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A bioinformatics approach for identifying potential molecular mechanisms and key genes involved in COVID-19 associated cardiac remodeling. GENE REPORTS 2021; 24:101246. [PMID: 34131597 PMCID: PMC8192842 DOI: 10.1016/j.genrep.2021.101246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
In 2019 coronavirus disease (COVID-19), whose main complication is respiratory involvement, different organs may also be affected in severe cases. However, COVID-19 associated cardiovascular manifestations are limited at present. The main purpose of this study was to identify potential candidate genes involved in COVID-19-associated heart damage by bioinformatics analysis. Differently expressed genes (DEGs) were identified using transcriptome profiles (GSE150392 and GSE4172) downloaded from the GEO database. After gene and pathway enrichment analyses, PPI network visualization, module analyses, and hub gene extraction were performed using Cytoscape software. A total of 228 (136 up and 92 downregulated) overlapping DEGs were identified at these two microarray datasets. Finally, the top hub genes (FGF2, JUN, TLR4, and VEGFA) were screened out as the critical genes among the DEGs from the PPI network. Identification of critical genes and mechanisms in any disease can lead us to better diagnosis and targeted therapy. Our findings identified core genes shared by inflammatory cardiomyopathy and SARS-CoV-2. The findings of the current study support the idea that these key genes can be used in understanding and managing the long-term cardiovascular effects of COVID-19.
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Shoucri SM, Purpura L, DeLaurentis C, Adan MA, Theodore DA, Irace AL, Robbins-Juarez SY, Khedagi AM, Letchford D, Harb AA, Zerihun LM, Lee KE, Gambina K, Lauring MC, Chen N, Sperring CP, Mehta SS, Myers EL, Shih H, Argenziano MG, Bruce SL, Slater CL, Tiao JR, Natarajan K, Hripcsak G, Chen R, Yin MT, Sobieszczyk ME, Castor D, Zucker JE. Characterising the long-term clinical outcomes of 1190 hospitalised patients with COVID-19 in New York City: a retrospective case series. BMJ Open 2021; 11:e049488. [PMID: 34083350 PMCID: PMC8182750 DOI: 10.1136/bmjopen-2021-049488] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To characterise the long-term outcomes of patients with COVID-19 admitted to a large New York City medical centre at 3 and 6 months after hospitalisation and describe their healthcare usage, symptoms, morbidity and mortality. DESIGN Retrospective cohort through manual chart review of the electronic medical record. SETTING NewYork-Presbyterian/Columbia University Irving Medical Center, a quaternary care academic medical centre in New York City. PARTICIPANTS The first 1190 consecutive patients with symptoms of COVID-19 who presented to the hospital for care between 1 March and 8 April 2020 and tested positive for SARS-CoV-2 on reverse transcriptase PCR assay. MAIN OUTCOME MEASURES Type and frequency of follow-up encounters, self-reported symptoms, morbidity and mortality at 3 and 6 months after presentation, respectively; patient disposition information prior to admission, at discharge, and at 3 and 6 months after hospital presentation. RESULTS Of the 1190 reviewed patients, 929 survived their initial hospitalisation and 261 died. Among survivors, 570 had follow-up encounters (488 at 3 months and 364 at 6 months). An additional 33 patients died in the follow-up period. In the first 3 months after admission, most encounters were telehealth visits (59%). Cardiopulmonary symptoms (35.7% and 28%), especially dyspnoea (22.1% and 15.9%), were the most common reported symptoms at 3-month and 6-month encounters, respectively. Additionally, a large number of patients reported generalised (26.4%) or neuropsychiatric (24.2%) symptoms 6 months after hospitalisation. Patients with severe COVID-19 were more likely to have reduced mobility, reduced independence or a new dialysis requirement in the 6 months after hospitalisation. CONCLUSIONS Patients hospitalised with SARS-CoV-2 infection reported persistent symptoms up to 6 months after diagnosis. These results highlight the long-term morbidity of COVID-19 and its burden on patients and healthcare resources.
