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Paules CI, Osevala N, Lehman E, Heilbrunn ES, Francis E, Hogentogler RE, Kong L, Kraschnewski JL. Underuse of SARS-CoV-2-Neutralizing Monoclonal Antibodies in Skilled Nursing Facilities. J Am Med Dir Assoc 2024; 25:290-295. [PMID: 37944905 PMCID: PMC10872363 DOI: 10.1016/j.jamda.2023.10.003] [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: 06/30/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Little is known about deployment of SARS-CoV-2-neutralizing monoclonal antibodies (mab) in skilled nursing facilities (SNFs), a high-risk population for COVID-19-related complications. We assessed the utilization of mabs in SNFs and identified facility characteristics associated with effective use. DESIGN Retrospective cohort study assessing the correlation of SNF characteristics with increasing mab use. SETTING AND PARTICIPANTS United States SNFs participating in Project ECHO (Extensions for Community Health Outcomes). METHODS The primary outcome was percentage of total mabs per COVID-19 cases in SNFs. Facilities were divided into 3 groups based on the percentage of the administration of mabs per number of cases: 0%, >0% to 20%, >20%. Ordinal logistic regression was applied to assess whether facility characteristics-study group, state, location, type, size, rating at baseline, weekly average of residents vaccinated, weekly average of staff vaccinated, and total weeks short staffed-correlated with the primary outcome. A multivariable model was used to evaluate the independent effect of predictors. RESULTS A total of 130 facilities were included. Between the weeks ending on May 30, 2021, and on May 29, 2022, mean mab use when accounting for the number of COVID-19 cases was 12.96% (±26.71%) and >50% of facilities administered 0 doses of mabs. Facility location was associated with mab use (P value .030), with micropolitan facilities having the highest percentage of facilities administering mabs (30.4% in >0% to 20%, and 39.1% in >20%, respectively). There was a nonsignificant trend toward increased mab use in facilities reporting fewer staffing shortages. When the multivariable ordinal logistic regression model was applied, location in a micropolitan vs metropolitan area was associated with higher odds [3.29 (1.30, 8.32), P value .012] of increasing percentage total mabs per cases. CONCLUSIONS AND IMPLICATIONS COVID-19 mabs were underutilized in a high-risk population for COVID-19 hospitalization and death. Understanding the barriers to effective distribution is critical in shaping pandemic preparedness efforts for the future.
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Affiliation(s)
- Catharine I Paules
- Division of Infectious Diseases, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Nicole Osevala
- Division of Geriatric Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA, USA
| | - Emily S Heilbrunn
- Department of Medicine, Penn State College of Medicine, Penn State University, Hershey, PA, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Penn State University, Hershey, PA, USA
| | - R Ellen Hogentogler
- Department of Medicine, Penn State College of Medicine, Penn State University, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA, USA
| | - Jennifer L Kraschnewski
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA, USA; Department of Medicine, Penn State College of Medicine, Penn State University, Hershey, PA, USA; Department of Pediatrics, Penn State College of Medicine, Penn State University, Hershey, PA, USA
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Kraschnewski JL, Heilbrunn ES, Calo WA, Kong L, Lehman E, Hogentogler E, Fisher A, Osevala N, Paules CI, Whitaker J, Urso J, Chamberlain L, Suda KM, Stedjan M, McNeil L. Accelerating guideline dissemination in nursing homes during the COVID-19 pandemic: A patient-centered randomized controlled trial. Geriatr Nurs 2023; 51:439-445. [PMID: 37167902 PMCID: PMC10126215 DOI: 10.1016/j.gerinurse.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Nursing homes were ill-equipped for the pandemic; though facilities are required to have infection control staff, only 3% have taken a basic infection control course. Little is known about the implementation of effective practices outside of the acute care setting. We proposed an intervention utilizing Project ECHO, to connect Penn State University experts with nursing home staff and administrators to explore how infection control guidelines can be implemented effectively. METHODS A stratified cluster randomized design was used to assign nursing homes to either AHRQ-funded COVID-19 ECHO or AHRQ-funded COVID-19 ECHO+. RESULTS 136 nursing homes participated. There were no significant differences in COVID-19 infection rate, hospitalization, deaths, or influenza, between ECHO or ECHO+. DISCUSSION The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multidisciplinary team of experts and utilizes case discussions that match the context of nursing homes.
