METHODS AND RESULTS This was a nationwide cohort study of patients with acute coronary syndrome (ACS) and ≥ 2 cTn measurements of one of four assays: Roche high-sensitivity cTnT (hs-cTnT), Abbott high sensitivity cTnI (hs-cTnI), Siemens Vista cTnI, and Siemens cTnI Ultra. Data were collected from Danish registries from 2009-18. Peak cTn concentration normalized to the 99th percentile was used. Outcomes were myocardial infarction (MI) during admission, one-year all-cause-, cardiovascular-, and non-cardiovascular mortality. Receiver operating characteristics and logistic regression calculating odds ratios (OR) were used. A total of 90 705 patients were included, of which 20 550 (23%) had MI. Siemens Vista cTnI was the strongest predictor of MI, Area under the curve (auc) 0.93 (95% CI 0.93-0.93). In 1 year 9012 (9.9%) of patients had died. An inverted U-shape relationship was observed between concentration of cTn and all-cause mortality. Hs-cTnT OR 21.3 (95% CI 18.4-24.8) at 2-5 times the 99th percentile and 12.1 (95% CI 10.3-14.1) for concentrations >100 times the 99th percentile. The inverted U-shape relationship was only present for non-cardiovascular mortality. The strongest predictor of cardiovascular mortality was hs-cTnT, OR 11.3 (95% CI 6.4-21.8) at 1-2 times the 99th percentile and 88.8 (95% CI 53.2-163.0) for concentrations >100 times the 99th percentile. CONCLUSION Siemens Vista cTnI was the strongest predictor of MI and hs-cTnT was the strongest predictor of mortality. An inverted U-shape relationship was observed between cTn concentration and non-cardiovascular mortality.
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Affiliation(s)
- Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
| | - Martin Schultz
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
| | - Philip A Schytz
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
| | - Nina Strandkjær
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
| | - Mia Pries-Heje
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
| | - Nicholas Carlson
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
- The Danish Heart Foundation, Copenhagen 1120, Denmark
| | - Morten Schou
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hilleroed 3400, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen 2200, Denmark
| | - Kasper K Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen 2730, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen 2200, Denmark
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2
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Münter R, Sørensen E, Hasselbalch RB, Christensen E, Nielsen SD, Garred P, Ostrowski SR, Bundgaard H, Iversen KK, Andresen TL, Larsen JB. Investigating Generation of Antibodies against the Lipid Nanoparticle Vector Following COVID-19 Vaccination with an mRNA Vaccine. Mol Pharm 2023. [PMID: 36952227 DOI: 10.1021/acs.molpharmaceut.2c01036] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Despite the success of mRNA-based vaccines against infectious diseases (including COVID-19), safety concerns have been raised relating to the lipid nanoparticles (LNPs) used to deliver the mRNA cargo. Antibodies against the polyethylene glycol (PEG) coating on these non-viral vectors are present in the general population and can in some instances induce allergic reactions. Furthermore, treatment with PEGylated therapeutics may increase the plasma concentration of such anti-PEG antibodies. The widespread use of PEGylated nanoparticles for mRNA vaccines concerns researchers and clinicians about a potential rise in future cases of allergic reactions against mRNA vaccines and cross-reactions with other PEGylated therapeutics. To determine if vaccination with Comirnaty increased the plasma concentration of antibodies against LNPs, we investigated the blood plasma concentration of anti-LNP antibodies in healthy individuals before and after vaccination with the mRNA-based COVID-19 vaccine Comirnaty (BNT162b2). Blood samples were acquired from 21 healthy adults before vaccination, 3-4 weeks after the first vaccination dose but before the second dose, and 2-6 months after the second (booster) dose. The blood plasma concentration of antibodies recognizing the LNPs was analyzed using a microscopy-based assay capable of measuring antibody-binding to individual authentic LNPs. No significant increase in anti-LNP antibodies was observed after two doses of Comirnaty. The LNPs used for intramuscular delivery of mRNA in the vaccine against COVID-19, Comirnaty, do, therefore, not seem to induce the generation of anti-vector antibodies.
