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Sedighi F, Zarghami M, Alizadeh Arimi F, Moosazadeh M, Ala S, Ghasemian R, Mehravaran H, Elyasi F. Efficacy and safety of adding fluoxetine to the treatment regimen of hospitalized patients with non-critical COVID-19 pneumonia: A double-blind randomized, placebo-controlled clinical trial. Neuropsychopharmacol Rep 2023; 43:202-212. [PMID: 36941089 PMCID: PMC10275279 DOI: 10.1002/npr2.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors are considered the drugs, whose effectiveness in viral pandemics has been studied. The aim of this study was to evaluate of adding fluoxetine to the treatment regimen of patients with COVID-19 pneumonia. METHODS This study was a double-blind randomized placebo controlled clinical trial .36 patients in the fluoxetine and 36 patients in the placebo group were enrolled. Patients in the intervention group were first treated with fluoxetine 10 mg for 4 days and then the dose of 20 mg was continued for 4 weeks. Data analysis was conducted using SPSS V. 22.0. RESULTS There was no statistically significant difference between the two groups in terms of clinical symptoms at the beginning of the study and also the score of anxiety and depression, oxygen saturation at the time of hospitalization, mid-hospitalization and discharge periods. The need for mechanical ventilator support (p = 1.00), the need for admission in the intensive care unit (ICU) (p = 1.00), rate for mortality (p = 1.00), and discharge with relative recovery (p = 1.00) were not significantly different between the two groups. The distribution of CRP within the study groups showed a significant decrease during different time periods (p = 0.001), and although there was no statistically significant difference between the two groups on the first day (p = 1.00) and at discharge (p = 0.585), mid-hospital CRP showed a significant decrease in the fluoxetine group (p = 0.032). CONCLUSION Fluoxetine resulted in a faster reduction of patients' inflammation without association with depression and anxiety.
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Affiliation(s)
- Faranak Sedighi
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
| | - Mehran Zarghami
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
- Department of PsychiatryFaculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Fatemeh Alizadeh Arimi
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research CenterNon‐communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Shahram Ala
- Department of Clinical PharmacyPharmaceutical Sciences Research CenterHemoglobinopathy Institute, Faculty of PharmacyMazandaran University of Medical SciencesSariIran
| | - Roya Ghasemian
- Antimicrobial Resistance Research CenterDepartment of Infectious DiseasesMazandaran University of Medical SciencesSariIran
| | - Hossein Mehravaran
- Department of Internal MedicinePulmonary and Critical Care DivisionFaculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
- Department of PsychiatryFaculty of MedicineMazandaran University of Medical SciencesSariIran
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Rozenblat T, Reifen E, Benov A, Shaul C, Neuman U, Karol D, Schvartz R, Bachar G. The value of tracheostomy of critically ill COVID-19 patients - A multicentral study. Am J Otolaryngol 2022; 43:103230. [PMID: 34537504 PMCID: PMC8440006 DOI: 10.1016/j.amjoto.2021.103230] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022]
Abstract
Purpose Tracheostomy is an aerosol-generating procedure, thus performing it during the COVID-19 pandemic arises considerations such as the most appropriate timing and the patients to whom it is suitable. Medical teams lack sufficient data to assist determining whether or not to conduct tracheostomy, its short- and long-term implications are not fully understood. This study aims to shed light on the critically ill COVID-19 patients that require tracheostomy, and to investigate its value. Methods A retrospective multicentral case-control study of 157 hospitalized critically ill COVID-19 patients, among whom 30 patients went through tracheostomy and consisted of our study group. Results The mean age was similar between study and control groups (68.9 ± 12.7 years vs 70.5 ± 15.8 years, p = 0.57), as well as comorbidity prevalence (56.7% vs 67.7%, p = 0.25). Patients in the study group were hospitalized for longer duration until defined critically ill (5 ± 4.3 vs 3 ± 3.9 days; p = 0.01), until admitted to the intensive care unit (6 ± 6.6 vs 2.5 ± 3.7 days respectively; p = 0.005), and until discharged (24 ± 9.7 vs 10.7 ± 9.1 days, p < 0.001). Mortality rate was lower in the study group (30% vs 59.8%, p = 0.003). Kaplan Meier survival analysis revealed a statistically significant difference in survival time between groups (Log rank chi-sq = 20.91, p < 0.001) with mean survival time of 41 ± 3.1 days vs 21 ± 2.2 days. Survival was significantly longer in the study group (OR = 0.37, p = 0.004). Conclusion Tracheostomy allows for more prolonged survival for gradually deteriorating critically ill COVID-19 patients. This should be integrated into the medical teams' considerations when debating whether or not to conduct tracheostomy.
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Affiliation(s)
- Tal Rozenblat
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ella Reifen
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Chanan Shaul
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel.
| | - Uri Neuman
- Department of Otolaryngology, Meir Medical Center, Kfar Saba, Israel.
| | - Dana Karol
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
| | - Reut Schvartz
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
| | - Gideon Bachar
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bezerra R, Teles F, Mendonca PB, Damte T, Likaka A, Ferrer-Miranda E, de Albuquerque JO, de Lima Filho JL. Outcomes of critically ill patients with acute kidney injury in COVID-19 infection: an observational study. Ren Fail 2021; 43:911-918. [PMID: 34057014 PMCID: PMC8168780 DOI: 10.1080/0886022x.2021.1933530] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Early reports indicate that AKI is common during COVID-19 infection. Different mortality rates of AKI due to SARS-CoV-2 have been reported, based on the degree of organic dysfunction and varying from public to private hospitals. However, there is a lack of data about AKI among critically ill patients with COVID-19. METHODS We conducted a multicenter cohort study of 424 critically ill adults with severe acute respiratory syndrome (SARS) and AKI, both associated with SARS-CoV-2, admitted to six public ICUs in Brazil. We used multivariable logistic regression to identify risk factors for AKI severity and in-hospital mortality. RESULTS The average age was 66.42 ± 13.79 years, 90.3% were on mechanical ventilation (MV), 76.6% were at KDIGO stage 3, and 79% underwent hemodialysis. The overall mortality was 90.1%. We found a higher frequency of dialysis (82.7% versus 45.2%), MV (95% versus 47.6%), vasopressors (81.2% versus 35.7%) (p < 0.001) and severe AKI (79.3% versus 52.4%; p = 0.002) in nonsurvivors. MV, vasopressors, dialysis, sepsis-associated AKI, and death (p < 0.001) were more frequent in KDIGO 3. Logistic regression for death demonstrated an association with MV (OR = 8.44; CI 3.43-20.74) and vasopressors (OR = 2.93; CI 1.28-6.71; p < 0.001). Severe AKI and dialysis need were not independent risk factors for death. MV (OR = 2.60; CI 1.23-5.45) and vasopressors (OR = 1.95; CI 1.12-3.99) were also independent risk factors for KDIGO 3 (p < 0.001). CONCLUSION Critically ill patients with SARS and AKI due to COVID-19 had high mortality in this cohort. Mortality was largely determined by the need for mechanical ventilation and vasopressors rather than AKI severity.
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Affiliation(s)
- Rodrigo Bezerra
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- PROCAPE, University of Pernambuco, Recife, Brazil
| | - Flávio Teles
- Clinical Medicine Department, Federal University of Alagoas, Maceio, Brazil
| | | | | | - Andrew Likaka
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
| | | | - Jones Oliveira de Albuquerque
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- Department of Statistics and Informatics, Federal Rural University of Pernambuco, Recife, Brazil
| | - José Luiz de Lima Filho
- Keizo Asami Laboratory of Immunopathology, Federal University of Pernambuco, Recife, Brazil
- Department of Biochemistry, Federal University of Pernambuco, Recife, Brazil
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Loomba RS, Aggarwal G, Aggarwal S, Flores S, Villarreal EG, Farias JS, Lavie CJ. Disparities in case frequency and mortality of coronavirus disease 2019 (COVID-19) among various states in the United States. Ann Med 2021; 53:151-159. [PMID: 33138653 PMCID: PMC7877922 DOI: 10.1080/07853890.2020.1840620] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To utilize publicly reported, state-level data to identify factors associated with the frequency of cases, tests, and mortality in the USA. MATERIALS AND METHODS Retrospective study using publicly reported data collected included the number of COVID-19 cases, tests and mortality from March 14th through April 30th. Publicly available state-level data was collected which included: demographics comorbidities, state characteristics and environmental factors. Univariate and multivariate regression analyses were performed to identify the significantly associated factors with percent mortality, case and testing frequency. All analyses were state-level analyses and not patient-level analyses. RESULTS A total of 1,090,500 COVID-19 cases were reported during the study period. The calculated case and testing frequency were 3332 and 19,193 per 1,000,000 patients. There were 63,642 deaths during this period which resulted in a mortality of 5.8%. Factors including to but not limited to population density (beta coefficient 7.5, p < .01), transportation volume (beta coefficient 0.1, p < .01), tourism index (beta coefficient -0.1, p = .02) and older age (beta coefficient 0.2, p = .01) are associated with case frequency and percent mortality. CONCLUSIONS There were wide variations in testing and case frequencies of COVID-19 among different states in the US. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality. Key messages There were wide variations in testing and case frequencies of COVID-19 among different states in the USA. States with higher population density had a higher case and testing rate. States with larger population of elderly and higher tourism had a higher mortality.
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Affiliation(s)
- Rohit S. Loomba
- Advocate Children’s Hospital, Chicago, IL, USA
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL, USA
| | | | | | - Saul Flores
- Texas Children’s Hospital, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Enrique G. Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Juan S. Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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Abstract
BACKGROUND The COVID-19 pandemic has caused the relocation of huge financial resources to departments dedicated to infected patients, at the expense of those suffering from other pathologies. AIM To compare clinical features and outcomes in COVID-19 pneumonia and non-COVID-19 pneumonia patients. PATIENTS AND METHODS 53 patients (35 males, mean age 61.5 years) with COVID-19 pneumonia and 50 patients (32 males, mean age 72.7 years) with non-COVID-19 pneumonia, consecutively admitted between March and May 2020 were included. Clinical, laboratory and radiological data at admission were analyzed. Duration of hospitalization and mortality rates were evaluated. RESULTS Among the non-COVID patients, mean age, presence of comorbidities (neurological diseases, chronic kidney disease and chronic obstructive pulmonary disease), Charlson Comorbidity Index and risk factors (tobacco use and protracted length of stay in geriatric healthcare facilities) were higher than in COVID patients. The non-COVID-19 pneumonia group showed a higher (24% vs. 17%), although not statistically significant in-hospital mortality rate; the average duration of hospitalization was longer for COVID patients (30 vs. 9 days, p = .0001). CONCLUSIONS In the early stages of the COVID pandemic, our centre noted no statistical difference in unadjusted in-hospital mortality between COVID and non-COVID patients. Non-COVID patients had higher Charlson Comorbidity Scores, reflecting a greater disease burden in this population.Key MessagesIn March 2020, the COVID-19 disease was declared a pandemic, with enormous consequences for the organization of health systems and in terms of human lives; this has caused the relocation of huge financial resources to departments dedicated to infected patients, at the expense of those suffering from other pathologies.Few published reports have compared COVID-19 and non-COVID-19 pneumonia. In our study, performed in a geographic area with a low prevalence of SARS-CoV-2 infection, we found few statistically significant differences in terms of clinical characteristics between the two groups analyzed.In the early stages of the COVID pandemic, our centre noted no statistical difference in unadjusted in-hospital mortality between COVID and non-COVID patients. Non-COVID patients had higher Charlson Comorbidity Scores, reflecting a greater disease burden in this population.
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Affiliation(s)
- Chiara Di Mitri
- Internal Medicine Unit, V. Cervello Hospital, Palermo, Italy
| | | | | | | | | | - Maurizio Soresi
- Internal Medicine, PROMISE Department, University of Palermo, Palermo, Italy
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Carrasco-Sánchez FJ, López-Carmona MD, Martínez-Marcos FJ, Pérez-Belmonte LM, Hidalgo-Jiménez A, Buonaiuto V, Suárez Fernández C, Freire Castro SJ, Luordo D, Pesqueira Fontan PM, Blázquez Encinar JC, Magallanes Gamboa JO, de la Peña Fernández A, Torres Peña JD, Fernández Solà J, Napal Lecumberri JJ, Amorós Martínez F, Guisado Espartero ME, Jorge Ripper C, Gómez Méndez R, Vicente López N, Román Bernal B, Rojano Rivero MG, Ramos Rincón JM, Gómez Huelgas R. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med 2021; 53:103-116. [PMID: 33063540 PMCID: PMC7651248 DOI: 10.1080/07853890.2020.1836566] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.
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Affiliation(s)
| | | | | | | | | | - Verónica Buonaiuto
- Internal Medicine Department, Málaga Regional University Hospital, Málaga, Spain
| | | | | | - Davide Luordo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Spain
| | | | | | | | | | - José David Torres Peña
- Lipis and Atherosclerosis Unit, Department of Interna Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Spain
- CIBER Fisiopatologia de la Obesidad y Nutrición (CIBEROBN), Insituto de Salud Carlos III, Córdoba, Spain
| | | | | | | | | | - Carlos Jorge Ripper
- Internal Medicine Department, Insular de Gran Canaria Hospital, Las Palmas de Gran Canaria, Spain
| | - Raquel Gómez Méndez
- Internal Medicine Department, Lucus Augusti University Hospital, Lugo, Spain
| | | | - Berta Román Bernal
- Internal Medicine Department, Doctor José Molina Orosa Hospital, Arrecife, Spain
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Halalau A, Imam Z, Karabon P, Mankuzhy N, Shaheen A, Tu J, Carpenter C. External validation of a clinical risk score to predict hospital admission and in-hospital mortality in COVID-19 patients. Ann Med 2021; 53:78-86. [PMID: 32997542 PMCID: PMC7877986 DOI: 10.1080/07853890.2020.1828616] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Identification of patients with novel coronavirus disease 2019 (COVID-19) requiring hospital admission or at high-risk of in-hospital mortality is essential to guide patient triage and to provide timely treatment for higher risk hospitalized patients. METHODS A retrospective multi-centre (8 hospital) cohort at Beaumont Health, Michigan, USA, reporting on COVID-19 patients diagnosed between 1 March and 1 April 2020 was used for score validation. The COVID-19 Risk of Complications Score was automatically computed by the EHR. Multivariate logistic regression models were built to predict hospital admission and in-hospital mortality using individual variables constituting the score. Validation was performed using both discrimination and calibration. RESULTS Compared to Green scores, Yellow Scores (OR: 5.72) and Red Scores (OR: 19.1) had significantly higher odds of admission (both p < .0001). Similarly, Yellow Scores (OR: 4.73) and Red Scores (OR: 13.3) had significantly higher odds of in-hospital mortality than Green Scores (both p < .0001). The cross-validated C-Statistics for the external validation cohort showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77-0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71-0.78)). CONCLUSIONS The COVID-19 Risk of Complications Score predicts the need for hospital admission and in-hospital mortality patients with COVID-19. Key points: Can an electronic health record generated risk score predict the risk of hospital admission and in-hospital mortality in patients diagnosed with coronavirus disease 2019 (COVID-19)? In both validation cohorts of 2,025 and 1,290 COVID-19, the cross-validated C-Statistics showed good discrimination for both hospital admission (C = 0.79 (95% CI: 0.77-0.81)) and in-hospital mortality (C = 0.75 (95% CI: 0.71-0.78)), respectively. The COVID-19 Risk of Complications Score may help predict the need for hospital admission if a patient contracts SARS-CoV-2 infection and in-hospital mortality for a hospitalized patient with COVID-19.