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Affiliation(s)
- Sherif M Shoucri
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Lawrence Purpura
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Clare DeLaurentis
- Medicine, Columbia University Irving Medical Center, New York City, New York, USA
| | - Matthew A Adan
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Deborah A Theodore
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Alexandria Lauren Irace
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | | | - Apurva M Khedagi
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Daniel Letchford
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Amro A Harb
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Lillian M Zerihun
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Kate E Lee
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Karen Gambina
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Max C Lauring
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Noah Chen
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Colin P Sperring
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Sanket S Mehta
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Ellen L Myers
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Hueyjong Shih
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Michael G Argenziano
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Samuel L Bruce
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Cody L Slater
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Jonathan R Tiao
- Columbia University Vagelos College of Physicians and Surgeons, New York City, New York, USA
| | - Karthik Natarajan
- Biomedical Informatics, Columbia University Irving Medical Center, New York City, New York, USA
| | - George Hripcsak
- Biomedical Informatics, Columbia University Irving Medical Center, New York City, New York, USA
| | - Ruijun Chen
- Biomedical Informatics, Columbia University Irving Medical Center, New York City, New York, USA
- Translational Data Science and Informatics, Geisinger, Danville, Pennsylvania, USA
| | - Michael T Yin
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Magdalena E Sobieszczyk
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Delivette Castor
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
| | - Jason E Zucker
- Medicine, Infectious Diseases, Columbia University Irving Medical Center, New York City, New York, USA
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Li J, Giabbanelli P. Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study. JMIR Med Inform 2021; 9:e27419. [PMID: 33872188 PMCID: PMC8086790 DOI: 10.2196/27419] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown. OBJECTIVE We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions. METHODS We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded. RESULTS For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections. CONCLUSIONS Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections.
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Affiliation(s)
- Junjiang Li
- Department of Computer Science & Software Engineering, Miami University, Oxford, OH, United States
| | - Philippe Giabbanelli
- Department of Computer Science & Software Engineering, Miami University, Oxford, OH, United States
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Bollavaram K, Leeman TH, Lee MW, Kulkarni A, Upshaw SG, Yang J, Song H, Platt MO. Multiple sites on SARS-CoV-2 spike protein are susceptible to proteolysis by cathepsins B, K, L, S, and V. Protein Sci 2021; 30:1131-1143. [PMID: 33786919 PMCID: PMC8138523 DOI: 10.1002/pro.4073] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/23/2022]
Abstract
SARS‐CoV‐2 is the coronavirus responsible for the COVID‐19 pandemic. Proteases are central to the infection process of SARS‐CoV‐2. Cleavage of the spike protein on the virus's capsid causes the conformational change that leads to membrane fusion and viral entry into the target cell. Since inhibition of one protease, even the dominant protease like TMPRSS2, may not be sufficient to block SARS‐CoV‐2 entry into cells, other proteases that may play an activating role and hydrolyze the spike protein must be identified. We identified amino acid sequences in all regions of spike protein, including the S1/S2 region critical for activation and viral entry, that are susceptible to cleavage by furin and cathepsins B, K, L, S, and V using PACMANS, a computational platform that identifies and ranks preferred sites of proteolytic cleavage on substrates, and verified with molecular docking analysis and immunoblotting to determine if binding of these proteases can occur on the spike protein that were identified as possible cleavage sites. Together, this study highlights cathepsins B, K, L, S, and V for consideration in SARS‐CoV‐2 infection and presents methodologies by which other proteases can be screened to determine a role in viral entry. This highlights additional proteases to be considered in COVID‐19 studies, particularly regarding exacerbated damage in inflammatory preconditions where these proteases are generally upregulated. PDB Code(s): 6VYB, 4Z2A, 5F02, 4P6E, 5TUN, 2IPP and 3H6S;
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Affiliation(s)
- Keval Bollavaram
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Tiffanie H Leeman
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Maggie W Lee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Akhil Kulkarni
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Sophia G Upshaw
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Jiabei Yang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA.,Biomedical Engineering, Peking University, Beijing, China
| | - Hannah Song
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - Manu O Platt
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
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55
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Fan BE, Cheung C. Post COVID-19 Arterial Thromboembolism: A Clear and Present Danger. Semin Thromb Hemost 2021; 48:112-114. [PMID: 33860515 DOI: 10.1055/s-0041-1728717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Bingwen Eugene Fan
- Department of Haematology, Tan Tock Seng Hospital, Singapore.,Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Molecular and Cell Biology, Singapore
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Grandone E, Tiscia G, Pesavento R, De Laurenzo A, Ceccato D, Sartori MT, Mirabella L, Cinnella G, Mastroianno M, Dalfino L, Colaizzo D, Vettor R, Intrieri M, Ostuni A, Margaglione M. Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation. J Thromb Thrombolysis 2021; 52:772-778. [PMID: 33844150 PMCID: PMC8040353 DOI: 10.1007/s11239-021-02429-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 01/08/2023]
Abstract
It is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann–Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13–0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH.