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Affiliation(s)
- Rasmus Münter
- Biotherapeutic Engineering and Drug Targeting, Department of Health Technology, Technical University of Denmark (DTU), Kgs. Lyngby 2800, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen 2100, Denmark
| | - Esben Christensen
- Biotherapeutic Engineering and Drug Targeting, Department of Health Technology, Technical University of Denmark (DTU), Kgs. Lyngby 2800, Denmark
| | - Susanne D Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Viru-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
| | - Peter Garred
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100, Denmark
| | - Kasper K Iversen
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital Herlev and Gentofte, Copenhagen 2100, Denmark
| | - Thomas L Andresen
- Biotherapeutic Engineering and Drug Targeting, Department of Health Technology, Technical University of Denmark (DTU), Kgs. Lyngby 2800, Denmark
| | - Jannik B Larsen
- Biotherapeutic Engineering and Drug Targeting, Department of Health Technology, Technical University of Denmark (DTU), Kgs. Lyngby 2800, Denmark
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3
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Fogh K, Eriksen ARR, Larsen TG, Hasselbalch RB, Bundgaard H, Scharff BFSS, Nielsen SD, Jørgensen CS, Erikstrup C, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Hindhede L, Mikkelsen S, Sækmose SG, Aagaard B, Holm DK, Harritshøj L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Benfield T, Mølbak K, Ethelberg S, Koch A, Vangsted AM, Krause TG, Fomsgaard A, Ullum H, Skov R, Iversen K. A Cross-Sectional Study of SARS-CoV-2 Antibodies and Risk Factors for Seropositivity in Staff in Day Care Facilities and Preschools in Denmark. Microbiol Spectr 2023; 11:e0417422. [PMID: 36546864 PMCID: PMC9927135 DOI: 10.1128/spectrum.04174-22] [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: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to provide information about immunity against COVID-19 along with risk factors and behavior among employees in day care facilities and preschools (DCS) in Denmark. In collaboration with the Danish Union of Pedagogues, during February and March 2021, 47,810 members were offered a point-of-care rapid SARS-CoV-2 antibody test (POCT) at work and were invited to fill in an electronic questionnaire covering COVID-19 exposure. Seroprevalence data from Danish blood donors (total Ig enzyme-linked immunosorbent assay [ELISA]) were used as a proxy for the Danish population. A total of 21,018 (45%) DCS employees completed the questionnaire and reported their POCT result {median age, 44.3 years (interquartile range [IQR], [32.7 to 53.6]); females, 84.1%}, of which 20,267 (96.4%) were unvaccinated and included in analysis. A total of 1,857 (9.2%) participants tested seropositive, significantly higher than a seroprevalence at 7.6% (risk ratio [RR], 1.2; 95% confidence interval [CI], 1.14 to 1.27) among 40,541 healthy blood donors (median age, 42 years [IQR, 28 to 53]; males, 51.3%). Exposure at work (RR, 2.9; 95% CI, 2.3 to 3.6) was less of a risk factor than exposure within the household (RR, 12.7; 95% CI, 10.2 to 15.8). Less than 25% of participants reported wearing face protection at work. Most of the participants expressed some degree of fear of contracting COVID-19 both at work and outside work. SARS-CoV-2 seroprevalence was slightly higher in DCS staff than in blood donors, but possible exposure at home was associated with a higher risk than at work. DCS staff expressed fear of contracting COVID-19, though there was limited use of face protection at work. IMPORTANCE Identifying at-risk groups and evaluating preventive interventions in at-risk groups is imperative for the ongoing pandemic as well as for the control of future epidemics. Although DCS staff have a much higher risk of being infected within their own household than at their workplace, most are fearful of being infected with COVID-19 or bringing COVID-19 to work. This represents an interesting dilemma and an important issue which should be addressed by public health authorities for risk communication and pandemic planning. This study design can be used in a strategy for ongoing surveillance of COVID-19 immunity or other infections in the population. The findings of this study can be used to assess the need for future preventive interventions in DCS, such as the use of personal protective equipment.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R. R. Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Rasmus B. Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bibi F. S. S. Scharff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Susanne D. Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Berit Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lotte Hindhede
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne G. Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Koege, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Dorte K. Holm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Lene Harritshøj
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K. Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Sisse R. Ostrowski
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Kåre Mølbak
- Statens Serum Institut, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | | | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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4
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Fogh K, Larsen TG, Hansen CB, Hasselbalch RB, Eriksen ARR, Bundgaard H, Frikke-Schmidt R, Hilsted LM, Østergaard L, Johansen IS, Hageman I, Garred P, Iversen K. Self-Reported Long COVID and Its Association with the Presence of SARS-CoV-2 Antibodies in a Danish Cohort up to 12 Months after Infection. Microbiol Spectr 2022; 10:e0253722. [PMID: 36350150 PMCID: PMC9769646 DOI: 10.1128/spectrum.02537-22] [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: 07/04/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022] Open
Abstract