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Affiliation(s)
- Alexandra Halalau
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Zaid Imam
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Nikhil Mankuzhy
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Aciel Shaheen
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - John Tu
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Clinical Informatics, Beaumont Health, Southfield, MI, USA
| | - Christopher Carpenter
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Section of Infectious Disease, Beaumont Health, Royal Oak, MI, USA
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Belli LS, Duvoux C, Cortesi PA, Facchetti R, Iacob S, Perricone G, Radenne S, Conti S, Patrono D, Berlakovich G, Hann A, Pasulo L, Castells L, Faitot F, Detry O, Invernizzi F, Magini G, De Simone P, Kounis I, Morelli MC, Díaz Fontenla F, Ericzon BG, Loinaz C, Johnston C, Gheorghe L, Lesurtel M, Romagnoli R, Kollmann D, Perera MTP, Fagiuoli S, Mirza D, Coilly A, Toso C, Zieniewicz K, Elkrief L, Karam V, Adam R, den Hoed C, Merli M, Puoti M, De Carlis L, Oniscu GC, Piano S, Angeli P, Fondevila C, Polak WG. COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study. Gut 2021; 70:1914-1924. [PMID: 34281984 PMCID: PMC8300535 DOI: 10.1136/gutjnl-2021-324879] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Explore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course. DESIGN Data from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed. RESULTS From 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10-30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15-19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44-102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31-170). CONCLUSIONS Increased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).
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Affiliation(s)
- Luca Saverio Belli
- Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Rita Facchetti
- Research Centre on Public Health (CESP), Universita degli Studi di Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Speranta Iacob
- Digestive Diseases and Liver Transplantation Center, Institutul Clinic Fundeni, Bucharest, Romania
| | - Giovanni Perricone
- Epatologia e Gastroenterologia, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sylvie Radenne
- Service Hépatologie et Gastro-Entérologie, Hospital Croix-Rousse, Lyon, France
| | - Sara Conti
- Research Centre on Public Health (CESP), Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Damiano Patrono
- Liver Transplantation Unit, Ospedale Molinette, Torino, Italy
| | - Gabriela Berlakovich
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Angus Hann
- Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Luisa Pasulo
- Gastroenterology and Transplant Hepatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Lluis Castells
- Liver Transplant Unit, HPB Surgery and Transplants, Hospital Vall d'Hebron, Barcelona, Spain
| | - Francois Faitot
- Service de Chirurgie Hepatobiliare and Transplantation, Hôpital de Hautepierre, Strasbourg, France
| | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Liege, Belgium
| | - Federica Invernizzi
- Division of Gastroenterology and Hepatology, Policlinico di Milano, Milan, Italy
| | - Giulia Magini
- Division of Abdominal Surgery, Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Paolo De Simone
- Trapiantologia Epatica Universitaria, Ospedale Cisanello, Pisa, Italy
| | - Ilias Kounis
- Centre Hépatobiliaire, Hospital Paul Brousse, Villejuif, France
| | - Maria Cristina Morelli
- Department of Organ Failures and Transplantation, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fernando Díaz Fontenla
- Liver Transplantation Unit, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Bo-Göran Ericzon
- Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Carmelo Loinaz
- HBP and Transplant Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Chris Johnston
- Liver Transplantation Unit, Edinburgh Royal Infirmary, Edinburgh, Edinburgh, UK
| | - Liliana Gheorghe
- Digestive Diseases and Liver Transplantation Center, Clinical Institute Fundeni, Bucuresti, Romania
| | - Mickael Lesurtel
- Department of Surgery and Transplanattion, Hospital Croix-Rousse, Lyon, Rhône-Alpes, France
| | | | - Dagmar Kollmann
- Division of Transplantation, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Stefano Fagiuoli
- Department of Gastroenterology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Lombardia, Italy
| | - Darius Mirza
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, Birmingham, UK
| | - Audrey Coilly
- Centre Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, Île-de-France, France
- UMR-S1193, INSERM, Villejuif, Île-de-France, France
| | - Christian Toso
- Department of Surgery, Geneva University Hospitals, Geneve, Switzerland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Faculty of Medicine, Medical University of Warsaw, Warszawa, Poland
| | - Laure Elkrief
- Hepatogastroenterology Unit, Hopital Trousseau, Chambray-les-Tours, France
| | - Vincent Karam
- Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | - Rene Adam
- Centre Hépatobiliaire, Hôpital Paul Brousse, Villejuif, France
| | | | - Marco Merli
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Massimo Puoti
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Luciano De Carlis
- Chirurgia Generale e dei Trapianti, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Gabriel C Oniscu
- Transplantation Surgery, Karolinska Institute, Stockholm, Sweden
| | - Salvatore Piano
- Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy
| | - Paolo Angeli
- Department of Medicine, Faculty of Medicine and Surgery, University of Padua, Padova, Italy
| | | | - Wojciech G Polak
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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9
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Jung C, Fjølner J, Bruno RR, Wernly B, Artigas A, Bollen Pinto B, Schefold JC, Wolff G, Kelm M, Beil M, Sviri S, van Heerden PV, Szczeklik W, Czuczwar M, Joannidis M, Oeyen S, Zafeiridis T, Andersen FH, Moreno R, Leaver S, Boumendil A, De Lange DW, Guidet B, Flaatten H. Differences in mortality in critically ill elderly patients during the second COVID-19 surge in Europe. Crit Care 2021; 25:344. [PMID: 34556171 PMCID: PMC8459701 DOI: 10.1186/s13054-021-03739-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The primary aim of this study was to assess the outcome of elderly intensive care unit (ICU) patients treated during the spring and autumn COVID-19 surges in Europe. METHODS This was a prospective European observational study (the COVIP study) in ICU patients aged 70 years and older admitted with COVID-19 disease from March to December 2020 to 159 ICUs in 14 European countries. An electronic database was used to register a number of parameters including: SOFA score, Clinical Frailty Scale, co-morbidities, usual ICU procedures and survival at 90 days. The study was registered at ClinicalTrials.gov (NCT04321265). RESULTS In total, 2625 patients were included, 1327 from the first and 1298 from the second surge. Median age was 74 and 75 years in surge 1 and 2, respectively. SOFA score was higher in the first surge (median 6 versus 5, p < 0.0001). The PaO2/FiO2 ratio at admission was higher during surge 1, and more patients received invasive mechanical ventilation (78% versus 68%, p < 0.0001). During the first 15 days of treatment, survival was similar during the first and the second surge. Survival was lower in the second surge after day 15 and differed after 30 days (57% vs 50%) as well as after 90 days (51% vs 40%). CONCLUSION An unexpected, but significant, decrease in 30-day and 90-day survival was observed during the second surge in our cohort of elderly ICU patients. The reason for this is unclear. Our main concern is whether the widespread changes in practice and treatment of COVID-19 between the two surges have contributed to this increased mortality in elderly patients. Further studies are urgently warranted to provide more evidence for current practice in elderly patients. TRIAL REGISTRATION NUMBER NCT04321265 , registered March 19th, 2020.
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Affiliation(s)
- Christian Jung
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Antonio Artigas
- Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Universitätsspital, University of Bern, Bern, Switzerland
| | - Georg Wolff
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Malte Kelm
- Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Miroslaw Czuczwar
- 2nd Department of Anesthesiology and Intensive Care, Medical University of Lublin, Staszica 16, 20-081, Lublin, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | | | - Finn H Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos E Trauma. Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospital NHS Foundation Trust, London, UK
| | - Ariane Boumendil
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Dylan W De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins, 75012, Paris, France
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Department of Anaestesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
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10
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Giannini F, Toselli M, Palmisano A, Cereda A, Vignale D, Leone R, Nicoletti V, Gnasso C, Monello A, Manfrini M, Khokhar A, Sticchi A, Biagi A, Turchio P, Tacchetti C, Landoni G, Boccia E, Campo G, Scoccia A, Ponticelli F, Danzi GB, Loffi M, Muri M, Pontone G, Andreini D, Mancini EM, Casella G, Iannopollo G, Nannini T, Ippolito D, Bellani G, Franzesi CT, Patelli G, Besana F, Costa C, Vignali L, Benatti G, Sverzellati N, Scarnecchia E, Lombardo FP, Anastasio F, Iannaccone M, Vaudano PG, Pacielli A, Baffoni L, Gardi I, Cesini E, Sperandio M, Micossi C, De Carlini CC, Spreafico C, Maggiolini S, Bonaffini PA, Iacovoni A, Sironi S, Senni M, Fominskiy E, De Cobelli F, Maggioni AP, Rapezzi C, Ferrari R, Colombo A, Esposito A. Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients. J Cardiovasc Comput Tomogr 2021; 15:421-430. [PMID: 33744175 PMCID: PMC7946543 DOI: 10.1016/j.jcct.2021.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. OBJECTIVES The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. METHODS 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes. RESULTS Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ± 570.92 vs 206.80 ± 424.13 mm2, p < 0.001); Volume (487.79 ± 565.34 vs 207.77 ± 406.81, p < 0.001)], aortic valve [Volume (322.45 ± 390.90 vs 98.27 ± 250.74 mm2, p < 0.001; Agatston 337.38 ± 414.97 vs 111.70 ± 282.15, p < 0.001)] and thoracic aorta [Volume (3786.71 ± 4225.57 vs 1487.63 ± 2973.19 mm2, p < 0.001); Agatston (4688.82 ± 5363.72 vs 1834.90 ± 3761.25, p < 0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046-1.637, p = 0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200-3.251, p = 0.007) resulted to be independent predictors of in-hospital mortality. CONCLUSION Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.
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Affiliation(s)
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Anna Palmisano
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Davide Vignale
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Riccardo Leone
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Valeria Nicoletti
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Chiara Gnasso
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | | | - Marco Manfrini
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Arif Khokhar
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | - Carlo Tacchetti
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | - Edda Boccia
- IRCCS San Raffaele Scientific Institute, Italy
| | - Gianluca Campo
- Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elisa Scarnecchia
- ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy
| | | | - Fabio Anastasio
- ASST Valtellina and Alto Lario, "Eugenio Morelli Hospital", Sondalo, Italy
| | | | | | | | - Lucio Baffoni
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Casa di Cura Villa dei Pini, Civitanova Marche, Italy
| | - Iljia Gardi
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Francesco De Cobelli
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
| | | | - Claudio Rapezzi
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy; Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Roberto Ferrari
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Colombo
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Antonio Esposito
- IRCCS San Raffaele Scientific Institute, Italy; Vita-Salute San Raffaele University, Italy
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11
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Sánchez-Rovira P, Pérez-Chica G, Ortega-Granados AL, Aguilar-García J, Díaz-Beltrán L, Gálvez-Montosa F, García-Verdejo F, Luque-Caro N, Quero-Blanco C, Fernández-Navarro M, Rodríguez-Sánchez A, Ruiz-Bailén M, Yaguez-Mateos L, Marín-Pozo JF, Sierra-Torres MI, Lacárcel-Bautista C, Duro-Ruiz GJ, Duro-Fernández MÁ, García-Alegría J, Herrero-Rodríguez C. Early use of tocilizumab in patients with severe pneumonia secondary to severe acute respiratory syndrome coronavirus 2 infection and poor prognostic criteria: Impact on mortality rate and intensive care unit admission. Medicine (Baltimore) 2021; 100:e26533. [PMID: 34398008 PMCID: PMC8294903 DOI: 10.1097/md.0000000000026533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/02/2021] [Accepted: 06/15/2021] [Indexed: 01/08/2023] Open
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, keeps spreading globally. Evidence suggests that a subgroup of patients with severe symptomatology might have cytokine storms, which increases mortality. The use of interleukin-6 (IL-6) inhibitors may help in controlling the pathological immune response to the virus. Tocilizumab, a monoclonal antibody against IL-6, stands as an optional treatment for COVID-19 patients presenting this inflammatory hyper-response.We conducted a retrospective, observational, cohort study including 50 patients affected by COVID-19 with severe pneumonia and poor prognosis criteria, who have also undergone standard treatment; 36 of these patients additionally received tocilizumab in an early stage. The need for intensive care unit (ICU) admission, mortality, recovery of respiratory function, and improvement of biochemical and hematological parameters were compared between cohorts.Most patients were men, non-smokers and the most frequently reported comorbidities were hypertension and diabetes. Recurrent symptoms were fever, cough, and dyspnoea. 54.8% of patients from the tocilizumab group needed intubation, while in the control group 85.7% needed it. Treatment with tocilizumab significatively increased IL-6 levels, (554.45; CI 95% 186.69, 1032.93; P < .05) while C-reactive protein mean levels were reduced (-108.19; CI 95% -140.15, -75.33; P < .05), but no significant difference was found between cohorts. In comparison with the controls, tocilizumab reduced mortality (25.0% vs 42.9%, P = .021) and the number of ICU admissions (63.9% vs 100.0%, P = .021). 44.1% of patients treated with tocilizumab showed favorable radiological evolution, when compared with 15.4% of patients from the control group.Tocilizumab may improve clinical symptoms and mitigate deterioration observed in severe COVID-19 patients, and could be considered as an effective therapeutic option in subjects experiencing a significant inflammatory response to the disease.