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Affiliation(s)
- Jennifer L Kraschnewski
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA; Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Emily S Heilbrunn
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - William A Calo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Erik Lehman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Ellie Hogentogler
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Abbey Fisher
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nicole Osevala
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Catherine I Paules
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Janice Whitaker
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, State College, PA, USA
| | | | - Linda Chamberlain
- Pennsylvania Department of Health, Division of Home Health, Harrisburg, PA, USA
| | - Kim M Suda
- Helion, A Division of Highmark Health, PA, USA
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Ssentongo P, Ssentongo A, Heilbrunn ES, Chinchilli VM. Gun violence in United States during the second year of the COVID-19 pandemic. Front Public Health 2023; 11:950475. [PMID: 36950096 PMCID: PMC10025286 DOI: 10.3389/fpubh.2023.950475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Objective In the first year of the COVID-19 pandemic, gun violence (GV) rates in the United States (US) rose by 30%. We estimate the relative risk of GV in the US in the second year compared to the first year of the pandemic, in time and space. Methods Daily police reports of gun-related injuries and deaths in the 50 states and the District of Columbia from March 1, 2020, to February 28, 2022, were obtained from the GV Archive. Generalized linear mixed-effects models in the form of Poisson regression analyses were utilized to estimate state-specific rates of GV. Results Nationally, GV rates during the second year of the pandemic (March 1, 2021, through February 28, 2022) remained the same as that of the first year (March 1, 2020, through February 28, 2021) (Intensity Ratio = 0.996; 95% CI 0.98, 1.01; p = 0.53). Nevertheless, hotspots of GV were identified. Nine (18%) states registered a significantly higher risk of GV during the second year of the pandemic compared to the same period in the first year. In 10 (20%) states, the risk of GV during the second year of the pandemic was significantly lower compared to the same period in the first year. Conclusion GV risk in the US is heterogeneous. It continues to be a public health crisis, with 18% of the states demonstrating significantly higher GV rates during the second year of the COVID-19 pandemic compared to the same timeframe 1 year prior.
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Affiliation(s)
- Paddy Ssentongo
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
- *Correspondence: Paddy Ssentongo
| | - Anna Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Emily S. Heilbrunn
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, United States
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Yeh HC, Kraschnewski JL, Kong L, Lehman EB, Heilbrunn ES, Williams P, Poger JM, Francis E, Bryce CL. Hospitalization and mortality in patients with COVID-19 with or at risk of type 2 diabetes: data from five health systems in Pennsylvania and Maryland. BMJ Open Diabetes Res Care 2022; 10:10/3/e002774. [PMID: 35680172 PMCID: PMC9184995 DOI: 10.1136/bmjdrc-2022-002774] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To identify the demographic and clinical characteristics associated with adverse COVID-19 outcomes across a 12-month period in 2020 and 2021. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study using electronic health records from five academic health systems in Pennsylvania and Maryland, including patients with COVID-19 with type 2 diabetes or at risk of type 2 diabetes. Patients were classified based on 30-day outcomes: (1) no hospitalization; (2) hospitalization only; or (3) a composite measure including admission to the intensive care unit (ICU), intubation, or death. Analyses were conducted in patients with type 2 diabetes and patients at risk of type 2 diabetes separately. RESULTS We included 15 725 patients with COVID-19 diagnoses between March 2020 and February 2021. Older age and higher Charlson Comorbidity Index scores were associated with higher odds of adverse outcomes, while COVID-19 diagnoses later in the study period were associated with lower odds of severe outcomes. In patients with type 2 diabetes, individuals on insulin treatment had higher odds for ICU/intubation/death (OR=1.59, 95% CI 1.27 to 1.99), whereas those on metformin had lower odds (OR=0.56, 95% CI 0.45 to 0.71). Compared with non-Hispanic White patients, Hispanic patients had higher odds of hospitalization in patients with type 2 diabetes (OR=1.73, 95% CI 1.36 to 2.19) or at risk of type 2 diabetes (OR=1.77, 95% CI 1.43 to 2.18.) CONCLUSIONS: Adults who were older, in racial minority groups, had multiple chronic conditions or were on insulin treatment had higher risks for severe COVID-19 outcomes. This study reinforced the urgency of preventing COVID-19 and its complications in vulnerable populations. TRIAL REGISTRATION NUMBER NCT02788903.