The majority of long coronavirus disease (COVID) symptoms are not specific to COVID-19 and could be explained by other conditions. The present study aimed to explore whether Danish individuals with a perception that they suffer from long COVID have antibodies against the nucleocapsid antigen, as a proxy for detecting previous infection. The study was conducted in February and March 2021, right after the second surge of the COVID-19 pandemic in Denmark. All members of the social media group on Facebook "Covidramte med senfølger" ("long COVID sufferers'') above the age of 17 years and living in Denmark were invited to participate in a short electronic questionnaire about long COVID risk factors and symptoms. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid (N) protein was detected in blood samples as a proxy for natural SARS-CoV-2 infection. The final study population comprised 341 participants (90.6% females) who completed blood sampling and answered the questionnaire. A total of 232 (68%) were seropositive (median age, 49.5 years; interquartile range [IQR], 41 to 55 years; 90.1% females). There was no significant difference between sexes and serostatus. Seronegative and seropositive individuals had a similar burden of symptoms that could be attributed to long COVID. Time since perceived COVID-19 was significantly longer in the group of seronegative individuals than the seropositive ones (P < 0.001). This study suggests that long-COVID sufferers are mostly women and showed that a third of the participants did not have detectable anti-N-protein antibodies. It emphasizes the importance of early confirmation of COVID-19, as this study indicates an overlap between long-COVID symptoms and symptoms that are possibly of another origin. IMPORTANCE This cohort study included questionnaire data as well as anti-nucleocapsid antibody analysis, allowing us to determine whether participants were seropositive due to vaccination or natural infection. The study emphasizes the importance of early confirmation of COVID-19, as antibodies recede with time, and it indicates an overlap between long COVID symptoms and symptoms possibly of another origin.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Tine Graakjær Larsen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Cecilie B. Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Rasmus B. Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Alexandra R. R. Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Linda M. Hilsted
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, Copenhagen University Hospital, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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5
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Try Lenz I, Pries-Heje M, Hjulmand J, Hasselbalch RB, Jarloev JO, Faurholt-Jepsen D, Moser C, Iversen K, Bundgaard H. Characteristics and outcomes in patients with infective endocarditis caused by Enterococcus faecium and Enterococcus faecalis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Enterococcus faecalis is the third most common cause of infective endocarditis (IE) and has been associated with a higher risk of relapse and death. Within the enterococcus species, E. faecium is the second most frequent cause of IE. As IE from E. faecalis or E. faecium most likely have different presentations and outcomes, research is needed for individualised and optimised clinical management.
Purpose
This study aims to characterise baseline characteristics and clinical outcomes for patients with IE caused by E. faecalis or E. faecium, including short- and long-term mortality and relapse. Additionally, we aim to determine risk factors associated with IE caused by the two bacterial species.
Methods
This is a retrospective study of patients hospitalised with at least one positive blood culture with E. faecalis or E. faecium between January 1, 2016 and December 31, 2018 at two large hospitals in Denmark. IE was diagnosed according to the modified Duke criteria. Index and follow-up data were collected from medical records. Categorical values were compared using chi-square test and categorial data using students t-test.
Results
614 patients had a positive blood culture with either E. faecalis (n=279) or E. faecium (n=335). Of these, 64 (10.4%) patients developed IE; E. faecalis in 56 patients (87.5%, male 83.3%, mean age 70 years (SD 14)) and E. faecium in 8 patients (12.5%, male 75.0%, mean age 65 years (SD 13)). The prevalence of IE was 20.1% for E. faecalis bacteraemia and 2.4% for E. faecium bacteraemia (p<0.001). Embolic events during primary admission were seen more often in the E. faecium group (62.5%) compared to the E. faecalis group (10.7%) (p=0.002). Both groups had multiple co-morbidities without significant differences between groups (Table 1).
Nineteen (40.4%) of the patients with E. faecalis IE had a minimum of one previous admission with E. faecalis bacteraemia within the last year before the IE diagnosis, whereas this was not seen for any patients with E. faecium IE. The 30-days all-cause mortality was 5.4% for patients with E. faecalis IE and 25% for patients with E. faecium IE (p=0.22). After a median follow up of 3.1 years (IQR=0.46–3.94) all-cause mortality was 55.4% for patients with E. faecalis IE and 62.5% for patients with E. faecium IE (p=1.00) (Table 1).
Conclusion
The prevalence of IE was significantly higher in patients with E. faecalis bacteraemia than with E. faecium bacteraemia. While the prevalence of complications was higher in patients with E. faecium IE, the difference was only significant for embolic events. This indicates that E. faecium IE is associated with a worse outcome compared to the outcome in patients with E. faecalis IE. All-cause mortality was above 50% for both groups, i.e. considerably higher than generally seen in patients with IE. These findings may be of importance of management of patients with E. faecalis or with E. faecium bacteraemia – and endocarditis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Try Lenz
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - M Pries-Heje
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Hjulmand
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | | | - D Faurholt-Jepsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Moser
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | | | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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Eriksen ARR, Fogh K, Hasselbalch RB, Bundgaard H, Nielsen SD, Jørgensen CS, Scharff BFSS, Erikstrup C, Sækmose SG, Holm DK, Aagaard B, Kristensen JH, Bødker CA, Norsk JB, Nielsen PB, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, K.Fischer T, Folke F, Lippert F, Ostrowski SR, Ethelberg S, Koch A, Vangsted AM, Krause T, Fomsgaard A, Nielsen C, Ullum H, Skov R, Iversen K. SARS-CoV-2 antibody prevalence among homeless people and shelter workers in Denmark: a nationwide cross-sectional study. BMC Public Health 2022; 22:1261. [PMID: 35761270 PMCID: PMC9238223 DOI: 10.1186/s12889-022-13642-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
People experiencing homelessness (PEH) and associated shelter workers may be at higher risk of infection with “Severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). The aim of this study was to determine the prevalence of SARS-CoV-2 among PEH and shelter workers in Denmark.