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12
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Huang R, Meng T, Zha Q, Cheng K, Zhou X, Zheng J, Zhang D, Liu R. The predicting roles of carcinoembryonic antigen and its underlying mechanism in the progression of coronavirus disease 2019. Crit Care 2021; 25:234. [PMID: 34217339 PMCID: PMC8254455 DOI: 10.1186/s13054-021-03661-y] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/29/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has induced a worldwide epidemiological event with a high infectivity and mortality. However, the predicting biomarkers and their potential mechanism in the progression of COVID-19 are not well known. OBJECTIVE The aim of this study is to identify the candidate predictors of COVID-19 and investigate their underlying mechanism. METHODS The retrospective study was conducted to identify the potential laboratory indicators with prognostic values of COVID-19 disease. Then, the prognostic nomogram was constructed to predict the overall survival of COVID-19 patients. Additionally, the scRNA-seq data of BALF and PBMCs from COVID-19 patients were downloaded to investigate the underlying mechanism of the most important prognostic indicators in lungs and peripherals, respectively. RESULTS In total, 304 hospitalized adult COVID-19 patients in Wuhan Jinyintan Hospital were included in the retrospective study. CEA was the only laboratory indicator with significant difference in the univariate (P < 0.001) and multivariate analysis (P = 0.020). The scRNA-seq data of BALF and PBMCs from COVID-19 patients were downloaded to investigate the underlying mechanism of CEA in lungs and peripherals, respectively. The results revealed the potential roles of CEA were significantly distributed in type II pneumocytes of BALF and developing neutrophils of PBMCs, participating in the progression of COVID-19 by regulating the cell-cell communication. CONCLUSION This study identifies the prognostic roles of CEA in COVID-19 patients and implies the potential roles of CEACAM8-CEACAM6 in the progression of COVID-19 by regulating the cell-cell communication of developing neutrophils and type II pneumocyte.
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Affiliation(s)
- Runzhi Huang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, 200065, China
| | - Tong Meng
- Shanghai General Hospital, 100 Haining Road, Shanghai, 200080, China
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | - Qiongfang Zha
- Department of Respiratory and Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China
| | - Kebin Cheng
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200433, China
| | - Xin Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, 100 Haining Road, Shanghai, 200080, China
| | - Junhua Zheng
- Tongji University Cancer Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China
| | | | - Ruilin Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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13
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Pop-Vicas A, Haleem A, Osman F, Fuglestad R, Shirley D, Striker R, Safdar N. Risk Factors and Mortality for Atypical Presentation of COVID-19 Infection in Hospitalized Patients - Lessons From the Early Pandemic. WMJ 2021; 120:94-99. [PMID: 34255947] [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: 06/13/2023]
Abstract
OBJECTIVE To assess the clinical epidemiology and outcomes of patients hospitalized with COVID-19 who did not experience fever and cough during the early pandemic. METHODS Retrospective cohort of all patients admitted during March 13, 2020 through May 13, 2020 with laboratory-confirmed COVID-19 to 3 tertiary-care hospitals. Patient-level data (demographic, clinical manifestations, comorbid illnesses, inpatient treatment) were analyzed. The main outcome variable was atypical presentation, defined as any hospitalized patient with COVID-19 infection who did not experience both fever and cough. We identified risk factors for atypical presentation on univariate and multivariate analyses and assessed 30-day mortality differences via survival analysis. RESULTS Of 163 patients in the study, 39 (24%) were atypical. On univariate analysis, atypical cases were significantly more likely to be older, reside in a long-term-care facility (LTCF), and have underlying diabetes mellitus, stroke, or cardiac disease; present without dyspnea or myalgia, have lower C-reactive proteins (CRP) and higher beta-natriuretic peptides. They were less likely to receive intensive care unit care or specific COVID-19 treatments (P < .05). The incidence of acute respiratory failure was not significantly different between the groups. On logistic regression, atypical cases were significantly more likely to be LTCF residents (P = 0.003) and have a lower average CRP (P = 0.01). Atypical cases had significantly higher 30-day mortality (hazard ratio 3.4 [95% CI, 1.6 - 7.2], P = 0.002). CONCLUSION During the first pandemic surge, COVID-19 patients without inflammatory signs and symptoms were more likely to be LTCF residents and had higher mortality. Timely recognition of these atypical presentations may have prevented spread and improved clinical outcomes.
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Affiliation(s)
- Aurora Pop-Vicas
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
| | - Ambar Haleem
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Fauzia Osman
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ryan Fuglestad
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Daniel Shirley
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert Striker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nasia Safdar
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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14
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Tilliridou V, Kirkbride R, Dickinson R, Tiernan J, Yong GL, van Beek EJR, Murchison JT, Williams MC. Pulmonary embolism severity before and during the COVID-19 pandemic. Br J Radiol 2021; 94:20210264. [PMID: 34106780 PMCID: PMC8248223 DOI: 10.1259/bjr.20210264] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. METHODS In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. RESULTS In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). CONCLUSION During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. ADVANCES IN KNOWLEDGE During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.
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Affiliation(s)
- Vicky Tilliridou
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rachael Kirkbride
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca Dickinson
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James Tiernan
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Guo Liang Yong
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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15
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Chua F, Vancheeswaran R, Draper A, Vaghela T, Knight M, Mogal R, Singh J, Spencer LG, Thwaite E, Mitchell H, Calmonson S, Mahdi N, Assadullah S, Leung M, O'Neill A, Popat C, Kumar R, Humphries T, Talbutt R, Raghunath S, Molyneaux PL, Schechter M, Lowe J, Barlow A. Early prognostication of COVID-19 to guide hospitalisation versus outpatient monitoring using a point-of-test risk prediction score. Thorax 2021; 76:696-703. [PMID: 33692174 PMCID: PMC7948158 DOI: 10.1136/thoraxjnl-2020-216425] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 10/19/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Risk factors of adverse outcomes in COVID-19 are defined but stratification of mortality using non-laboratory measured scores, particularly at the time of prehospital SARS-CoV-2 testing, is lacking. METHODS Multivariate regression with bootstrapping was used to identify independent mortality predictors in patients admitted to an acute hospital with a confirmed diagnosis of COVID-19. Predictions were externally validated in a large random sample of the ISARIC cohort (N=14 231) and a smaller cohort from Aintree (N=290). RESULTS 983 patients (median age 70, IQR 53-83; in-hospital mortality 29.9%) were recruited over an 11-week study period. Through sequential modelling, a five-predictor score termed SOARS (SpO2, Obesity, Age, Respiratory rate, Stroke history) was developed to correlate COVID-19 severity across low, moderate and high strata of mortality risk. The score discriminated well for in-hospital death, with area under the receiver operating characteristic values of 0.82, 0.80 and 0.74 in the derivation, Aintree and ISARIC validation cohorts, respectively. Its predictive accuracy (calibration) in both external cohorts was consistently higher in patients with milder disease (SOARS 0-1), the same individuals who could be identified for safe outpatient monitoring. Prediction of a non-fatal outcome in this group was accompanied by high score sensitivity (99.2%) and negative predictive value (95.9%). CONCLUSION The SOARS score uses constitutive and readily assessed individual characteristics to predict the risk of COVID-19 death. Deployment of the score could potentially inform clinical triage in preadmission settings where expedient and reliable decision-making is key. The resurgence of SARS-CoV-2 transmission provides an opportunity to further validate and update its performance.
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Affiliation(s)
- Felix Chua
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rama Vancheeswaran
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Adrian Draper
- Respiratory Medicine, St. George's Hospital, London, UK
| | - Tejal Vaghela
- Information Governance, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Matthew Knight
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Rahul Mogal
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Jaswinder Singh
- Radiology, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Lisa G Spencer
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Erica Thwaite
- Radiology, Aintree site, Liverpool Hospitals NHS Foundation Trust, UK, Liverpool, UK
| | - Harry Mitchell
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Sam Calmonson
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Noor Mahdi
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | - Matthew Leung
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Aisling O'Neill
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Chhaya Popat
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Radhika Kumar
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Thomas Humphries
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rebecca Talbutt
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sarika Raghunath
- Respiratory Medicine, Aintree site, Liverpool Hospitals NHS Foundation Trust, Liverpool, UK
| | - Philip L Molyneaux
- Interstitial Lung Disease Unit, Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Miriam Schechter
- Information Governance, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Jeremy Lowe
- Information Governance, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Andrew Barlow
- Respiratory Medicine, West Hertfordshire Hospitals NHS Trust, Watford, UK
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Bhutta ZA, Siddiqi S, Hafeez A, Islam M, Nundy S, Qadri F, Sultan F. Beyond the numbers: understanding the diversity of covid-19 epidemiology and response in South Asia. BMJ 2021; 373:n1544. [PMID: 34172460 DOI: 10.1136/bmj.n1544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Zulfiqar A Bhutta
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Assad Hafeez
- Health Services Academy University, Islamabad, Pakistan
| | - Muhammad Islam
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Samiran Nundy
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
| | - Firdausi Qadri
- International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Faisal Sultan
- Ministry of Health Services, Regulation and Coordination, Islamabad, Pakistan
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17
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Adham D, Habibzadeh S, Ghobadi H, Jajin SA, Abbasi-Ghahramanloo A, Moradi-Asl E. Epidemiological characteristics and mortality risk factors among COVID-19 patients in Ardabil, Northwest of Iran. BMC Emerg Med 2021; 21:67. [PMID: 34078273 PMCID: PMC8170426 DOI: 10.1186/s12873-021-00463-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. METHODS In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. RESULTS Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. CONCLUSIONS Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.
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Affiliation(s)
- Davoud Adham
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shahram Habibzadeh
- Department of Infection Diseases, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Ghobadi
- Department of Internal Medicine, Pulmonary Division, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Shabnam Asghari Jajin
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Eslam Moradi-Asl
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran.
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18
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Bamgboye EL, Omiye JA, Afolaranmi OJ, Davids MR, Tannor EK, Wadee S, Niang A, Were A, Naicker S. COVID-19 Pandemic: Is Africa Different? J Natl Med Assoc 2021; 113:324-335. [PMID: 33153755 PMCID: PMC7607238 DOI: 10.1016/j.jnma.2020.10.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 09/16/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
COVID-19 has now spread to all the continents of the world with the possible exception of Antarctica. However, Africa appears different when compared with all the other continents. The absence of exponential growth and the low mortality rates contrary to that experienced in other continents, and contrary to the projections for Africa by various agencies, including the World Health Organization (WHO) has been a puzzle to many. Although Africa is the second most populous continent with an estimated 17.2% of the world's population, the continent accounts for only 5% of the total cases and 3% of the mortality. Mortality for the whole of Africa remains at a reported 19,726 as at August 01, 2020. The onset of the pandemic was later, the rate of rise has been slower and the severity of illness and case fatality rates have been lower in comparison to other continents. In addition, contrary to what had been documented in other continents, the occurrence of the renal complications in these patients also appeared to be much lower. This report documents the striking differences between the continents and within the continent of Africa itself and then attempts to explain the reasons for these differences. It is hoped that information presented in this review will help policymakers in the fight to contain the pandemic, particularly within Africa with its resource-constrained health care systems.
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Affiliation(s)
| | | | | | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Shoyab Wadee
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdou Niang
- Dalal Jamm Hospital, Dakar Cheikh A. Diop University, Senegal
| | - Anthony Were
- Department of Medicine, East African Kidney Institute, College of Health Sciences, University of Nairobi, Kenya
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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19
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Abstract
OBJECTIVE Current meta-analysis aims to understand the effect of oral supplementation of vitamin D on intensive care unit (ICU) requirement and mortality in hospitalized COVID-19 patients. METHODS Databases PubMed, preprint servers, and google scholar were searched from December 2019 to December 2020. Authors searched for the articles assessing role of vitamin D supplementation on COVID-19. Cochrane RevMan tool was used for quantitative assessment of the data, where heterogeneity was assessed using I2 and Q statistics and data was expressed using odds ratio with 95% confidence interval. RESULTS Final meta-analysis involved pooled data of 532 hospitalized patients (189 on vitamin D supplementation and 343 on usual care/placebo) of COVID-19 from three studies (Two randomized controlled trials, one retrospective case-control study). Statistically (p<0.0001) lower ICU requirement was observed in patients with vitamin D supplementation as compared to patients without supplementations (odds ratio: 0.36; 95% CI: 0.210-0.626). However, it suffered from significant heterogeneity, which reduced after sensitivity analysis. In case of mortality, vitamin D supplements has comparable findings with placebo treatment/usual care (odds ratio: 0.93; 95% CI: 0.413-2.113; p=0.87). The studies did not show any publication bias and had fair quality score. Subgroup analysis could not be performed due to limited number of studies and hence dose and duration dependent effect of vitamin D could not be evaluated. CONCLUSIONS Although the current meta-analysis findings indicate potential role of vitamin D in improving COVID-19 severity in hospitalized patients, more robust data from randomized controlled trials are needed to substantiate its effects on mortality.