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Affiliation(s)
- Hsin-Chieh Yeh
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer L Kraschnewski
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Lan Kong
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Emily S Heilbrunn
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Pamela Williams
- Cancer and Chronic Disease Bureau, Maryland Department of Health, Baltimore, Maryland, USA
| | - Jennifer M Poger
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Erica Francis
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Cindy L Bryce
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ssentongo P, Heilbrunn ES, Ssentongo AE, Ssenyonga LVN, Lekoubou A. Birth prevalence of neural tube defects in eastern Africa: a systematic review and meta-analysis. BMC Neurol 2022; 22:202. [PMID: 35650541 PMCID: PMC9158202 DOI: 10.1186/s12883-022-02697-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neural tube defects (NTDs) are associated with high rates of neonatal mortality and morbidity worldwide. The promotion of folic acid fortification and supplementation in pregnant women by the Food and Drug Administration significantly decreased the incidence of NTDs in the United States. This practice is not widely adopted in Eastern Africa countries. We hypothesized that these countries experience a higher burden of NTDs than countries that promote the use of folic acid. We aimed to estimate the birth prevalence of NTDs in the United Nations (UN) Eastern African region. METHODS PubMed (Medline), Embase, and Cochrane Library databases were systematically searched from inception to December 17, 2021. We included randomized controlled trials or observational studies that reported the prevalence estimates of NTDs in Eastern Africa. Random effects model was used to pool the effect estimates. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to assess the certainty of the evidence. Outcome measures were overall and specific (spina bifida, anencephaly, encephalocele) rates of NTDs per 10,000 births, including live and stillborn cases. RESULTS The meta-analysis included 20 studies consisting of 752,936 individuals. The pooled prevalence of all NTDs per 10,000 births in Eastern Africa was 33.30 (95% CI: 21.58 to 51.34). Between-study heterogeneity was high (I2 = 97%, p < 0.0001), The rate was highest in Ethiopia (60 per 10,000). Birth prevalence of spina bifida (20 per 10,000) was higher than anencephaly (9 per 10,000) and encephalocele (2.33 per 10,000). No studies on NTDs were identified in 70% of the UN Eastern Africa region. Birth prevalence increased by 4% per year from 1983 to 2018. The level of evidence as qualified with GRADE was moderate. CONCLUSION The birth prevalence of NTDs in the United Nations region of Eastern Africa is 5 times as high as observed in Western countries with mandatory folic acid supplementation in place. Therefore, mandatory folic acid supplementation of stable foods may decrease the risk of NTDs in Eastern Africa.
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Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA. .,Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, State College, PA, USA. .,Department of Medicine, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, USA.
| | - Emily S Heilbrunn
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Surgery, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Lydia V N Ssenyonga
- Department of Nursing, Faculty of Health Sciences, Busitema University, TORORO, Uganda
| | - Alain Lekoubou
- Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Neurology, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
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Heilbrunn ES, Ssentongo P, Chinchilli VM, Oh J, Ssentongo AE. Sudden death in individuals with obstructive sleep apnoea: a systematic review and meta-analysis. BMJ Open Respir Res 2021; 8:8/1/e000656. [PMID: 34108135 PMCID: PMC8191609 DOI: 10.1136/bmjresp-2020-000656] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 05/02/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Over 1 billion individuals worldwide experience some form of sleep apnoea, and this number is steadily rising. Obstructive sleep apnoea (OSA) can negatively influence one’s quality of life and potentially increase mortality risk. However, the association between OSA and mortality has not been reliably estimated. This meta-analysis estimates the risk of all-cause and cardiovascular mortality in individuals with OSA. Design Systematic review and meta-analysis. Data sources MEDLINE, Cochrane Library, Scopus and Joanna Briggs Institute Evidence-Based Practice databases were searched from inception through 1 January 2020. Eligibility criteria for selecting studies We included observational studies assessing the association of sudden deaths in individuals with and without OSA. Data extraction and synthesis Two independent reviewers (AES and ESH) extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale quality assessment tool. Data were pooled using the random-effects models and reported as risk ratios (RRs) with 95% CIs. Heterogeneity was quantified with I2 statistic. Results We identified 22 observational studies (n=42 099 participants). The mean age was 62 years and 64% were men. OSA was associated with all-cause sudden death (RR=1.74, 95% CI: 1.44 to 2.10, I2=72%) and cardiovascular mortality (RR=1.94, 95% CI: 1.39 to 2.70, I2=32%). A marginally significant dose–response relationship between severity of OSA and the risk of death was observed (p for interaction=0.05): mild OSA (RR=1.16, 95% CI: 0.70 to 1.93), moderate OSA (RR=1.72, 95% CI: 1.11 to 2.67) and severe OSA (RR=2.87, 95% CI: 1.70 to 4.85). Meta-regression analysis showed that older age was a significant contributing factor in the relationship between OSA and mortality. The median study methodological quality was considered high. Conclusions OSA is a significant risk factor for all-cause mortality and cardiac mortality. Prevention and treatment strategies to optimise survival and quality of life in individuals with OSA are urgently needed. PROSPERO registration number CRD42020164941.