Design and methods
In November 2020, we conducted a nationwide cross-sectional seroprevalence study among PEH and shelter workers at 21 recruitment sites in Denmark. The assessment included a point-of-care test for antibodies against SARS-CoV-2, followed by a questionnaire. The seroprevalence was compared to that of geographically matched blood donors considered as a proxy for the background population, tested using a total Ig ELISA assay.
Results
We included 827 participants in the study, of whom 819 provided their SARS-CoV-2 antibody results. Of those, 628 were PEH (median age 50.8 (IQR 40.9–59.1) years, 35.5% female) and 191 were shelter workers (median age 46.6 (IQR 36.1–55.0) years and 74.5% female). The overall seroprevalence was 6.7% and was similar among PEH and shelter workers (6.8% vs 6.3%, p = 0.87); and 12.2% among all participants who engaged in sex work. The overall participant seroprevalence was significantly higher than that of the background population (2.9%, p < 0.001). When combining all participants who reported sex work or were recruited at designated safe havens, we found a significantly increased risk of seropositivity compared to other participants (OR 2.23, 95%CI 1.06–4.43, p = 0.02). Seropositive and seronegative participants reported a similar presence of at least one SARS-CoV-2 associated symptom (49% and 54%, respectively).
Interpretations
The prevalence of SARS-CoV-2 antibodies was more than twice as high among PEH and associated shelter workers, compared to the background population. These results could be taken into consideration when deciding in which phase PEH are eligible for a vaccine, as part of the Danish national SARS-CoV-2 vaccination program rollout.
Funding
TrygFonden and HelseFonden.
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7
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Fogh K, Eriksen ARR, Hasselbalch RB, Kristensen ES, Bundgaard H, Nielsen SD, Jørgensen CS, Scharff BFSS, Erikstrup C, Sækmose SG, Holm DK, Aagaard B, Norsk J, Nielsen PB, Kristensen JH, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Ethelberg S, Koch A, Vangsted AM, Krause TG, Fomsgaard A, Nielsen C, Ullum H, Skov R, Iversen K. Seroprevalence of SARS-CoV-2 antibodies in social housing areas in Denmark. BMC Infect Dis 2022; 22:143. [PMID: 35144550 PMCID: PMC8830972 DOI: 10.1186/s12879-022-07102-1] [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: 05/30/2021] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND COVID-19 is thought to be more prevalent among ethnic minorities and individuals with low socioeconomic status. We aimed to investigate the prevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among citizens 15 years or older in Denmark living in social housing (SH) areas. METHODS We conducted a study between January 8th and January 31st, 2021 with recruitment in 13 selected SH areas. Participants were offered a point-of-care rapid SARS-CoV-2 IgM and IgG antibody test and a questionnaire concerning risk factors associated with COVID-19. As a proxy for the general Danish population we accessed data on seroprevalence from Danish blood donors (total Ig ELISA assay) in same time period. RESULTS Of the 13,279 included participants, 2296 (17.3%) were seropositive (mean age 46.6 (SD 16.4) years, 54.2% female), which was 3 times higher than in the general Danish population (mean age 41.7 (SD 14.1) years, 48.5% female) in the same period (5.8%, risk ratios (RR) 2.96, 95% CI 2.78-3.16, p > 0.001). Seropositivity was higher among males (RR 1.1, 95% CI 1.05-1.22%, p = 0.001) and increased with age, with an OR seropositivity of 1.03 for each 10-year increase in age (95% CI 1.00-1.06, p = 0.031). Close contact with COVID-19-infected individuals was associated with a higher risk of infection, especially among household members (OR 5.0, 95% CI 4.1-6.2 p < 0,001). Living at least four people in a household significantly increased the OR of seropositivity (OR 1.3, 95% CI 1.0-1.6, p = 0.02) as did living in a multi-generational household (OR 1.3 per generation, 95% CI 1.1-1.6, p = 0.003). Only 1.6% of participants reported not following any of the national COVID-19 recommendations. CONCLUSIONS Danish citizens living in SH areas of low socioeconomic status had a three times higher SARS-CoV-2 seroprevalence compared to the general Danish population. The seroprevalence was significantly higher in males and increased slightly with age. Living in multiple generations households or in households of more than four persons was a strong risk factor for being seropositive. Results of this study can be used for future consideration of the need for preventive measures in the populations living in SH areas.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark. .,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Alexandra R R Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Sofie Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Bibi F S S Scharff
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Norsk
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Fogh K, Strange JE, Scharff BFSS, Eriksen ARR, Hasselbalch RB, Bundgaard H, Nielsen SD, Jørgensen CS, Erikstrup C, Norsk J, Nielsen PB, Kristensen JH, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Benfield T, Mølbak K, Ethelberg S, Koch A, Sönksen UW, Vangsted AM, Krause TG, Fomsgaard A, Ullum H, Skov R, Iversen K. Testing Denmark: a Danish Nationwide Surveillance Study of COVID-19. Microbiol Spectr 2021; 9:e0133021. [PMID: 34908473 PMCID: PMC8672904 DOI: 10.1128/spectrum.01330-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