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Affiliation(s)
- K Shah
- From the Indian Institute of Public Health—Gandhinagar, Gandhinagar 382042, Gujarat, India
| | - D Saxena
- From the Indian Institute of Public Health—Gandhinagar, Gandhinagar 382042, Gujarat, India
| | - D Mavalankar
- From the Indian Institute of Public Health—Gandhinagar, Gandhinagar 382042, Gujarat, India
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20
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Raheja H, Chukwuka N, Agarwal C, Sharma D, Munoz-Martinez A, Fogel J, Khalid M, Hashmi AT, Ehrlich S, Waheed MA, Siddiqui S, de Brito Gomes BA, Aslam A, Merino Gualan CJ, Aftab I, Tiwari A, Singh S, Pouching K, Somal N, Shani J, Rojas-Marte G. Should COVID-19 patients >75 years be Ventilated? An Outcome Study. QJM 2021; 114:182-189. [PMID: 33580251 PMCID: PMC7928642 DOI: 10.1093/qjmed/hcab029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Elderly patients with COVID-19 disease are at increased risk for adverse outcomes. Current data regarding disease characteristics and outcomes in this population are limited. AIM To delineate the adverse factors associated with outcomes of COVID-19 patients ≥75 years of age. DESIGN Retrospective cohort study. METHODS Patients were classified into mild/moderate, severe/very severe and critical disease (intubated) based on oxygen requirements. The primary outcome was in-hospital mortality. RESULTS A total of 355 patients aged ≥75 years hospitalized with COVID-19 between 19 March and 25 April 2020 were included.Mean age was 84.3 years. One-third of the patients developed critical disease. Mean length of stay was 7.10 days. Vasopressors were required in 27%, with the highest frequency in the critical disease group (74.1%). Overall mortality was 57.2%, with a significant difference between severity groups (mild/moderate disease: 17.4%, severe/very severe disease: 71.3%, critical disease: 94.9%, P < 0.001).Increased age, dementia, and severe/very severe and critical disease groups were independently associated with increased odds for mortality while diarrhea was associated with decreased odds for mortality (OR: 0.12, 95% CI: 0.02-0.60, P < 0.05). None of the cardiovascular comorbidities were significantly associated with mortality. CONCLUSION Age and dementia are associated with increased odds for mortality in patients ≥75 years of age hospitalized with COVID-19. Those who require intubation have the greatest odds for mortality. Diarrhea as a presenting symptom was associated with lower odds for mortality.
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Affiliation(s)
- H Raheja
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - N Chukwuka
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - C Agarwal
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - D Sharma
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - A Munoz-Martinez
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - J Fogel
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - M Khalid
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - A T Hashmi
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - S Ehrlich
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - M A Waheed
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - S Siddiqui
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - B A de Brito Gomes
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - A Aslam
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - C J Merino Gualan
- Department of Volunteer and Student Services, Maimonides Medical Center, Brooklyn, NY, USA
| | - I Aftab
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - A Tiwari
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - S Singh
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - K Pouching
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - N Somal
- Department of Internal Medicine, Maimonides Medical Center, 475 Seaview Avenue, Staten Island NY 10305, USA
| | - J Shani
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
| | - G Rojas-Marte
- Department of Cardiology, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Staten Island, NY, USA
- Address correspondence to Geurys R Rojas-Marte, M.D., Department of Cardiology, Maimonides Medical Center, Assistant Professor of Cardiology, Zucker School of Medicine at Hosftra/Northwell, 4802 10th Ave, Brooklyn, NY, USA.
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21
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Mohammadi F, Oshvandi K, Shamsaei F, Cheraghi F, Khodaveisi M, Bijani M. The mental health crises of the families of COVID-19 victims: a qualitative study. BMC Fam Pract 2021; 22:94. [PMID: 33992079 PMCID: PMC8123094 DOI: 10.1186/s12875-021-01442-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 04/23/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The bereaved families of COVID-19 victims are among the most vulnerable social groups in the COVID-19 pandemic. This highly infectious and contagious disease has afflicted these families with numerous psychological crises which have not been studied much yet. The present study is an attempt at investigating the psychological challenges and issues which the families of COVID-19 victims are faced with. The present study aims to identify the Mental Health crises which the families of COVID-19 deceased victims are going through. METHODS A qualitative research, the present study uses a conventional content analysis design. The participants were 16 members of the families of COVID-19 victims selected from medical centers in Iran from February to May 2020 via purposeful sampling. Sampling continued to the point of data saturation Data were collected via semi-structured individual interviews conducted online. The collected data were analyzed according to the conventional qualitative content analysis approach. RESULTS Analyses of the data yielded two main themes and seven categories. Emotional shock included (feelings of guilt and rumination, bitter farewell, strange burial and concern about unreligious burial), and fear of the future included (instability in the family, lack of job security and difficult financial conditions, Stigmatization and complications in social interactions). CONCLUSION The families of COVID-19 deceased victims are affected by various psychological crises which have exposed them to a deep sense of loss and emotional shock. Therefore, there is an urgent need for a cultural context which recognizes and supports all the various aspects of the mental health of these families.
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Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases(Home Care) Research Center and Autism Spectrum Disorders Research Center, School of Nursing and Midwifery, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Mother and Child Care Research Center, School of Nursing and Midwifery, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Shamsaei
- Behavioral Disorders and Substance Abuse Research Center, Institute of Mental Health and Addiction, School of Nursing and Midwifery, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fateme Cheraghi
- Chronic Diseases (Homecare) Research Center, School of Nursing and Midwifery, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Khodaveisi
- Chronic Diseases (Homecare) Research Center, School of Nursing and Midwifery, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mostafa Bijani
- Clinical Research Development Unit, Valiasr Hospital, Fasa University of Medical Sciences, Fasa, Iran.
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22
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Abstract
Respiratory failure is the major cause of death in patients with coronavirus disease (COVID-19). Data on factors affecting the need for oxygen therapy in early-stage COVID-19 are limited. This study aimed to evaluate the factors associated with the need for oxygen therapy in patients with COVID-19.This is a retrospective study of consecutive COVID-19 patients who were hospitalized between February 27 and June 28, 2020, in South Korea. Logistic regression analyses were performed to identify the factors associated with the need for oxygen therapy.Of the 265 patients included in the study, 26 (9.8%) received oxygen therapy, and 7 of these patients (29.2%) were transferred to a step-up facility, and 3 (11.5%) died. The median age of all patients was 46 years (IQR, 30-60 years), and the median modified early warning score at admission was 1 (IQR, 1-2). In a multivariate logistic regression analysis, being a current smoker (odds ratio [OR] 7.641, 95% confidence interval [CI] 1.686-34.630, P = .008), heart rate (OR 1.053, 95% CI 1.010-1.097, P = .014), aspartate aminotransferase values (OR 1.049, 95% CI 1.008-1.092, P = .020), blood urea nitrogen levels (OR 1.171, 95% CI 1.073-1.278, P < .001), and chest radiographic findings (OR 3.173, 95% CI 1.870-5.382, P < .001) were associated with oxygen therapy.In patients with less severe COVID-19, the need for oxygen therapy is affected by smoking and elevated values of aspartate aminotransferase and blood urea nitrogen. Further research is warranted on the risk factors for deterioration in COVID-19 to efficiently allocate medical resources.
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Affiliation(s)
- Chang Suk Noh
- Department of Pulmonology, Seongnam Citizens Medical Center, Seongnam-si, Gyeonggi-do
| | - Won-Young Kim
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Moon Seong Baek
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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23
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Kim DH, Park HC, Cho A, Kim J, Yun KS, Kim J, Lee YK. Age-adjusted Charlson comorbidity index score is the best predictor for severe clinical outcome in the hospitalized patients with COVID-19 infection. Medicine (Baltimore) 2021; 100:e25900. [PMID: 33951004 PMCID: PMC8104192 DOI: 10.1097/md.0000000000025900] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain.This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit, use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death.Among 5621 patients, the high CCIS (≥ 3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45-5.37, P < .001) and patient mortality (HR 22.96, 95% CI 7.20-73.24, P < .001). The nomogram showed that CCIS was the most important factor contributing to the prognosis followed by the presence of dyspnea (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.16-3.83), low body mass index < 18.5 kg/m2 (HR 2.36, CI 1.49-3.75), lymphopenia (<0.8 x109/L) (HR 2.15, CI 1.59-2.91), thrombocytopenia (<150.0 x109/L) (HR 1.29, CI 0.94-1.78), anemia (<12.0 g/dL) (HR 1.80, CI 1.33-2.43), and male sex (HR 1.76, CI 1.32-2.34). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality.The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.
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Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Ajin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Juhee Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Kyu-sang Yun
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Jinseog Kim
- Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
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24
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Lee HY, Ahn J, Park J, Kang CK, Won SH, Kim DW, Park JH, Chung KH, Joh JS, Bang JIH, Kang CH, Oh MD, Pyun WB. Different therapeutic associations of renin-angiotensin system inhibitors with coronavirus disease 2019 compared with usual pneumonia. Korean J Intern Med 2021; 36:617-628. [PMID: 33858123 PMCID: PMC8137390 DOI: 10.3904/kjim.2020.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND/AIMS Although it is near concluded that renin-angiotensin system inhibitors do not have a harmful effect on coronavirus disease 2019 (COVID-19), there is no report about whether angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) offer any protective role. This study aimed to compare the association of ARBs and ACEIs with COVID-19-related mortality. METHODS All patients with COVID-19 in Korea between January 19 and April 16, 2020 were enrolled. The association of ARBs and ACEIs with mortality within 60 days were evaluated. A comparison of hazard ratio (HR) was performed between COVID-19 patients and a retrospective cohort of pneumonia patients hospitalized in 2019 in Korea. RESULTS Among 10,448 COVID-19 patients, ARBs and ACEIs were prescribed in 1,231 (11.7%) and 57 (0.6%) patients, respectively. After adjusting for age, sex, and history of comorbidities, the ARB group showed neutral association (HR, 1.034; 95% CI, 0.765 to 1.399; p = 0.8270) and the ACEI groups showed no significant associations likely owing to the small population size (HR, 0.736; 95% CI, 0.314 to 1.726; p = 0.4810). When comparing HR between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia in 2019, the trend of ACEIs showed similar benefits, whereas the protective effect of ARBs observed in the retrospective cohort was absent in COVID-19 patients. Meta-analyses showed significant positive correlation with survival of ACEIs, whereas a neutral association between ARBs and mortality. CONCLUSION Although ARBs or ACEIs were not associated with fatal outcomes, potential beneficial effects of ARBs observed in pneumonia were attenuated in COVID-19.
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Affiliation(s)
- Hae-Young Lee
- Korean Society of Hypertension, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Juhee Ahn
- Department of Public Health Sciences, Seoul National University, Seoul, Korea
| | - Juhong Park
- Department of Public Health Sciences, Seoul National University, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung-Ho Won
- Department of Public Health Sciences, Seoul National University, Seoul, Korea
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | | | - Jong-Heon Park
- National Health Insurance Service, Wonju, Korea
- Department of Benefits Strategy, National Health Insurance Service, Wonju, Korea
| | - Ki-Hyun Chung
- National Medical Center, Seoul, Korea
- National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
| | | | - JI Hwan Bang
- National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
- The Central Infectious Disease Hospital, Seoul, Korea
| | | | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- National Committee for Clinical Management of Emerging Infectious Diseases, Seoul, Korea
| | - Wook Bum Pyun
- Korean Society of Hypertension, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
- Correspondence to Wook Bum Pyun, M.D. Korean Society of Hypertension and Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, 1071 Anyangcheonro, Yangcheon-gu, Seoul 07985, Korea TEL: +82-2-6986-1627 FAX: +82-2-2650-6166 E-mail:
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Budhathoki P, Shrestha DB, Khadka S, Rawal E. Is Hydroxychloroquine with Azithromycin a Good Combination in COVID-19 Compared to Hydroxychloroquine Alone from Cardiac Perspective? A Systematic Review and Meta-Analysis. J Nepal Health Res Counc 2021; 19:1-9. [PMID: 33934125 DOI: 10.33314/jnhrc.v19i1.3270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/07/2020] [Accepted: 04/23/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND The global spread of COVID-19 and the lack of definite treatment have caused an alarming crisis in the world. We aimed to evaluate the outcome and potential harmful cardiac effects of hydroxychloroquine and azithromycin compared to hydroxychloroquine alone for COVID-19 treatment. METHODS PubMed, Medline, Google Scholar, Cochrane Library, clinicaltrials.gov, and World Health Organization clinical trial registry were searched using appropriate keywords and identified six studies using PRISMA guidelines. The quantitative synthesis was performed using fixed or random effects for the pooling of studies based on heterogeneities. RESULTS The risk of mortality (RR=1.16; CI: 0.92-1.46) and adverse cardiac events (OR=1.06; CI: 0.82-1.37) demonstrated a small increment though of no significance. There were no increased odds of mechanical ventilation (OR=0.84; CI: 0.33-2.15) and significant QTc prolongation (OR=0.84, CI: 0.59-1.21). Neither the critical QTc threshold (OR=1.92, CI: 0.81-4.56) nor absolute ?QTc ?60ms (OR=1.95, CI:0.55-6.96) increased to the level of statistical significance among hydroxychloroquine and azithromycin arm compared to hydroxychloroquine alone, but the slightly increased odds need to be considered in clinical practice. CONCLUSIONS The combination of hydroxychloroquine and azithromycin leads to small increased odds of mortality and cardiac events compared to hydroxychloroquine alone. The use of hydroxychloroquine and azithromycin led to increased odds of QT prolongation, although not statistically significant.
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Affiliation(s)
- Pravash Budhathoki
- Department of Emergency Medicine, Dr Iwamura Memorial Hospital, Bhaktapur-44800, Nepal
| | | | - Sitaram Khadka
- Department of Pharmacy, Shree Birendra Hospital; Nepalese Army Institute of Health Sciences, Kathmandu-44600, Nepal
| | - Era Rawal
- Department of Emergency Medicine, Kathmandu Medical College, Kathmandu-44600, Nepal
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Dentone C, Vena A, Loconte M, Grillo F, Brunetti I, Barisione E, Tedone E, Mora S, Di Biagio A, Orsi A, De Maria A, Nicolini L, Ball L, Giacobbe DR, Magnasco L, Delfino E, Mastracci L, Mangerini R, Taramasso L, Sepulcri C, Pincino R, Bavastro M, Cerchiaro M, Mikulska M, Bruzzone B, Icardi G, Frisoni P, Gratarola A, Patroniti N, Pelosi P, Bassetti M. Bronchoalveolar lavage fluid characteristics and outcomes of invasively mechanically ventilated patients with COVID-19 pneumonia in Genoa, Italy. BMC Infect Dis 2021; 21:353. [PMID: 33858331 PMCID: PMC8049078 DOI: 10.1186/s12879-021-06015-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/10/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The primary objective of the study is to describe the cellular characteristics of bronchoalveolar lavage fluid (BALF) of COVID-19 patients requiring invasive mechanical ventilation; the secondary outcome is to describe BALF findings between survivors vs non-survivors. MATERIALS AND METHODS Patients positive for SARS-CoV-2 RT PCR, admitted to ICU between March and April 2020 were enrolled. At ICU admission, BALF were analyzed by flow cytometry. Univariate, multivariate and Spearman correlation analyses were performed. RESULTS Sixty-four patients were enrolled, median age of 64 years (IQR 58-69). The majority cells in the BALF were neutrophils (70%, IQR 37.5-90.5) and macrophages (27%, IQR 7-49) while a minority were lymphocytes, 1%, TCD3+ 92% (IQR 82-95). The ICU mortality was 32.8%. Non-survivors had a significantly older age (p = 0.033) and peripheral lymphocytes (p = 0.012) were lower compared to the survivors. At multivariate analysis the percentage of macrophages in the BALF correlated with poor outcome (OR 1.336, CI95% 1.014-1.759, p = 0.039). CONCLUSIONS In critically ill patients, BALF cellularity is mainly composed of neutrophils and macrophages. The macrophages percentage in the BALF at ICU admittance correlated with higher ICU mortality. The lack of lymphocytes in BALF could partly explain a reduced anti-viral response.