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Affiliation(s)
- Emily S Heilbrunn
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA.,Center for Neural Engineering, Penn State University, University Park, Pennsylvania, USA
| | - Vernon M Chinchilli
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - John Oh
- Department Surgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Anna E Ssentongo
- Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA .,Department Surgery, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Ssentongo P, Heilbrunn ES, Ssentongo AE, Advani S, Chinchilli VM, Nunez JJ, Du P. Epidemiology and outcomes of COVID-19 in HIV-infected individuals: a systematic review and meta-analysis. Sci Rep 2021; 11:6283. [PMID: 33737527 PMCID: PMC7973415 DOI: 10.1038/s41598-021-85359-3] [Citation(s) in RCA: 155] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/28/2021] [Indexed: 12/16/2022] Open
Abstract
Susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the risk of mortality among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) is largely unknown. PLWHA are unique due to their altered immune system from their history of chronic HIV infection and their use of antiretroviral therapy, some of which have been used experimentally to treat coronavirus disease 2019 (COVID-19). Therefore, we conducted a systematic review and meta-analysis to assess the epidemiology of SARS-COV-2/HIV coinfection and estimate associated mortality from COVID-19 (Prospero Registration ID: CRD42020187980). PubMed, SCOPUS, OVID and Cochrane Library databases, and medRxiv preprint repositories were searched from January 1, 2020, to December 12, 2020. Data were extracted from studies reporting COVID-19 attack and mortality rates in PLWHA compared to their HIV-negative counterparts. Pooled attack and mortality risks were quantified using random-effects models. We identified 22 studies that included 20,982,498 participants across North America, Africa, Europe, and Asia. The median age was 56 years, and 50% were male. HIV-positive persons had a significantly higher risk of SARS-CoV-2 infection [risk ratio (RR) 1.24, 95% CI 1.05-1.46)] and mortality from COVID-19 (RR 1.78, 95% CI 1.21-2.60) than HIV-negative individuals. The beneficial effects of tenofovir and protease-inhibitors in reducing the risk of SARS-CoV-2 infection and death from COVID-19 in PLWHA remain inconclusive. HIV remains a significant risk factor for acquiring SARS-CoV-2 infection and is associated with a higher risk of mortality from COVID-19. In support of the current Centers for Disease Control and Prevention (CDC) guidelines, persons with HIV need priority consideration for the SARS-CoV-2 vaccine.
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Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA.
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, USA.
| | - Emily S Heilbrunn
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Anna E Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
- Division of Trauma Surgery, Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Shailesh Advani
- Department of Oncology, Georgetown University School of Medicine, Georgetown University, Washington, DC, USA
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonathan J Nunez
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Medicine, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
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Ssentongo P, Ssentongo AE, Heilbrunn ES, Du P. 393. Prevalence of HIV in Patients Hospitalized for COVID-19 and Associated Mortality Outcomes: A Systematic Review and Meta-analysis. Open Forum Infect Dis 2020. [PMCID: PMC7776420 DOI: 10.1093/ofid/ofaa439.588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background As of June 3rd, 2020, the number of confirmed cases of novel SARS-CoV-2, the causative agent of COVID-19, was approximately 6,538,456, with 386,503 deaths globally. Individuals with pre-existing conditions are particularly susceptible to and more likely to die from Covid-19. However, individuals with human immunodeficiency virus (HIV) are unique due to their use of antiretroviral therapy, including protease inhibitors, which have been used to treat COVID-19. We aimed to conduct a systematic review and meta-analysis exploring the prevalence and prevalence of HIV in patients hospitalized for COVID-19 and delineating the mortality rates. Methods MEDLINE, SCOPUS, and Cochrane Library databases and medrxiv.org were searched from January 1st, 2020, to June 15th, 2020. Studies reporting on the prevalence of HIV among hospitalized COVID-19 patients among and outcome of mortality were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed proportions and risk ratio estimates, and heterogeneity was quantified. Results A total of 144,795 hospitalized COVID-19 patients were identified from 14 studies (United States 8, Spain 3, China 1, Italy1, and Germany 1). The pooled prevalence of HIV in COVID-19 patients was 1.22 % [95% confidence interval (CI): 