"Testing Denmark" is a national, large-scale, epidemiological surveillance study of SARS-CoV-2 in the Danish population. Between September and October 2020, approximately 1.3 million people (age >15 years) were randomly invited to fill in an electronic questionnaire covering COVID-19 exposures and symptoms. The prevalence of SARS-CoV-2 antibodies was determined by point-of care rapid test (POCT) distributed to participants' home addresses. In total, 318,552 participants (24.5% invitees) completed the study and 2,519 (0.79%) were seropositive. Of the participants with a prior positive PCR test (n = 1,828), 29.1% were seropositive in the POCT. Although seropositivity increased with age, participants 61 years and over reported fewer symptoms and were tested less frequently. Seropositivity was associated with physical contact with SARS-CoV-2 infected individuals (risk ratio [RR] 7.43, 95% CI: 6.57-8.41), particular in household members (RR 17.70, 95% CI: 15.60-20.10). A greater risk of seropositivity was seen in home care workers (RR 2.09, 95% CI: 1.58-2.78) compared to office workers. A high degree of adherence with national preventive recommendations was reported (e.g., >80% use of face masks), but no difference were found between seropositive and seronegative participants. The seroprevalence result was somewhat hampered by a lower-than-expected performance of the POCT. This is likely due to a low sensitivity of the POCT or problems reading the test results, and the main findings therefore relate to risk associations. More emphasis should be placed on age, occupation, and exposure in local communities. IMPORTANCE To date, including 318,522 participants, this is the largest population-based study with broad national participation where tests and questionnaires have been sent to participants' homes. We found that more emphasis from national and local authorities toward the risk of infection should be placed on age of tested individuals, type of occupation, as well as exposure in local communities and households. To meet the challenge that broad nationwide information can be difficult to gather. This study design sets the stage for a novel way of conducting studies. Additionally, this study design can be used as a supplementary model in future general test strategy for ongoing monitoring of COVID-19 immunity in the population, both from past infection and from vaccination against SARS-CoV-2, however, with attention to the complexity of performing and reading the POCT at home.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bibi F S S Scharff
- Department of Clinical Immunology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R R Eriksen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Erikstrup
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Jakob Norsk
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Østergaard
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Clinical Microbiology, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Berit Andersen
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospitalgrid.7143.1, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Mølbak
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Steen Ethelberg
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Public health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Henrik Ullum
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
| | - Robert Skov
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Madsen JR, Nielsen JPS, Fogh K, Hansen CB, Nielsen PB, Lange T, Hasselbalch RB, Garred P, Iversen K. Anti-SARS-CoV-2 Seropositivity Among Medical Students in Copenhagen. Open Forum Infect Dis 2021; 8:ofab273. [PMID: 34423066 PMCID: PMC8374058 DOI: 10.1093/ofid/ofab273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/02/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Health care workers are at a higher risk of getting infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than the general population. Knowledge about medical students' exposure to SARS-CoV-2 is lacking. Thus, we measured the prevalence of SARS-CoV-2 antibodies in a cohort of Danish medical students. METHODS We invited all medical students at the University of Copenhagen (UCPH) to participate. Students underwent venous blood sampling and a questionnaire about work-life behaviors possibly associated with SARS-CoV-2 exposure and coronavirus disease 2019 (COVID-19) symptoms. Samples were analyzed for total immunoglobulin G (IgG) antibodies against SARS-CoV-2, and seropositive samples were screened for IgG, immunoglobulin M, and immunoglobulin A antibodies. We determined associations between seropositivity and clinical and social activities and self-reported symptoms. RESULTS Between October 19 and 26, 1120 students participated in the questionnaire and 1096 were included. Of all included, 379 (34.58%) were seropositive. Seropositivity was associated with attendance at 2 parties at UCPH, on February 29 and March 6, 2020 (odds ratio [OR], 5.96; 95% CI, 4.34-8.24; P < .001). Four hundred sixty-one students (42.06%) worked with COVID-19 patients, which was significantly associated with seropositivity (OR, 1.38; 95% CI, 1.03-1.85; P = .033). The symptom most associated with seropositivity was loss of smell and/or taste (n = 183 of all, 31.35%; OR, 24.48; 95% CI, 15.49-40.60; P < .001). Bachelor's students were significantly more likely to be seropositive than Master's students (42.28% vs 16.87%; P < .001). CONCLUSIONS Medical students have the highest reported seropositivity in the Danish health care system. In this cohort of students at UCPH, seropositivity was associated with social behavior markers and, to a lesser extent, with self-reported contact with SARS-CoV-2-infected patients.