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Affiliation(s)
- Elvira Grandone
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy.
- Ob/Gyn Department of The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
| | - Giovanni Tiscia
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy
| | | | - Antonio De Laurenzo
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy
| | - Davide Ceccato
- Department of Internal Medicine, University of Padua, Padua, Italy
| | | | - Lucia Mirabella
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Mario Mastroianno
- Scientific Direction, Fondazione I.R.C.C.S. "Casa Sollievo Della Sofferenza", S. Giovanni Rotondo, Foggia, Italy
| | - Lidia Dalfino
- Anesthesia and Intensive Care Unit, University of Bari, Bari, Italy
| | - Donatella Colaizzo
- Thrombosis and Haemostasis Unit, Fondazione I.R.C.C.S. "Casa Sollievo della Sofferenza", Viale Cappuccini, S. Giovanni Rotondo, 71013, Foggia, Italy
| | - Roberto Vettor
- Department of Internal Medicine, University of Padua, Padua, Italy
| | - Mariano Intrieri
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Angelo Ostuni
- Immunohematology and Transfusion Medicine Service, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, University of Bari "Aldo Moro", and Struttura Regionale Coordinamento Puglia, Bari, Italy
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Tamborrini G, Micheroli R. [CME Rheumatology 23: Rheumatoid Arthritis Following COVID-19/SARS-CoV-2 Infection]. PRAXIS 2021; 110:293-297. [PMID: 33906448 DOI: 10.1024/1661-8157/a003670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME Rheumatology 23: Rheumatoid Arthritis Following COVID-19/SARS-CoV-2 Infection Abstract. Individuals with rheumatic diseases, especially those on immuno-modulating treatment, have an increased risk of infection. On the other hand, it is known that viral infections may be a cause for acute arthralgias and of arthritis. We present in the following a case of ACPA-positive and RF-positive rheumatoid arthritis after an acute COVID-19/SARS-CoV-2 infection and discuss the possible association with the infection.
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Affiliation(s)
- Giorgio Tamborrini
- UZR® - Schweizer Ultraschallzentrum und Institut für Rheumatologie, Basel
- Klinik für Rheumatologie, Universitätsspital Basel, Basel
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Inhaled aerosols: Their role in COVID-19 transmission, including biophysical interactions in the lungs. Curr Opin Colloid Interface Sci 2021; 54:101451. [PMID: 33782631 PMCID: PMC7989069 DOI: 10.1016/j.cocis.2021.101451] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The high rate of spreading of COVID-19 is attributed to airborne particles exhaled by infected but often asymptomatic individuals. In this review, the role of aerosols in SARS-CoV-2 coronavirus transmission is discussed from the biophysical perspective. The essential properties of the coronavirus virus transported inside aerosol droplets, their successive inhalation, and size-dependent deposition in the respiratory system are highlighted. The importance of face covers (respirators and masks) in the reduction of aerosol spreading is analyzed. Finally, the discussion of the physicochemical phenomena of the coronavirus entering the surface of lung liquids (bronchial mucus and pulmonary surfactant) is presented with a focus on a possible role of interfacial phenomena in pulmonary alveoli. Information given in this review should be important in understanding the essential biophysical conditions of COVID-19 infection via aerosol route as a prerequisite for effective strategies of respiratory tract protection, and possibly, indications for future treatments of the disease.
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Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I, Banerjee A. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021; 372:n693. [PMID: 33789877 PMCID: PMC8010267 DOI: 10.1136/bmj.n693] [Citation(s) in RCA: 385] [Impact Index Per Article: 128.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population. DESIGN Retrospective cohort study. SETTING NHS hospitals in England. PARTICIPANTS 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records. MAIN OUTCOME MEASURES Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity. RESULTS Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). CONCLUSIONS Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.