0.61%-2.43%)] translating to a 2-fold increase compared to the respective local-level pooled HIV prevalence in the general population of 0.65% (95% CI: 0.48%-0.89%. When we stratified the analysis by country, pooled HIV prevalence among COVID-19 patients in United States (1.43%, 95% CI: 0.98% -2.07%) was significantly higher compared to Spain (0.26%, 95% CI: 0.23%-0.29%) but not different from China (0.99 %, 95% CI: 0.25 %-3.85%). The pooled mortality rates in HIV-positive patients hospitalized for COVID-19 was 14.1 % 95% CI: 5.78%-30.50% and was substantially higher in the United States compared to other countries. Conclusion The prevalence of HIV among COVID-19 patients may be higher compared to the general population, suggesting higher susceptibility to COVID-19. The mortality rates are high but vary significantly across countries. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | | | | | - Ping Du
- Penn State Hershey College of Medicine, Hershey, PA
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Ssentongo AE, Ssentongo P, Heilbrunn ES, Lekoubou A, Du P, Liao D, Oh JS, Chinchilli VM. Renin-angiotensin-aldosterone system inhibitors and the risk of mortality in patients with hypertension hospitalised for COVID-19: systematic review and meta-analysis. Open Heart 2020; 7:e001353. [PMID: 33154144 PMCID: PMC7646321 DOI: 10.1136/openhrt-2020-001353] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/05/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension. METHODS PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv.org were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified. RESULTS Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19; mean age 61 years; 53% male). Overall, the between-study heterogeneity was high (I2=80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality. CONCLUSIONS In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension. PROSPERO REGISTRATION NUMBER The present study has been registered with PROSPERO (registration ID: CRD 42020187963).
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Affiliation(s)
- Anna E Ssentongo
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Center for Neural Engineering, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily S Heilbrunn
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Alain Lekoubou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - John S Oh
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS One 2020; 15:e0238215. [PMID: 32845926 PMCID: PMC7449476 DOI: 10.1371/journal.pone.0238215] [Citation(s) in RCA: 302] [Impact Index Per Article: 75.5] [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: 05/19/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Estimating the risk of pre-existing comorbidities on coronavirus disease 2019 (COVID-19) mortality may promote the importance of targeting populations at risk to improve survival. This systematic review and meta-analysis aimed to estimate the association of pre-existing comorbidities with COVID-19 mortality. METHODS We searched MEDLINE, SCOPUS, OVID, and Cochrane Library databases, and medrxiv.org from December 1st, 2019, to July 9th, 2020. The outcome of interest was the risk of COVID-19 mortality in patients with and without pre-existing comorbidities. We analyzed 11 comorbidities: cardiovascular diseases, hypertension, diabetes, congestive heart failure, cerebrovascular disease, chronic kidney disease, chronic liver disease, cancer, chronic obstructive pulmonary disease, asthma, and HIV/AIDS. Two reviewers independently extracted data and assessed the risk of bias. All analyses were performed using random-effects models and heterogeneity was quantified. RESULTS Eleven pre-existing comorbidities from 25 studies were included in the meta-analysis (n = 65, 484 patients with COVID-19; mean age; 61 years; 57% male). Overall, the between-study heterogeneity was medium, and studies had low publication bias and high quality. Cardiovascular disease (risk ratio (RR) 2.25, 95% CI = 1.60-3.17, number of studies (n) = 14), hypertension (1.82 [1.43 to 2.32], n = 13), diabetes (1.48 [1.02 to 2.15], n = 16), congestive heart failure (2.03 [1.28 to 3.21], n = 3), chronic kidney disease (3.25 [1.13 to 9.28)], n = 9) and cancer (1.47 [1.01 to 2.14), n = 10) were associated with a significantly greater risk of mortality from COVID-19. CONCLUSIONS Patients with COVID-19 with cardiovascular disease, hypertension, diabetes, congestive heart failure, chronic kidney disease and cancer have a greater risk of mortality compared to patients with COVID-19 without these comorbidities. Tailored infection prevention and treatment strategies targeting this high-risk population might improve survival.
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Affiliation(s)
- Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Surgery, Penn State College of Medicine and Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Emily S. Heilbrunn
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
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