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Affiliation(s)
- Johannes R Madsen
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen,Denmark
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P S Nielsen
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen,Denmark
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kamille Fogh
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen,Denmark
| | - Cecilie B Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille B Nielsen
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen,Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Copenhagen,Denmark
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10
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Harritshøj LH, Gybel-Brask M, Afzal S, Kamstrup PR, Jørgensen CS, Thomsen MK, Hilsted L, Friis-Hansen L, Szecsi PB, Pedersen L, Nielsen L, Hansen CB, Garred P, Korsholm TL, Mikkelsen S, Nielsen KO, Møller BK, Hansen AT, Iversen KK, Nielsen PB, Hasselbalch RB, Fogh K, Norsk JB, Kristensen JH, Schønning K, Kirkby NS, Nielsen ACY, Landsy LH, Loftager M, Holm DK, Nilsson AC, Sækmose SG, Grum-Schwensen B, Aagaard B, Jensen TG, Nielsen DM, Ullum H, Dessau RB. Comparison of 16 Serological SARS-CoV-2 Immunoassays in 16 Clinical Laboratories. J Clin Microbiol 2021; 59:e02596-20. [PMID: 33574119 PMCID: PMC8091860 DOI: 10.1128/jcm.02596-20] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
Serological assays for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are needed to support clinical diagnosis and epidemiological investigations. Recently, assays for large-scale detection of total antibodies (Ab), immunoglobulin G (IgG), and IgM against SARS-CoV-2 antigens have been developed, but there are limited data on the diagnostic accuracy of these assays. This study was a Danish national collaboration and evaluated 15 commercial and one in-house anti-SARS-CoV-2 assays in 16 laboratories. Sensitivity was evaluated using 150 samples from individuals with asymptomatic, mild, or moderate COVID-19, nonhospitalized or hospitalized, confirmed by nucleic acid amplification tests (NAAT); samples were collected 13 to 73 days either from symptom onset or from positive NAAT (patients without symptoms). Specificity and cross-reactivity were evaluated in samples collected prior to the SARS-CoV-2 epidemic from >586 blood donors and patients with autoimmune diseases, cytomegalovirus or Epstein-Barr virus infections, and acute viral infections. A specificity of ≥99% was achieved by all total-Ab and IgG assays except one, DiaSorin Liaison XL IgG (97.2%). Sensitivities in descending order were Wantai ELISA total Ab (96.7%), CUH-NOVO in-house ELISA total Ab (96.0%), Ortho Vitros total Ab (95.3%), YHLO iFlash IgG (94.0%), Ortho Vitros IgG (93.3%), Siemens Atellica total Ab (93.2%), Roche Elecsys total Ab (92.7%), Abbott Architect IgG (90.0%), Abbott Alinity IgG (median 88.0%), DiaSorin Liaison XL IgG (median 84.6%), Siemens Vista total Ab (81.0%), Euroimmun/ELISA IgG (78.0%), and Snibe Maglumi IgG (median 78.0%). However, confidence intervals overlapped for several assays. The IgM results were variable, with the Wantai IgM ELISA showing the highest sensitivity (82.7%) and specificity (99%). The rate of seropositivity increased with time from symptom onset and symptom severity.
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Affiliation(s)
- Lene H Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Gybel-Brask
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Shoaib Afzal
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Charlotte S Jørgensen
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Linda Hilsted
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lennart Friis-Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Bispebjerg, and Frederiksberg Hospital, Copenhagen, Denmark
| | - Pal B Szecsi
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lise Pedersen
- Department of Clinical Biochemistry, Holbæk Hospital, Holbæk, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Cecilie B Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Trine-Line Korsholm
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirstine O Nielsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjarne K Møller
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne T Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kasper K Iversen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Pernille B Nielsen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas Henrik Kristensen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
- Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nikolai S Kirkby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alex C Y Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lone H Landsy
- Department of Nonclinical and Clinical Assay Sciences in Global Discovery & Development Sciences, Novo Nordisk A/S, Måløv, Denmark
| | - Mette Loftager
- Department of Nonclinical and Clinical Assay Sciences in Global Discovery & Development Sciences, Novo Nordisk A/S, Måløv, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Anna C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Susanne G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Næstved Hospital, Næstved, Denmark
| | - Birgitte Grum-Schwensen
- Department of Clinical Immunology, Zealand University Hospital, Næstved Hospital, Næstved, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Thøger G Jensen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit for Clinical Microbiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Dorte M Nielsen
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse Hospital, Slagelse, Denmark
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11
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Iversen K, Bundgaard H, Hasselbalch RB, Kristensen JH, Nielsen PB, Pries-Heje M, Knudsen AD, Christensen CE, Fogh K, Norsk JB, Andersen O, Fischer TK, Jensen CAJ, Larsen M, Torp-Pedersen C, Rungby J, Ditlev SB, Hageman I, Møgelvang R, Hother CE, Gybel-Brask M, Sørensen E, Harritshøj L, Folke F, Sten C, Benfield T, Nielsen SD, Ullum H. Risk of COVID-19 in health-care workers in Denmark: an observational cohort study. Lancet Infect Dis 2020; 20:1401-1408. [PMID: 32758438 PMCID: PMC7398038 DOI: 10.1016/s1473-3099(20)30589-2] [Citation(s) in RCA: 290] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022]