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Affiliation(s)
- Chiara Dentone
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Maurizio Loconte
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Federica Grillo
- Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Emanuela Barisione
- Interventional Pulmonology Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Elisabetta Tedone
- Flow Cytometry Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Sara Mora
- Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, Genoa, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Andrea Orsi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Andrea De Maria
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Nicolini
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Laura Magnasco
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Emanuele Delfino
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Luca Mastracci
- Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Rosa Mangerini
- Flow Cytometry Unit, Policlinico San Martino University Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Chiara Sepulcri
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Rachele Pincino
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Martina Bavastro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matteo Cerchiaro
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Malgorzata Mikulska
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Hygiene Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Paolo Frisoni
- Department of Anesthesia and Resuscitation, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Angelo Gratarola
- Department of Anesthesia and Resuscitation, Policlinico San Martino Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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Cottini M, Lombardi C, Berti A. Obesity is a Major Risk Factor for Hospitalization in Community-Managed COVID-19 Pneumonia. Mayo Clin Proc 2021; 96:921-931. [PMID: 33814092 PMCID: PMC7859712 DOI: 10.1016/j.mayocp.2021.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed to investigate whether the stratification of outpatients with coronavirus disease 2019 (COVID-19) pneumonia by body mass index (BMI) can help predict hospitalization and other severe outcomes. PATIENTS AND METHODS We prospectively collected consecutive cases of community-managed COVID-19 pneumonia from March 1 to April 20, 2020, in the province of Bergamo and evaluated the association of overweight (25 kg/m2 ≤ BMI <30 kg/m2) and obesity (≥30 kg/m2) with time to hospitalization (primary end point), low-flow domiciliary oxygen need, noninvasive mechanical ventilation, intubation, and death due to COVID-19 (secondary end points) in this cohort. We analyzed the primary end point using multivariable Cox models. RESULTS Of 338 patients included, 133 (39.4%) were overweight and 77 (22.8%) were obese. Age at diagnosis was younger in obese patients compared with those overweight or with normal weight (P<.001), whereas diabetes, dyslipidemia, and heart diseases were differently distributed among BMI categories. Azithromycin, hydroxychloroquine, and prednisolone use were similar between BMI categories (P>.05). Overall, 105 (31.1%) patients were hospitalized, and time to hospitalization was significantly shorter for obese vs over- or normal-weight patients (P<.001). In the final multivariable analysis, obese patients were more likely to require hospitalization than nonobese patients (hazard ratio, 5.83; 95% CI, 3.91 to 8.71). Results were similar in multiple sensitivity analyses. Low-flow domiciliary oxygen need, hospitalization with noninvasive mechanical ventilation, intubation, and death were significantly associated with obesity (P<.001). CONCLUSION In patients with community-managed COVID-19 pneumonia, obesity is associated with a higher hospitalization risk and overall worse outcomes than for nonobese patients.
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Key Words
- bmi, body mass index
- covid-19, coronavirus disease 2019
- ct, computed tomography
- hcq, hydroxychloroquine
- hr, hazard ratio
- icu, intensive care unit
- niv, noninvasive ventilation
- o2, oxygen
- rt-pcr, reverse transcriptase–polymerase chain reaction
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
- Marcello Cottini
- Pulmonology, Allergy & Clinical Immunology Outpatient Clinic, Bergamo, Italy.
| | - Carlo Lombardi
- Departmental Unit of Pneumology & Allergology-COVID19 Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alvise Berti
- Ospedale Santa Chiara and Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Italy; Thoracic Disease Research Unit, Mayo Clinic, Rochester, MN.
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Imran MM, Ahmad U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio-A marker of COVID-19 pneumonia severity. Int J Clin Pract 2021; 75:e13698. [PMID: 32892477 DOI: 10.1111/ijcp.13698] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/26/2020] [Indexed: 01/07/2023] Open
Abstract
AIM To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID-19 pneumonia in the South-Asian population. METHODS This was a prospective, cross-sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty-three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C-reactive protein, serum albumin and serum fibrinogen were measured. Patients' demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, medication use and history of lung malignancy were retrieved from their medical history. Patients were categorised into either a general group (with mild COVID-19) or a heavy group (with moderate to severe COVID-19). RESULTS There were significant differences between the two groups in diabetes prevalence, NLR, C-reactive protein and serum albumin. NLR and C-reactive protein were positively correlated (P < .001, P = .04, respectively) whereas serum albumin was negatively correlated (P = .009) with severe COVID-19. NLR was found to be an independent risk factor for severe COVID-19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = .015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for the early detection of deteriorating severe COVID-19 infection. CONCLUSION NLR can be used as an early warning signal for deteriorating severe COVID-19 infection and can provide an objective basis for early identification and management of severe COVID-19 pneumonia.
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Affiliation(s)
- Mehr Muhammad Imran
- Department of Pulmonology, District Headquarter Hospital, Faisalabad, Pakistan
| | - Umair Ahmad
- Department of Medicine, Allied Hospital, Faisalabad, Pakistan
- Medical Unit II, Faisalabad Medical University, Faisalabad, Pakistan
| | - Umer Usman
- Department of Pulmonology, District Headquarter Hospital, Faisalabad, Pakistan
- Medical Unit II, Faisalabad Medical University, Faisalabad, Pakistan
| | - Majid Ali
- College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Aamir Shaukat
- Department of Pulmonology, District Headquarter Hospital, Faisalabad, Pakistan
| | - Noor Gul
- Department of Pulmonology, District Headquarter Hospital, Faisalabad, Pakistan
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Keim ME, Lovallo AP. Validity of the National Health Security Preparedness Index as a Predictor of Excess COVID-19 Mortality. Prehosp Disaster Med 2021; 36:141-144. [PMID: 33397547 PMCID: PMC7809220 DOI: 10.1017/s1049023x20001521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020). METHODS Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient. RESULTS These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico. CONCLUSION The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.
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Affiliation(s)
- Mark E. Keim
- DisasterDoc LLC, Atlanta, GeorgiaUSA
- Beth Israel Deaconess Medical Center Disaster Medicine Fellowship, Harvard University, Boston, MassachusettsUSA
- Rollins School of Public Health, Emory University, Atlanta, GeorgiaUSA
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Ginsburgh V, Magerman G, Natali I. COVID-19 and the role of inequality in French regional departments. Eur J Health Econ 2021; 22:311-327. [PMID: 33387139 PMCID: PMC7776317 DOI: 10.1007/s10198-020-01254-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/24/2020] [Indexed: 05/26/2023]
Abstract
In this paper, we examine the variation in the outbreak of COVID-19 across departments in continental France. We use information on the cumulated number of deaths, discharged patients and infections from COVID-19 at the department level, and study how these relate to income inequality, controlling for other factors. We find that unfortunately, inequality kills: departments with higher income inequality face more deaths, more discharged (gravely ill) patients and more infections. While other papers have studied the impact of the level of income on the severity of COVID-19, we find that it is in fact the dispersion across incomes within the same department that drives the results. Our results suggest that individuals in relatively more precarious conditions deserve dedicated policies, to avoid that temporary shocks such as COVID-19 lead to permanent increases in inequality.
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Affiliation(s)
- Victor Ginsburgh
- ECARES, Université Libre de Bruxelles and CORE, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Glenn Magerman
- ECARES, Université Libre de Bruxelles and I3h, Université Libre de Bruxelles, Brussels, Belgium.
| | - Ilaria Natali
- ECARES, Université Libre de Bruxelles and I3h, Université Libre de Bruxelles, Brussels, Belgium
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Bloomer MJ, Bouchoucha S. Australian College of Critical Care Nurses and Australasian College for Infection Prevention and Control position statement on facilitating next-of-kin presence for patients dying from coronavirus disease 2019 (COVID-19) in the intensive care unit. Aust Crit Care 2021; 34:132-134. [PMID: 32826150 PMCID: PMC7365101 DOI: 10.1016/j.aucc.2020.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is challenging healthcare systems worldwide, none more so than critical and intensive care settings. Significant attention has been paid to the capacity of Australian intensive care unit (ICUs) to respond to a COVID-19 surge, particularly in relation to beds, ventilators, staffing, personal protective equipment, and unparalleled increase in deaths in ICUs associated with COVID-19 seen internationally. While death is not uncommon in critical care, the international experience demonstrates that restrictions to family presence at the end of life result in significant distress for families and clinicians. As a result, the Australian College of Critical Care Nurses and the Australasian College for Infection Prevention and Control supported the development of a position statement to provide critical care nurses with specific guidance and recommendations for practice for this emerging priority area. Where possible, position statements are founded on high-quality evidence. However, the short time period since the first recognition of a cluster of pneumonia-like cases in China in January, 2020, meant that an integrative approach was required to expedite timely development of this position statement in preparation for a COVID-19 surge in Australia. This position statement is intended to provide practical guidance to critical care nurses in facilitating next-of-kin presence for patients dying from COVID-19 in the ICU.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Research Advisory Panel, Australian College of Critical Care Nurses, Surrey Hills, Victoria, 3127, Australia.
| | - Stéphane Bouchoucha
- School of Nursing and Midwifery, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Centre for Quality and Patient Safety Research, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Australasian College for Infection Prevention and Control, 228 Liverpool Street, Hobart, Tasmania, 7000, Australia
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Bello-Chavolla OY, González-Díaz A, Antonio-Villa NE, Fermín-Martínez CA, Márquez-Salinas A, Vargas-Vázquez A, Bahena-López JP, García-Peña C, Aguilar-Salinas CA, Gutiérrez-Robledo LM. Unequal Impact of Structural Health Determinants and Comorbidity on COVID-19 Severity and Lethality in Older Mexican Adults: Considerations Beyond Chronological Aging. J Gerontol A Biol Sci Med Sci 2021; 76:e52-e59. [PMID: 32598450 PMCID: PMC7337730 DOI: 10.1093/gerona/glaa163] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 has had a disproportionate impact on older adults. Mexico's population is younger, yet COVID-19's impact on older adults is comparable to countries with older population structures. Here, we aim to identify health and structural determinants that increase susceptibility to COVID-19 in older Mexican adults beyond chronological aging. METHODS We analyzed confirmed COVID-19 cases in older adults using data from the General Directorate of Epidemiology of Mexican Ministry of Health. We modeled risk factors for increased COVID-19 severity and mortality, using mixed models to incorporate multilevel data concerning healthcare access and marginalization. We also evaluated structural factors and comorbidity profiles compared to chronological age for COVID-19 mortality risk prediction. RESULTS We analyzed 20 804 confirmed SARS-CoV-2 cases in adults aged 60 and older. Male sex, smoking, diabetes, and obesity were associated with pneumonia, hospitalization, and intensive care unit (ICU) admission in older adults, CKD and COPD were associated with hospitalization. High social lag indexes and access to private care were predictors of COVID-19 severity and mortality. Age was not a predictor of COVID-19 severity in individuals without comorbidities and combination of structural factors and comorbidities were better predictors of COVID-19 lethality and severity compared to chronological age alone. COVID-19 baseline lethality hazards were heterogeneously distributed across Mexican municipalities, particularly when comparing urban and rural areas. CONCLUSIONS Structural factors and comorbidity explain excess risk for COVID-19 severity and mortality over chronological age in older Mexican adults. Clinical decision-making related to COVID-19 should focus away from chronological aging onto more a comprehensive geriatric care approach.
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Affiliation(s)
- Omar Yaxmehen Bello-Chavolla
- Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Neftali Eduardo Antonio-Villa
- Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Carlos A Fermín-Martínez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Alejandro Márquez-Salinas
- Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Carmen García-Peña
- Division of Research, Instituto Nacional de Geriatría, Mexico City, Mexico
| | - Carlos A Aguilar-Salinas
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Endocrinolgy and Metabolism. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Nuevo León, Mexico
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Yan Q, Zuo P, Cheng L, Li Y, Song K, Chen Y, Dai Y, Yang Y, Zhou L, Yu W, Li Y, Xie M, Zhang C, Gao H. Acute Kidney Injury Is Associated With In-hospital Mortality in Older Patients With COVID-19. J Gerontol A Biol Sci Med Sci 2021; 76:456-462. [PMID: 32766817 PMCID: PMC7454401 DOI: 10.1093/gerona/glaa181] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 04/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The epidemic of COVID-19 presents a special threat to older adults. However, information on kidney damage in older patients with COVID-19 is limited. Acute kidney injury (AKI) is common in hospitalized adults and associated with poor prognosis. We sought to explore the association between AKI and mortality in older patients with COVID-19. METHODS We conducted a retrospective, observational cohort study in a large tertiary care university hospital in Wuhan, China. All consecutive inpatients older than 65 years with COVID-19 were enrolled in this cohort. Demographic data, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between patients with AKI and without AKI. The association between AKI and mortality was analyzed. RESULTS Of 1764 in-hospital patients, 882 older adult cases were included in this cohort. The median age was 71 years (interquartile range: 68-77), 440 (49.9%) were men. The most presented comorbidity was cardiovascular diseases (58.2%), followed by diabetes (31.4%). Of 882 older patients, 115 (13%) developed AKI and 128 (14.5%) died. Patients with AKI had higher mortality than those without AKI (68 [59.1%] vs 60 [7.8%]; p < .001). Multivariable Cox regression analysis showed that increasing odds of in-hospital mortality are associated with higher interleukin-6 on admission, myocardial injury, and AKI. CONCLUSIONS Acute kidney injury is not an uncommon complication in older patients with COVID-19 but is associated with a high risk of death. Physicians should be aware of the risk of AKI in older patients with COVID-19.