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Affiliation(s)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Vahé Nafilyan
- Office for National Statistics, Government Buildings, Newport, UK
| | - Thomas Maddox
- Office for National Statistics, Government Buildings, Newport, UK
| | - Ben Humberstone
- Office for National Statistics, Government Buildings, Newport, UK
| | - Ian Diamond
- Office for National Statistics, Government Buildings, Newport, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London NW1 2DA, UK
- University College London Hospitals NHS Trust, London, UK
- Barts Health NHS Trust, Royal London Hospital, London, UK
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Tomar BS, Singh M, Nathiya D, Sharma A, Sharma E, Bareth H, Suman S, Ruparelia DP, Patel JB, Gajera VK. Prevalence of Symptoms in Patients Discharged from COVID Care Facility of NIMS Hospital: Is RT PCR Negativity Truly Reflecting Recovery? A Single-Centre Observational Study. Int J Gen Med 2021; 14:1069-1078. [PMID: 33790636 PMCID: PMC8006813 DOI: 10.2147/ijgm.s295499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To assess the prevalence of post-COVID symptoms in patients with recovered COVID-19 (nasopharyngeal RT PCR negative) who were discharged from an acute COVID care facility at a tertiary care teaching hospital in North India. METHODS This study was an observational study with retrospective data collection, conducted in the COVID follow-up clinic, a combined clinic of medicine and endocrinology. Patients discharged from the acute COVID care facility were recruited after 14 days of discharge if they fulfilled inclusion and exclusion criteria. The retrospective data was collected from the hospital records/EMR and analysed by the SPSSv23. RESULTS Fifty patients, who fulfilled the inclusion and exclusion criteria, were included in the study. The Mean age of patients was 53.4±13.8 years (range 28-77). Seventy six percent were male, and 38% had type 2 diabetes. Fever (94%), cough (78%) and breathlessness (68%), were the most common symptoms at presentation to acute care facility. Oxygen saturation at presentation had a negative correlation with D-Dimer, age, and C reactive protein. When patients were evaluated clinically, after 14 days (range 15 to 50 days) of the discharge, 82% of patients had at least one persistent symptom. Fatigue (74%) was the most common symptoms in follow-up followed by breathlessness (44%), and muscle weakness (36%). Two patients had persistent fever, even after negative RT PCR status. CONCLUSION Patients discharged from the acute COVID care facility had a high prevalence of post-COVID symptoms even after 14 days.
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Affiliation(s)
- Balvir S Tomar
- Institute of Gastroenterology, Hepatology & Transplant, Nims University Rajasthan, Jaipur, India
| | - Mahaveer Singh
- Department of Endocrinology, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, 303121, India
| | - Deepak Nathiya
- Department of Pharmacy Practice, Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Abhishek Sharma
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Eshan Sharma
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Hemant Bareth
- Department of Pharmacy Practice, Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Supriya Suman
- Department of Pharmacy Practice, Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
| | - Darshan Purshotambhai Ruparelia
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Jaykumar Bharatbhai Patel
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - Vikrant Kantilal Gajera
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
| | - On Behalf of the NIMS COVID 19 Investigator Group
- Institute of Gastroenterology, Hepatology & Transplant, Nims University Rajasthan, Jaipur, India
- Department of Endocrinology, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, 303121, India
- Department of Pharmacy Practice, Institute of Pharmacy, Nims University Rajasthan, Jaipur, India
- Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India
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Becker RC. COVID-19 and its sequelae: a platform for optimal patient care, discovery and training. J Thromb Thrombolysis 2021; 51:587-594. [PMID: 33501596 PMCID: PMC7838017 DOI: 10.1007/s11239-021-02375-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
COVID-19- related patient care and research have focused on short-term outcomes, particularly among those with underlying or preexisting medical conditions. A major focus has been on mortality rates. Broadening the dialogue is neither meant nor intended to disparage the near-term devastation felt globally each day, but rather to begin preparation for optimally caring for and addressing the needs of survivors. The sequelae of COVID-19 includes acute, subacute and chronic stages of the condition. If one applies current World Health Organization (WHO) statistics to calculate the global burden of disease, there are 98,000,000 COVID-19 survivors. The following editorial focuses on post-COVID sequelae as a continuum of patient care needs, as well as discovery and training opportunities in an academic setting.
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Affiliation(s)
- Richard C Becker
- Heart, Lung and Vascular Institute, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
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Bruno RR, Wolff G, Kelm M, Jung C. COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen. AKTUELLE KARDIOLOGIE 2020. [DOI: 10.1055/a-1314-9342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
ZusammenfassungEtwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO2 < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden
Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO2 ≥ 90% oder ein paO2 > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.
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Affiliation(s)
- Raphael Romano Bruno
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
| | - Georg Wolff
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
| | - Malte Kelm
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
- CARID – Cardiovascular Research Institute Düsseldorf, Universitätsklinikum Düsseldorf, Deutschland
| | - Christian Jung
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Deutschland
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Delayed catastrophic thrombotic events in young and asymptomatic post COVID-19 patients. J Thromb Thrombolysis 2020; 51:971-977. [PMID: 33159640 PMCID: PMC7648538 DOI: 10.1007/s11239-020-02332-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 01/02/2023]
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