Abstract
Background Health-care workers are thought to be highly exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to investigate the prevalence of antibodies against SARS-CoV-2 in health-care workers and the proportion of seroconverted health-care workers with previous symptoms of COVID-19. Methods In this observational cohort study, screening was offered to health-care workers in the Capital Region of Denmark, including medical, nursing, and other students who were associated with hospitals in the region. Screening included point-of-care tests for IgM and IgG antibodies against SARS-CoV-2. Test results and participant characteristics were recorded. Results were compared with findings in blood donors in the Capital Region in the study period. Findings Between April 15 and April 23, 2020, we screened 29 295 health-care workers, of whom 28 792 (98·28%) provided their test results. We identified 1163 (4·04% [95% CI 3·82–4·27]) seropositive health-care workers. Seroprevalence was higher in health-care workers than in blood donors (142 [3·04%] of 4672; risk ratio [RR] 1·33 [95% CI 1·12–1·58]; p<0·001). Seroprevalence was higher in male health-care workers (331 [5·45%] of 6077) than in female health-care workers (832 [3·66%] of 22 715; RR 1·49 [1·31–1·68]; p<0·001). Frontline health-care workers working in hospitals had a significantly higher seroprevalence (779 [4·55%] of 16 356) than health-care workers in other settings (384 [3·29%] of 11 657; RR 1·38 [1·22–1·56]; p<0·001). Health-care workers working on dedicated COVID-19 wards (95 [7·19%] of 1321) had a significantly higher seroprevalence than other frontline health-care workers working in hospitals (696 [4·35%] of 15 983; RR 1·65 [1·34–2·03]; p<0·001). 622 [53·5%] of 1163 seropositive participants reported symptoms attributable to SARS-CoV-2. Loss of taste or smell was the symptom that was most strongly associated with seropositivity (377 [32·39%] of 1164 participants with this symptom were seropositive vs 786 [2·84%] of 27 628 without this symptom; RR 11·38 [10·22–12·68]). The study is registered at ClinicalTrials.gov, NCT04346186. Interpretation The prevalence of health-care workers with antibodies against SARS-CoV-2 was low but higher than in blood donors. The risk of SARS-CoV-2 infection in health-care workers was related to exposure to infected patients. More than half of seropositive health-care workers reported symptoms attributable to COVID-19. Funding Lundbeck Foundation.
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Affiliation(s)
- Kasper Iversen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark.
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Pernille B Nielsen
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Mia Pries-Heje
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas D Knudsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Casper E Christensen
- Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Kamille Fogh
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Department of Emergency Medicine, Herlev og Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Ove Andersen
- Department of Emergency and Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Thea K Fischer
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Margit Larsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jørgen Rungby
- Department of Endocrinology and Copenhagen Center for Translational Research, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sisse B Ditlev
- Department of Pulmonary Medicine and Copenhagen Center for Translational Research, Bispebjerg Hospital, Copenhagen, Denmark
| | - Ida Hageman
- Mental Health Services-The Capital Region of Denmark, Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer E Hother
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Gybel-Brask
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Fredrik Folke
- Emergency Medical Services, Ballerup, Copenhagen, Denmark
| | - Curt Sten
- Diagnostisk Enhed, Bornholms Hospital, Rønne, Denmark
| | - Thomas Benfield
- Department of Infectious Disease, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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12
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Roenhoej Rønhøj R, Hasselbalch RB, Schultz M, Pries-Heje M, Plesner LL, Ravn L, Lind M, Jensen BN, Hoei-Hansen Høi-Hansen T, Carlson N, Torp-Pedersen C, Rasmussen LS, Rasmussen LJH, Eugen-Olsen J, Koeber Køber L, Iversen K. Abnormal routine blood tests as predictors of mortality in acutely admitted patients. Clin Biochem 2019; 77:14-19. [PMID: 31843666 DOI: 10.1016/j.clinbiochem.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/07/2019] [Accepted: 12/12/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study aimed to improve early risk stratification in the emergency department by creating a simple blood test score based on routine biomarkers and assess its predictive ability for 30-day mortality of acutely admitted patients. METHODS This was a secondary analysis of data from the TRIAGE II study. It included unselected acutely admitted medical and surgical patients, who had albumin, C-reactive protein, creatinine, haemoglobin, leukocytes, potassium, sodium and thrombocytes levels analysed upon admission. Patients were classified according to the number of biomarker results outside the reference range into four risk groups termed "very low", "low", "intermediate", and "high" with 0-1, 2-3, 4-5 and 6-8 abnormal biomarker results, respectively. Logistic regression was used to calculate odds ratios for 30-day mortality and receiver operating characteristic was used to test the discriminative value. The primary analysis was done in patients triaged with ADAPT (Adaptive Process Triage). Subsequently, we analysed two other cohorts of acutely admitted patients. RESULTS The TRIAGE II cohort included 17,058 eligible patients, 30-day mortality was 5.2%. The primary analysis included 7782 patients. Logistic regression adjusted for age and sex showed an OR of 24.1 (95% CI 14.9-41.0) between the very low- and the high-risk group. The area under the curve (AUC) was 0.79 (95% CI 0.76-0.81) for the blood test score in predicting 30-day mortality. The subsequent analyses confirmed the results. CONCLUSIONS A blood test score based on number of routine biomarkers with an abnormal result was a predictor of 30-day mortality in acutely admitted patients.