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Affiliation(s)
- Qi Yan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peiyuan Zuo
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Cheng
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuanyuan Li
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaixin Song
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuting Chen
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Dai
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Yang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lun Zhou
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiwei Yu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongsheng Li
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Xie
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyu Gao
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sang S, Sun R, Coquet J, Carmichael H, Seto T, Hernandez-Boussard T. Learning From Past Respiratory Infections to Predict COVID-19 Outcomes: Retrospective Study. J Med Internet Res 2021; 23:e23026. [PMID: 33534724 PMCID: PMC7901593 DOI: 10.2196/23026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/29/2020] [Revised: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND For the clinical care of patients with well-established diseases, randomized trials, literature, and research are supplemented with clinical judgment to understand disease prognosis and inform treatment choices. In the void created by a lack of clinical experience with COVID-19, artificial intelligence (AI) may be an important tool to bolster clinical judgment and decision making. However, a lack of clinical data restricts the design and development of such AI tools, particularly in preparation for an impending crisis or pandemic. OBJECTIVE This study aimed to develop and test the feasibility of a "patients-like-me" framework to predict the deterioration of patients with COVID-19 using a retrospective cohort of patients with similar respiratory diseases. METHODS Our framework used COVID-19-like cohorts to design and train AI models that were then validated on the COVID-19 population. The COVID-19-like cohorts included patients diagnosed with bacterial pneumonia, viral pneumonia, unspecified pneumonia, influenza, and acute respiratory distress syndrome (ARDS) at an academic medical center from 2008 to 2019. In total, 15 training cohorts were created using different combinations of the COVID-19-like cohorts with the ARDS cohort for exploratory purposes. In this study, two machine learning models were developed: one to predict invasive mechanical ventilation (IMV) within 48 hours for each hospitalized day, and one to predict all-cause mortality at the time of admission. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value, and negative predictive value. We established model interpretability by calculating SHapley Additive exPlanations (SHAP) scores to identify important features. RESULTS Compared to the COVID-19-like cohorts (n=16,509), the patients hospitalized with COVID-19 (n=159) were significantly younger, with a higher proportion of patients of Hispanic ethnicity, a lower proportion of patients with smoking history, and fewer patients with comorbidities (P<.001). Patients with COVID-19 had a lower IMV rate (15.1 versus 23.2, P=.02) and shorter time to IMV (2.9 versus 4.1 days, P<.001) compared to the COVID-19-like patients. In the COVID-19-like training data, the top models achieved excellent performance (AUROC>0.90). Validating in the COVID-19 cohort, the top-performing model for predicting IMV was the XGBoost model (AUROC=0.826) trained on the viral pneumonia cohort. Similarly, the XGBoost model trained on all 4 COVID-19-like cohorts without ARDS achieved the best performance (AUROC=0.928) in predicting mortality. Important predictors included demographic information (age), vital signs (oxygen saturation), and laboratory values (white blood cell count, cardiac troponin, albumin, etc). Our models had class imbalance, which resulted in high negative predictive values and low positive predictive values. CONCLUSIONS We provided a feasible framework for modeling patient deterioration using existing data and AI technology to address data limitations during the onset of a novel, rapidly changing pandemic.
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Affiliation(s)
- Shengtian Sang
- Department of Medicine, Biomedical Informatics, Stanford University, Stanford, CA, United States
| | - Ran Sun
- Department of Medicine, Biomedical Informatics, Stanford University, Stanford, CA, United States
| | - Jean Coquet
- Department of Medicine, Biomedical Informatics, Stanford University, Stanford, CA, United States
| | | | - Tina Seto
- Technology and Digital Solutions, Stanford University, Stanford, CA, United States
| | - Tina Hernandez-Boussard
- Department of Medicine, Biomedical Informatics, Stanford University, Stanford, CA, United States
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Zhang Q, Xiong Y, Wu T, Zhu W. Very fast-progressive pulmonary opacities and high inflammatory factors levels are associated with decease of young Coronavirus Disease 2019 patients. Medicine (Baltimore) 2021; 100:e24668. [PMID: 33607804 PMCID: PMC7899904 DOI: 10.1097/md.0000000000024668] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/18/2021] [Indexed: 01/05/2023] Open
Abstract
We aimed to retrospectively analyze the clinical and computed tomography (CT) characteristics of young adults with Coronavirus Disease 2019 (COVID-19) pneumonia who were critically ill and to identify the features associated with non-survival.Thirty-eight COVID-19 patients (20-45 years old, 28 men) who had been admitted in the intensive care unit were included, including 18 non-survivors (group 1) and 20 survivors (group 2). Their clinical characteristics and initial and follow-up CT were compared between groups.In group 1, the days from illness onset to death were 21.1 ± 10.3 days; 7 patients had underlying comorbidities. At admission, group 1 exhibited higher serum ferritin and interleukin-6 (IL-6) levels (1142.6 ± 242.4 mg/L and 33.8 ± 18.6 mmol/L) compared with group 2 (728.3 ± 150.9 mg/L and 15.2 ± 6.9 mmol/L, P < .01). Group 1 exhibited more rapidly progressive opacities and consolidation in follow-up CT (16.7 ± 3.1 scores, 15.7 ± 3.1 segments) than group 2 (11.4 ± 4.0 scores, 10.3 ± 4.6 segments, P < .01). The oxygenation index was lower (87.6 ± 19.2 vs 99.1 ± 20.4 mm Hg) and the mechanical ventilation duration was longer (14.7 ± 6.9 vs 9.7 ± 3.7 days) in group 1 compare with group 2 (P < .01).Compared with the survivors, the non-survivors showed higher serum ferritin and IL-6 levels, more rapidly progressive opacities in CT, lower oxygenation index, and longer mechanical ventilation durations. Special attention to ferritin/IL-6 levels and oxygenation index as well as early CT application and timely reexaminations are important to identify the individuals who may be at risk of becoming critically ill.
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Affiliation(s)
| | | | - Ting Wu
- Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Simonovich VA, Burgos Pratx LD, Scibona P, Beruto MV, Vallone MG, Vázquez C, Savoy N, Giunta DH, Pérez LG, Sánchez MDL, Gamarnik AV, Ojeda DS, Santoro DM, Camino PJ, Antelo S, Rainero K, Vidiella GP, Miyazaki EA, Cornistein W, Trabadelo OA, Ross FM, Spotti M, Funtowicz G, Scordo WE, Losso MH, Ferniot I, Pardo PE, Rodriguez E, Rucci P, Pasquali J, Fuentes NA, Esperatti M, Speroni GA, Nannini EC, Matteaccio A, Michelangelo HG, Follmann D, Lane HC, Belloso WH. A Randomized Trial of Convalescent Plasma in Covid-19 Severe Pneumonia. N Engl J Med 2021; 384:619-629. [PMID: 33232588 PMCID: PMC7722692 DOI: 10.1056/nejmoa2031304] [Citation(s) in RCA: 611] [Impact Index Per Article: 203.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Convalescent plasma is frequently administered to patients with Covid-19 and has been reported, largely on the basis of observational data, to improve clinical outcomes. Minimal data are available from adequately powered randomized, controlled trials. METHODS We randomly assigned hospitalized adult patients with severe Covid-19 pneumonia in a 2:1 ratio to receive convalescent plasma or placebo. The primary outcome was the patient's clinical status 30 days after the intervention, as measured on a six-point ordinal scale ranging from total recovery to death. RESULTS A total of 228 patients were assigned to receive convalescent plasma and 105 to receive placebo. The median time from the onset of symptoms to enrollment in the trial was 8 days (interquartile range, 5 to 10), and hypoxemia was the most frequent severity criterion for enrollment. The infused convalescent plasma had a median titer of 1:3200 of total SARS-CoV-2 antibodies (interquartile range, 1:800 to 1:3200). No patients were lost to follow-up. At day 30 day, no significant difference was noted between the convalescent plasma group and the placebo group in the distribution of clinical outcomes according to the ordinal scale (odds ratio, 0.83; 95% confidence interval [CI], 0.52 to 1.35; P = 0.46). Overall mortality was 10.96% in the convalescent plasma group and 11.43% in the placebo group, for a risk difference of -0.46 percentage points (95% CI, -7.8 to 6.8). Total SARS-CoV-2 antibody titers tended to be higher in the convalescent plasma group at day 2 after the intervention. Adverse events and serious adverse events were similar in the two groups. CONCLUSIONS No significant differences were observed in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo. (PlasmAr ClinicalTrials.gov number, NCT04383535.).
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Affiliation(s)
- Ventura A Simonovich
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Leandro D Burgos Pratx
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Paula Scibona
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - María V Beruto
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Marcelo G Vallone
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Carolina Vázquez
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Nadia Savoy
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Diego H Giunta
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Lucía G Pérez
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Marisa Del L Sánchez
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Andrea Vanesa Gamarnik
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Diego S Ojeda
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Diego M Santoro
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Pablo J Camino
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Sebastian Antelo
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Karina Rainero
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Gabriela P Vidiella
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Erica A Miyazaki
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Wanda Cornistein
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Omar A Trabadelo
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Fernando M Ross
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Mariano Spotti
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Gabriel Funtowicz
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Walter E Scordo
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Marcelo H Losso
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Inés Ferniot
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Pablo E Pardo
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Eulalia Rodriguez
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Pablo Rucci
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Julieta Pasquali
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Nora A Fuentes
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Mariano Esperatti
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Gerardo A Speroni
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Esteban C Nannini
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Alejandra Matteaccio
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Hernán G Michelangelo
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Dean Follmann
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - H Clifford Lane
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Waldo H Belloso
- From the Clinical Pharmacology Section (V.A.S., P.S., M.V.B., N.S.), Intermediate Care Unit (M.G.V., C.V., H.G.M.), and Infectious Diseases Section (M.L.S.), Department of Internal Medicine, and the Departments of Research (V.A.S., D.H.G., L.G.P., W.H.B.) and Transfusional Medicine (L.D.B.P., D.M.S., P.J.C., S.A.), Hospital Italiano de Buenos Aires, Buenos Aires; Department of Virology, Leloir Institute Foundation, Buenos Aires (A.V.G., D.S.O.), the Departments of Transfusional Medicine (K.R.), Infectious Diseases, Sanatorio Agote (G.P.V.), and Critical Care, Clínica Zabala (E.A.M.), Swiss Medical, Buenos Aires, the Departments of Infection Control (W.C.) and Transfusional Medicine (O.A.T.), Hospital Universitario Austral, Pilar, the Departments of Internal Medicine (F.M.R.) and Transfusional Medicine (M.S.), Clínica Santa Isabel, Buenos Aires, the Departments of Emergency and Internal Medicine (L.D.B.P., G.F.) and Transfusional Medicine (W.E.S.), Hospital Italiano Agustín Rocca, San Justo, the Departments of Medicine (M.H.L.) and Transfusional Medicine (I.F.), Hospital General de Agudos José María Ramos Mejía, Buenos Aires, the Departments of Internal Medicine (P.E.P.) and Transfusional Medicine (E.R.), Sanatorio Trinidad de Palermo, Buenos Aires, the Departments of Clinical Research (N.A.F., M.E.) and Transfusional Medicine (G.A.S.), Hospital Privado de la Comunidad de Mar del Plata and Escuela Superior de Medicina Universidad Nacional de Mar del Plata, Mar del Plata (N.A.F., M.E.), the Departments of Internal Medicine (P.R.) and Transfusional Medicine (J.P.), Hospital Zonal Ramón Carrillo, Bariloche, and the Departments of Infectious Diseases (E.C.N.) and Transfusional Medicine (A.M.), Sanatorio Británico de Rosario, Santa Fé - all in Argentina; and the Biostatistics Research Branch (D.F.), Division of Clinical Research (D.F., H.C.L.), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
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Iijima Y, Okamoto T, Shirai T, Mitsumura T, Sakakibara R, Honda T, Ishizuka M, Tateishi T, Tamaoka M, Aiboshi J, Otomo Y, Anzai T, Takahashi K, Miyazaki Y. MuLBSTA score is a useful tool for predicting COVID-19 disease behavior. J Infect Chemother 2021; 27:284-290. [PMID: 33129694 PMCID: PMC7552979 DOI: 10.1016/j.jiac.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 07/17/2020] [Revised: 09/19/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prediction of COVID-19 disease behavior in the early phase of infection is challenging but urgently needed. MuLBSTA score is a scoring system that predicts the mortality of viral pneumonia induced by a variety of viruses, including coronavirus, but the scoring system has not been verified in novel coronavirus pneumonia. The aim of this study was to validate this scoring system for estimating the risk of disease worsening in patients with COVID-19. METHODS This study included the patients who were treated between April 1 st and March 13 th , 2020. The patients were classified into mild, moderate, and severe groups according to the extent of respiratory failure. MuLBSTA score was applied to estimate the risk of disease worsening in each severity group and we validated the utility of the scoring system. RESULTS A total of 72 patients were analyzed. Among the 46 patients with mild disease, 17 showed disease progression to moderate or severe disease after admission. The model showed a sensitivity of 100% and a specificity of only 34.5% with a cut-off value of 5 points. Among the 55 patients with mild or moderate disease, 6 deteriorated to severe disease, and the model showed a sensitivity of 83.3% and a specificity of 71.4% with a cut-off value of 11 points. CONCLUSIONS This study showed that MuLBSTA score is a potentially useful tool for predicting COVID-19 disease behavior. This scoring system may be used as one of the criteria to identify high-risk patients worsening to life-threatening status.