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Affiliation(s)
- Rasmus Roenhoej Rønhøj
- Department of Cardiology, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.
| | - Rasmus B Hasselbalch
- Department of Cardiology, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Martin Schultz
- Department of Cardiology, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Mia Pries-Heje
- Department of Cardiology, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Louis L Plesner
- Department of Cardiology, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Lisbet Ravn
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Morten Lind
- Department of Emergency Medicine, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Birgitte N Jensen
- Department of Emergency Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | | | - Nicholas Carlson
- Department of Cardiology, Gentofte Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark; The Danish Heart Foundation, Vognmagergade 7, 1120 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Departments of Cardiology and Clinical Research, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hilleroed, Denmark; Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Center of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Line J H Rasmussen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, 2650 Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Hvidovre Hospital, University of Copenhagen, Kettegaard Alle 30, 2650 Hvidovre, Denmark
| | - Lars Koeber Køber
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Emergency Medicine, Herlev-Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
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13
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Hasselbalch RB, Schultz M, Hartmann Rasmussen LJ, Hoei-Hansen T, Kjoeller E, Nybo Jensen B, Lind MN, Ravn L, Kallemose T, Lange T, Koeber L, Eugen-Olsen J, Iversen KK. P1745Routine blood tests are strong predictors of mortality among patients with suspected heart disease in the emergency department. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1745] [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: 11/13/2022] Open
Affiliation(s)
- R B Hasselbalch
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - M Schultz
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L J Hartmann Rasmussen
- Hvidovre Hospital - Copenhagen University Hospital, Clinical Research Centre, Hvidovre, Denmark
| | - T Hoei-Hansen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - E Kjoeller
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - B Nybo Jensen
- Bispebjerg University Hospital, Department of Emergency Medicine, Bispebjerg, Denmark
| | - M N Lind
- Herlev Hospital, Department of Emergency Medicine, Herlev, Denmark
| | - L Ravn
- Herlev Hospital, Department of Emergency Medicine, Herlev, Denmark
| | - T Kallemose
- Hvidovre Hospital - Copenhagen University Hospital, Clinical Research Centre, Hvidovre, Denmark
| | - T Lange
- University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - L Koeber
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Eugen-Olsen
- Hvidovre Hospital - Copenhagen University Hospital, Clinical Research Centre, Hvidovre, Denmark
| | - K K Iversen
- Herlev Hospital - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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14
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Abdullah OB, Grand J, Sijapati A, Nimskov P, Nielsen FE, Schmidt JC, Pérez N, Kirkegaard T, Fløjstrup M, Brabrand M, Galthen-Sørensen M, Ramoskiene R, Arshad A, Lassen A, Teglbjærg LS, Andersen O, Jørgensen LM, Sivertsen DM, Kirk JW, Petersen J, Klausen HH, Bodilsen AC, Petersen J, Bandholm T, Haupt T, Sivertsen DM, Andersen O, Hansen CS, Pottegård A, Ekelund U, Forberg JL, Jensen HK, Lassen AT, Madsen JLB, Graumann O, Posth S, Pietersen PI, Konge L, Laursen CB, Madsen JLB, Hansen SN, Jensen KM, Brabrand M, Hasselbalch RB, Pries-Heje M, Ravn L, Lind M, Rasmussen LS, Jensen BN, Havshøj U, Henriksen DP, Brabrand M, Lassen AT, Nygaard HH, Maschmann C, Skjøt-Arkil H, Mogensen CB, Hansen LH, Wittenhoff L, Mogensen CB, Skjøt-Arkil H, Duvald I, Duvald I, Rasmussen LJH, Ladelund S, Haupt TH, Ellekilde G, Eugen-Olsen J, Andersen O, Betzer M, Lyngby R, Elkjær M, Jørgensen C, Brabrand M, Gram B, Pries-Heje MM, Hasselbalch RB, Ravn L, Lind MN, Boel T, Ulriksen PS, Jensen NH, Jensen KM, Mølleskov E, Fog IØ, Kristensen MR, Jensen E. Meeting abstracts from the 7th Danish Emergency Medicine Conference. Scand J Trauma Resusc Emerg Med 2017. [PMCID: PMC5374601 DOI: 10.1186/s13049-017-0364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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