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Affiliation(s)
- Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masahiro Ishizuka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tatsuhiko Anzai
- M & D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Kunihiko Takahashi
- M & D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Surugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Affiliation(s)
- Xing Wang
- West China HospitalSichuan UniversityChengduChina
| | - Yu Zhang
- West China HospitalSichuan UniversityChengduChina
- Affiliated Hospital & Clinical Medical College of Chengdu UniversityChengduChina
| | - Fang Fang
- West China HospitalSichuan UniversityChengduChina
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Gómez Antúnez M, Muiño Míguez A, Bendala Estrada AD, Maestro de la Calle G, Monge Monge D, Boixeda R, Ena J, Mella Pérez C, Anton Santos JM, Lumbreras Bermejo C. Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2. Int J Chron Obstruct Pulmon Dis 2021; 15:3433-3445. [PMID: 33447021 PMCID: PMC7801905 DOI: 10.2147/copd.s276692] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To describe the characteristics and prognosis of patients with COPD admitted to the hospital due to SARS-CoV-2 infection. Methods The SEMI-COVID registry is an ongoing retrospective cohort comprising consecutive COVID-19 patients hospitalized in Spain since the beginning of the pandemic in March 2020. Data on demographics, clinical characteristics, comorbidities, laboratory tests, radiology, treatment, and progress are collected. Patients with COPD were selected and compared to patients without COPD. Factors associated with a poor prognosis were analyzed. Results Of the 10,420 patients included in the SEMI-COVID registry as of May 21, 2020, 746 (7.16%) had a diagnosis of COPD. Patients with COPD are older than those without COPD (77 years vs 68 years) and more frequently male. They have more comorbidities (hypertension, hyperlipidemia, diabetes mellitus, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, kidney failure) and a higher Charlson Comorbidity Index (2 vs 1, p<0.001). The mortality rate in COPD patients was 38.3% compared to 19.2% in patients without COPD (p<0.001). Male sex, a history of hypertension, heart failure, moderate-severe chronic kidney disease, presence of cerebrovascular disease with sequelae, degenerative neurological disease, dementia, functional dependence, and a higher Charlson Comorbidity Index have been associated with increased mortality due to COVID-19 in COPD patients. Survival was higher among patients with COPD who were treated with hydroxychloroquine (87.1% vs 74.9%, p<0.001) and with macrolides (57.9% vs 50%, p<0.037). Neither prone positioning nor non-invasive mechanical ventilation, high-flow nasal cannula, or invasive mechanical ventilation were associated with a better prognosis. Conclusion COPD patients admitted to the hospital with SARS-CoV-2 infection have more severe disease and a worse prognosis than non-COPD patients.
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Affiliation(s)
- María Gómez Antúnez
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Muiño Míguez
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | | | | | - Ramón Boixeda
- Internal Medicine Department, Mataró Hospital, Mataró, Barcelona, Spain
| | - Javier Ena
- Internal Medicine Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
| | - Carmen Mella Pérez
- Internal Medicine Department, Ferrol University Hospital Complex, Ferrol, A Coruña, Spain
| | | | | | - On behalf of the SEMI-COVID-19 Network
- Internal Medicine Department, Gregorio Marañón University Hospital, Madrid, Spain
- Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain
- Internal Medicine Department, Segovia Hospital Complex, Segovia, Spain
- Internal Medicine Department, Mataró Hospital, Mataró, Barcelona, Spain
- Internal Medicine Department, Marina Baixa Hospital, Villajoyosa, Alicante, Spain
- Internal Medicine Department, Ferrol University Hospital Complex, Ferrol, A Coruña, Spain
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Madrid, Spain
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Ossimetha A, Ossimetha A, Kosar CM, Rahman M. Socioeconomic Disparities in Community Mobility Reduction and COVID-19 Growth. Mayo Clin Proc 2021; 96:78-85. [PMID: 33413837 PMCID: PMC7580696 DOI: 10.1016/j.mayocp.2020.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/27/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine differences in community mobility reduction and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes across counties with differing levels of socioeconomic disadvantage. METHODS The sample included counties in the United States with at least one SARS-CoV-2 case between April 1 and May 15, 2020. Outcomes were growth in SARS-CoV-2 cases, SARS-CoV-2-related deaths, and mobility reduction across three settings: retail/recreation, grocery/pharmacy, and workplace. The main explanatory variable was the social deprivation index (SDI), a composite socioeconomic disadvantage measure. RESULTS Adjusted differences in outcomes between low-, medium-, and high-SDI counties (defined by tertile) were calculated using linear regression with state-fixed effects. Workplace mobility reduction was 1.75 (95% CI, -2.36 to -1.14; P<.001) and 3.48 percentage points (95% CI, -4.21 to -2.75; P<.001) lower for medium- and high-SDI counties relative to low-SDI counties, respectively. Mobility reductions in the other settings were also significantly lower for higher-SDI counties. In analyses adjusted for SARS-CoV-2 prevalence on April 1, medium- and high-SDI counties had 1.39 (95% CI, 0.85 to 1.93; P<.001) and 2.56 (95% CI, 1.77 to 3.34; P<.001) more SARS-CoV-2 cases/1000 population on May 15 compared with low-SDI counties, respectively. Deaths per capita were also significantly higher for higher-SDI counties. CONCLUSION Counties with higher social deprivation scores experienced greater growth in SARS-CoV-2 cases and deaths, but reduced mobility at lower rates. These findings are consistent with evidence demonstrating that economically disadvantaged communities have been disproportionately impacted by the coronavirus disease 2019 pandemic. Efforts to socially distance may be more burdensome for these communities, potentially exacerbating disparities in SARS-CoV-2-related outcomes.
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Affiliation(s)
| | - Angelina Ossimetha
- Department of Health Services Research, Policy, and Practice, Brown University, Providence, RI
| | - Cyrus M Kosar
- Department of Health Services Research, Policy, and Practice, Brown University, Providence, RI
| | - Momotazur Rahman
- Department of Health Services Research, Policy, and Practice, Brown University, Providence, RI.
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Tian M, Li H, Yan T, Dai Y, Dong L, Wei H, Song X, Dong J, Cheng F, Li W. Clinical features of patients undergoing hemodialysis with COVID-19. Semin Dial 2021; 34:57-65. [PMID: 33118200 PMCID: PMC7894471 DOI: 10.1111/sdi.12928] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/23/2020] [Revised: 07/29/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
Hemodialysis patients are susceptible to coronavirus disease 2019 (COVID-19). The aim of this study was to describe the epidemiological, clinical characteristics, and mortality-related risk factors for those who undergoing hemodialysis with COVID-19. We conducted a retrospective study. A total of 49 hemodialysis patients with COVID-19 (Group 1) and 74 uninfected patients (Group 2) were included. For patients in Group 1, we found the median age was 62 years (36-89 years), 59.3% were male, and the median dialysis vintage was 26 months. Twenty-eight patients (57%) had three or more comorbidities and two patients (4%) died. The most common symptoms were fever (32.7%) and dry cough (46.9%), while nine patients (18.4%) were asymptomatic. Blood routine tests indicated lymphocytopenia, the proportion of lymphocyte subsets was generally reduced, and chest CT scans showed ground-glass opacity (45.8%) and patchy shadowing (35.4%). However, these findings were not specific to hemodialysis patients with COVID-19, and similar manifestations could be found in patients without SARS-CoV-2 infection. In conclusion, for hemodialysis patients with COVID-19, lymphocytopenia and ground-glass opacities or patchy opacities were common but not specific to them, early active treatment and interventions against nosocomial infection can significantly reduce the mortality and the risk of SARS-CoV-2 infection.
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Affiliation(s)
- Ming Tian
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Hua Li
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Ting Yan
- Department of NephrologyThe First People's Hospital of Jiangxia DistrictWuhanP.R. China
| | - Yujie Dai
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Liping Dong
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Honglan Wei
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Xiaohong Song
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Junwu Dong
- Department of NephrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Fangxiong Cheng
- Department of Clinical LaboratoryWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Wenzhou Li
- Department of UrologyWuhan Fourth HospitalPuai HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
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Sangla F, Legouis D, Marti PE, Sgardello SD, Brebion A, Saint-Sardos P, Adda M, Lautrette A, Pereira B, Souweine B. One year after ICU admission for severe community-acquired pneumonia of bacterial, viral or unidentified etiology. What are the outcomes? PLoS One 2020; 15:e0243762. [PMID: 33315946 PMCID: PMC7735561 DOI: 10.1371/journal.pone.0243762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/01/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Multiplex polymerase chain reaction (mPCR) for respiratory virus testing is increasingly used in community-acquired pneumonia (CAP), however data on one-year outcome in intensive care unit (ICU) patients with reference to the causative pathogen are scarce. MATERIALS AND METHODS We performed a single-center retrospective study in 123 ICU patients who had undergone respiratory virus testing for CAP by mPCR and with known one-year survival status. Functional status including dyspnea (mMRC score), autonomy (ADL Katz score) and need for new home-care ventilatory support was assessed at a one-year post-ICU follow-up. Mortality rates and functional status were compared in patients with CAP of a bacterial, viral or unidentified etiology one year after ICU admission. RESULTS The bacterial, viral and unidentified groups included 19 (15.4%), 37 (30.1%), and 67 (54.5%) patients, respectively. In multivariate analysis, one-year mortality in the bacterial group was higher compared to the viral group (HR 2.92, 95% CI 1.71-7.28, p = 0.02) and tended to be higher compared to the unidentified etiology group (p = 0.06); but no difference was found between the viral and the unidentified etiology group (p = 0.43). In 64/83 one-year survivors with a post-ICU follow-up consultation, there were no differences in mMRC score, ADL Katz score and new home-care ventilatory support between the groups (p = 0.52, p = 0.37, p = 0.24, respectively). Severe dyspnea (mMRC score = 4 or death), severe autonomy deficiencies (ADL Katz score ≤ 2 or death), and major adverse respiratory events (new home-care ventilatory support or death) were observed in 52/104 (50.0%), 47/104 (45.2%), and 65/104 (62.5%) patients, respectively; with no difference between the bacterial, viral and unidentified group: p = 0.58, p = 0.06, p = 0.61, respectively. CONCLUSIONS CAP of bacterial origin had a poorer outcome than CAP of viral or unidentified origin. At one-year, impairment of functional status was frequently observed, with no difference according to the etiology.
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Affiliation(s)
- Frédéric Sangla
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
- * E-mail:
| | - David Legouis
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Pierre-Emmanuel Marti
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sebastian D. Sgardello
- Service de Soins intensifs adultes, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Amélie Brebion
- Laboratoire de Virologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Pierre Saint-Sardos
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Mireille Adda
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Bruno Pereira
- Département de Biostatistique, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Bertrand Souweine
- Service de Médecine intensive et réanimation, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
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Peyronnet V, Sibiude J, Huissoud C, Lescure FX, Lucet JC, Mandelbrot L, Nisand I, Belaish-Allart J, Vayssière C, Yazpandanah Y, Luton D, Picone O. [Infection with SARS-CoV-2 in pregnancy. Update of Information and proposed care. CNGOF]. Gynecol Obstet Fertil Senol 2020; 48:858-870. [PMID: 33031963 PMCID: PMC7534662 DOI: 10.1016/j.gofs.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The coronavirus SARS-CoV-2 identified late 2019 in China had spread across all continents. In the majority of cases, patients have mild symptoms (fever, cough, myalgia, headache, some digestive disorders) or are asymptomatic, however it can cause serious lung diseases and lead to death. On September 2020, over 28 million people have been infected with over 920,000 deaths. METHODS In view of the evolution of the epidemic the French National College of Obstetricians and Gynecologists has decided to update the recommendations previously issued. To do this, the same group of experts was called upon to carry out a review of the literature and take into account the opinions of the General Directorate of Health (DGS), the "Haute Autorité de Santé" (HAS) and the "Haut Conseil de santé Publique" (HCSP). RESULTS The data on consequences during pregnancy have accumulated. The symptoms in pregnant women appear to be similar to those of the general population, but an increased risk of respiratory distress exists in pregnant women especially in the third trimester. A case of intrauterine maternal-fetal transmission has been clearly identified. Induced prematurity and cases of respiratory distress in newborns of infected mothers have been described. CONCLUSION In light of the new data, we propose updated recommendations. These proposals may continue to evolve in view of the pandemic and of advances in studies in pregnant women.
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Affiliation(s)
- V Peyronnet
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France
| | - J Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France
| | - C Huissoud
- University Lyon, University Claude Bernard, 69000 Lyon, France; Hôpital de la Croix-Rousse, hospices civils de Lyon, 69004 Lyon, France; Inserm U846, stem cell and brain research institute, 18, avenue Doyen-Lepine, 69500 Bron, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France
| | - F-X Lescure
- Inserm IAME-U1137, 75000 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat Claude-Bernard, université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - J-C Lucet
- Inserm IAME-U1137, 75000 Paris, France
| | - L Mandelbrot
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France
| | - I Nisand
- CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France
| | | | - C Vayssière
- Hôpital Paule-de-Viguier, CHU de Toulouse, 31000 Toulouse, France; Inserm UMR1027, équipe SPHERE, université Toulouse III, 31000 Toulouse, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France
| | - Y Yazpandanah
- Inserm IAME-U1137, 75000 Paris, France; Service de maladies infectieuses et tropicales, hôpital Bichat Claude-Bernard, université de Paris, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - D Luton
- FHU Prematurity Inserm U1016, service de gynécologie obstétrique, maternité Aline de Crepy, hôpital Bichat, institut IMAGINE, université de Paris, AP-HP, 75018 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France
| | - O Picone
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm IAME-U1137, 75000 Paris, France; Groupe de recherche sur les infections pendant la grossesse (GRIG), 75000 Paris, France; CNGOF, 91, boulevard de Sébastopol, 75002 Paris, France.
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Eckel F, Küsters F, Drossel B, Konert M, Mattes H, Schopf S. Variplex™ test system fails to reliably detect SARS-CoV-2 directly from respiratory samples without RNA extraction. Eur J Clin Microbiol Infect Dis 2020; 39:2373-2377. [PMID: 32681309 PMCID: PMC7367510 DOI: 10.1007/s10096-020-03983-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 12/22/2022]
Abstract
Diagnosis of COVID is performed by PCR methods, but their capacity is limited by the requirement of high-level facilities and instruments. The loop-mediated isothermal amplification (LAMP) method has been utilized for the detection of isolated virus-specific RNA. Preliminary data suggest the possibility of isothermal amplification directly from respiratory samples without RNA extraction. All patients admitted to our hospital were screened for SARS-CoV-2 by routine. Respiratory samples were tested by variplex system based on LAMP method directly without RNA extraction and by PCR. Primary endpoint was the false-negative rate of variplex test compared with PCR as gold standard. In 109 patients variplex test and PCR assay were performed simultaneously. Median age was 80 years and male/female ratio was 40/60%. The prevalence of PCR-confirmed COVID diagnosis was 43.1%. Variplex test was positive in 13.8%. False-negative rate of variplex test compared with PCR was 83.0%. The potential of LAMP technology using isolated RNA has been demonstrated impressively by others, and excellent sensitivity and specificity of detecting SARS-CoV-2 has been reported. However, without RNA extraction, the variplex test system failed to reliably detect SARS-CoV-2 directly in respiratory samples.
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Affiliation(s)
- Florian Eckel
- Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
- Medical Department, RoMed Klink Bad Aibling, Harthauser Str. 16, 83043, Bad Aibling, Germany.
| | - Franziska Küsters
- Medical Department, RoMed Klink Bad Aibling, Harthauser Str. 16, 83043, Bad Aibling, Germany
| | - Bernhard Drossel
- Hospital Laboratory, RoMed Klink Bad Aibling, Harthauser Str. 16, 83043, Bad Aibling, Germany
| | - Markus Konert
- Department of Anesthesia, RoMed Klink Bad Aibling, Harthauser Str. 16, 83043, Bad Aibling, Germany
| | - Hans Mattes
- Hospital Hygiene, RoMed Klinikum Rosenheim, Pettenkoferstr. 10, 83022, Rosenheim, Germany
| | - Stefan Schopf
- Surgical Department, RoMed Klink Bad Aibling, Harthauser Str. 16, 83043, Bad Aibling, Germany
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Lampasona V, Secchi M, Scavini M, Bazzigaluppi E, Brigatti C, Marzinotto I, Davalli A, Caretto A, Laurenzi A, Martinenghi S, Molinari C, Vitali G, Di Filippo L, Mercalli A, Melzi R, Tresoldi C, Rovere-Querini P, Landoni G, Ciceri F, Bosi E, Piemonti L. Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study. Diabetologia 2020; 63:2548-2558. [PMID: 33029657 PMCID: PMC7541098 DOI: 10.1007/s00125-020-05284-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/09/2020] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to characterise the humoral response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with diabetes. Demonstrating the ability to mount an appropriate antibody response in the presence of hyperglycaemia is relevant for the comprehension of mechanisms related to the observed worse clinical outcome of coronavirus disease 2019 (COVID-19) pneumonia in patients with diabetes and for the development of any future vaccination campaign to prevent SARS-CoV-2 infection. METHODS Using a highly specific and sensitive measurement of antibodies by fluid-phase luciferase immunoprecipitation assays, we characterised the IgG, IgM and IgA response against multiple antigens of SARS-CoV-2 in a cohort of 509 patients with documented diagnosis of COVID-19, prospectively followed at our institution. We analysed clinical outcomes and antibody titres according to the presence of hyperglycaemia, i.e., either diagnosed or undiagnosed diabetes, at the time of, or during, hospitalisation. RESULTS Among patients with confirmed COVID-19, 139 (27.3%) had diabetes: 90 (17.7%) had diabetes diagnosed prior to the hospital admission (comorbid diabetes) while 49 (9.6%) had diabetes diagnosed at the time of admission (newly diagnosed). Diabetes was associated with increased levels of inflammatory biomarkers and hypercoagulopathy, as well as leucocytosis and neutrophilia. Diabetes was independently associated with risk of death (HR 2.32 [95% CI 1.44, 3.75], p = 0.001), even after adjustment for age, sex and other relevant comorbidities. Moreover, a strong association between higher glucose levels and risk of death was documented irrespective of diabetes diagnosis (HR 1.14 × 1.1 mmol/l [95% CI 1.08, 1.21], p < 0.001). The humoral response against SARS-CoV-2 in patients with diabetes was present and superimposable, as for timing and antibody titres, to that of non-diabetic patients, with marginal differences, and was not influenced by glucose levels. Of the measured antibody responses, positivity for IgG against the SARS-CoV-2 spike receptor-binding domain (RBD) was predictive of survival rate, both in the presence or absence of diabetes. CONCLUSIONS/INTERPRETATION The observed increased severity and mortality risk of COVID-19 pneumonia in patients with hyperglycaemia was not the result of an impaired humoral response against SARS-CoV-2. RBD IgG positivity was associated with a remarkable protective effect, allowing for a cautious optimism about the efficacy of future vaccines against SARs-COV-2 in people with diabetes. Graphical abstract.
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Affiliation(s)
- Vito Lampasona
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Secchi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marina Scavini
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elena Bazzigaluppi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Brigatti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ilaria Marzinotto
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Davalli
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Amelia Caretto
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sabina Martinenghi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Molinari
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giordano Vitali
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Di Filippo
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Mercalli
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raffaella Melzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere-Querini
- Department of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
- School of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
| | - Giovanni Landoni
- School of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
- Department of Anesthesia and Intensive Care, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Ciceri
- School of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
- Hematology and Bone Marrow Transplantation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Bosi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
- School of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy
| | - Lorenzo Piemonti
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
- School of Medicine and Surgery, Università Vita-Salute San Raffaele, Milan, Italy.
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Lumbreras-Marquez MI, Campos-Zamora M, Seifert SM, Kim J, Lumbreras-Marquez J, Vazquez-Alaniz F, Fields KG, Farber MK. Excess Maternal Deaths Associated With Coronavirus Disease 2019 (COVID-19) in Mexico. Obstet Gynecol 2020; 136:1114-1116. [PMID: 32909969 DOI: 10.1097/aog.0000000000004140] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mario I Lumbreras-Marquez
- Departments of Obstetrics and Gynecology and Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, and the Department of Postgraduate Medical Education, Harvard Medical School, Boston, Massachusetts; and Hospital Central "Dr. Ignacio Morones Prieto," San Luis Potosí, and Hospital General 450, Durango, Durango, Mexico
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Abstract
A new study examined post-mortem kidney tissue from 63 patients with COVID-19. The results suggest that SARS-CoV-2 has kidney tropism, including the ability to replicate in kidney cells, and that kidney transduction by SARS-CoV-2 is associated with shorter survival time and increased incidence of acute kidney injury.
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Affiliation(s)
- Anitha Vijayan
- Division of Nephrology, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Benjamin D Humphreys
- Division of Nephrology, Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
- Department of Developmental Biology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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Hu H, Du H, Li J, Wang Y, Wu X, Wang C, Zhang Y, Zhang G, Zhao Y, Kang W, Lian J. Early prediction and identification for severe patients during the pandemic of COVID-19: A severe COVID-19 risk model constructed by multivariate logistic regression analysis. J Glob Health 2020; 10:020510. [PMID: 33110593 PMCID: PMC7567445 DOI: 10.7189/jogh.10.020510] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As an emergent and fulminant infectious disease, Corona Virus Disease 2019 (COVID-19) has caused a worldwide pandemic. The early identification and timely treatment of severe patients are crucial to reducing the mortality of COVID-19. This study aimed to investigate the clinical characteristics and early predictors for severe COVID-19, and to establish a prediction model for the identification and triage of severe patients. METHODS All confirmed patients with COVID-19 admitted by the Second Affiliated Hospital of Air Force Medical University were enrolled in this retrospective non-interventional study. The patients were divided into a mild group and a severe group, and the clinical data were compared between the two groups. Univariate and multivariate analysis were used to identify the independent early predictors for severe COVID-19, and the prediction model was constructed by multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction model and each early predictor. RESULTS A total of 40 patients were enrolled in this study, of whom 19 were mild and 21 were severe. The proportions of patients with venerable age (≥60 years old), comorbidities, and hypertension in severe patients were higher than that of the mild (P < 0.05). The duration of fever and respiratory symptoms, and the interval from illness onset to viral clearance were longer in severe patients (P < 0.05). Most patients received at least one form of oxygen treatments, while severe patients required more mechanical ventilation (P < 0.05). Univariate and multivariate analysis showed that venerable age, hypertension, lymphopenia, hypoalbuminemia and elevated neutrophil lymphocyte ratio (NLR) were the independent high-risk factors for severe COVID-19. ROC curves demonstrated significant predictive value of age, lymphocyte count, albumin and NLR for severe COVID-19. The sensitivity and specificity of the newly constructed prediction model for predicting severe COVID-19 was 90.5% and 84.2%, respectively, and whose positive predictive value, negative predictive value and crude agreement were all over 85%. CONCLUSIONS The severe COVID-19 risk model might help clinicians quickly identify severe patients at an early stage and timely take optimal therapeutic schedule for them.
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Affiliation(s)
| | | | - Jing Li
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Yage Wang
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiaoqing Wu
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Chunfu Wang
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Ye Zhang
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Gufen Zhang
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
| | - Yanyan Zhao
- Center for Infectious Diseases, Second Affiliated Hospital of Air Force Medical University, Xi’an, Shaanxi, China
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Wang X, Liu Z, Li J, Zhang J, Tian S, Lu S, Qi M, Ma J, Qiu B, Dong W, Xu Y. Impacts of Type 2 Diabetes on Disease Severity, Therapeutic Effect, and Mortality of Patients With COVID-19. J Clin Endocrinol Metab 2020; 105:5912005. [PMID: 32979271 PMCID: PMC7543468 DOI: 10.1210/clinem/dgaa535] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) has become a topic of concern worldwide; however, the impacts of type 2 diabetes mellitus (T2DM) on disease severity, therapeutic effect, and mortality of patients with COVID-19 are unclear. METHODS All consecutive patients with COVID-19 admitted to the Renmin Hospital of Wuhan University from January 11 to February 6, 2020, were included in this study. RESULTS A total of 663 patients with COVID-19 were included, while 67 patients with T2DM accounted for 10.1% of the total. Compared with patients with COVID-19 without T2DM, those with T2DM were older (aged 66 years vs 57 years; P < 0.001) and had a male predominance (62.7% vs 37.3%; P = 0.019) and higher prevalence of cardiovascular diseases (61.2% vs 20.6%; P < 0.001) and urinary diseases (9% vs 2.5%; P = 0.014). Patients with T2DM were prone to developing severe (58.2% vs 46.3%; P = 0.002) and critical COVID-19 (20.9% vs 13.4%; P = 0.002) and having poor therapeutic effect (76.1% vs 60.4%; P = 0.017). But there was no obvious difference in the mortality between patients with COVID-19 with and without T2DM (4.5% vs 3.7%; P = 0.732). Multivariate logistic regression analysis identified that T2DM was associated with poor therapeutic effect in patients with COVID-19 (odd ratio [OR] 2.99; 95% confidence interval [CI], 1.07-8.66; P = 0.04). Moreover, having a severe and critical COVID-19 condition (OR 3.27; 95% CI, 1.02-9.00; P = 0.029) and decreased lymphocytes (OR 1.59; 95% CI, 1.10-2.34; P = 0.016) were independent risk factors associated with poor therapeutic effect in patients with COVID-19 with T2DM. CONCLUSIONS T2DM influenced the disease severity and therapeutic effect and was one of the independent risk factors for poor therapeutic effect in patients with COVID-19.
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Affiliation(s)
- Xiaoli Wang
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhengru Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jiao Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jixiang Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shan Tian
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shimin Lu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Mingming Qi
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jingjing Ma
- Department of Geriatrics, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Bo Qiu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Weiguo Dong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Correspondence and Reprint Requests: Yu Xu, Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China. E-mail: ; or Weiguo Dong, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China. E-mail:
| | - Yu Xu
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
- Correspondence and Reprint Requests: Yu Xu, Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China. E-mail: ; or Weiguo Dong, Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China. E-mail:
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Sharov KS. SARS-CoV-2-related pneumonia cases in pneumonia picture in Russia in March-May 2020: Secondary bacterial pneumonia and viral co-infections. J Glob Health 2020; 10:020504. [PMID: 33110587 PMCID: PMC7568231 DOI: 10.7189/jogh.10.020504] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We are communicating the results of investigating statistics on SARS-CoV-2-related pneumonias in Russia: percentage, mortality, cases with other viral agents, cases accompanied by secondary bacterial pneumonias, age breakdown, clinical course and outcome. METHODS We studied two sampling sets (Set 1 and Set 2). Set 1 consisted of results of testing 3382 assays of out-patients and hospital patients (5-88 years old) with community-acquired and hospital-acquired pneumonia of yet undetermined aetiology. Set 2 contained results of 1204 assays of hospital patients (12-94 years old) with pneumonia and COVID-19 already diagnosed by molecular biological techniques in test laboratories. The results were collected in twelve Russian cities/provinces in time range 2 March - 5 May 2020. Assays were analysed for 10 bacterial, 15 viral, 2 fungal and 2 parasitic aetiological agents. RESULTS In Set 1, 4.35% of total pneumonia cases were related to SARS-CoV-2, with substantially larger proportion (18.75%) of deaths of pneumonia with COVID-19 diagnosed. However, studying Set 2, we revealed that 52.82% patients in it were also positive for different typical and atypical aetiological agents usually causing pneumonia. 433 COVID-19 patients (35.96%) were tested positive for various bacterial aetiological agents, with Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae infections accounting for the majority of secondary pneumonia cases. CONCLUSIONS SARS-CoV-2, a low-pathogenic virus itself, becomes exceptionally dangerous if secondary bacterial pneumonia attacks a COVID-19 patient as a complication. An essential part of the severest complications and mortality associated with COVID-19 in Russia in March-May 2020, may be attributed to secondary bacterial pneumonia and to a much less extent viral co-infections. The problem of hospital-acquired bacterial infection is exceptionally urgent in treating SARS-CoV-2 patients. The risk of secondary bacterial pneumonia and its further complications, should be given very serious attention in combating SARS-CoV-2.
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Affiliation(s)
- Konstantin S Sharov
- Koltzov Institute of Developmental Biology of Russian Academy of Sciences, Moscow, Russia
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