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Mone P, Jankauskas SS, Manzi MV, Gambardella J, Coppola A, Kansakar U, Izzo R, Fiorentino G, Lombardi A, Varzideh F, Sorriento D, Trimarco B, Santulli G. Endothelial Extracellular Vesicles Enriched in microRNA-34a Predict New-Onset Diabetes in Coronavirus Disease 2019 (COVID-19) Patients: Novel Insights for Long COVID Metabolic Sequelae. J Pharmacol Exp Ther 2024; 389:34-39. [PMID: 38336381 PMCID: PMC10949163 DOI: 10.1124/jpet.122.001253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Emerging evidence indicates that the relationship between coronavirus disease 2019 (COVID-19) and diabetes is 2-fold: 1) it is known that the presence of diabetes and other metabolic alterations poses a considerably high risk to develop a severe COVID-19; 2) patients who survived a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an increased risk of developing new-onset diabetes. However, the mechanisms underlying this association are mostly unknown, and there are no reliable biomarkers to predict the development of new-onset diabetes. In the present study, we demonstrate that a specific microRNA (miR-34a) contained in circulating extracellular vesicles released by endothelial cells reliably predicts the risk of developing new-onset diabetes in COVID-19. This association was independent of age, sex, body mass index (BMI), hypertension, dyslipidemia, smoking status, and D-dimer. SIGNIFICANCE STATEMENT: We demonstrate for the first time that a specific microRNA (miR-34a) contained in circulating extracellular vesicles released by endothelial cells is able to reliably predict the risk of developing diabetes after having contracted coronavirus disease 2019 (COVID-19). This association was independent of age, sex, body mass index (BMI), hypertension, dyslipidemia, smoking status, and D-dimer. Our findings are also relevant when considering the emerging importance of post-acute sequelae of COVID-19, with systemic manifestations observed even months after viral negativization (long COVID).
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Stanislovas S Jankauskas
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Maria Virginia Manzi
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Jessica Gambardella
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Antonietta Coppola
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Urna Kansakar
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Raffaele Izzo
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Giuseppe Fiorentino
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Angela Lombardi
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Fahimeh Varzideh
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Daniela Sorriento
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Bruno Trimarco
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
| | - Gaetano Santulli
- Department of Medicine, Einstein-Sinai Diabetes Research Center, Fleischer Institute for Diabetes and Metabolism, Einstein Institute for Aging Research (P.M., S.S.J., J.G., U.K., A.L., F.V., G.S.) and Department of Molecular Pharmacology, Wilf Family Cardiovascular Research Institute, Einstein Institute for Neuroimmunology and Inflammation (G.S.), Albert Einstein College of Medicine, New York, New York; Department of Advanced Biomedical Sciences, International Translational Research and Medical Education, "Federico II" University, Naples, Italy (M.V.M., J.G., R.I., D.S., B.T., G.S.); Clinica Montevergine, Mercogliano, Avellino (P.M.); and COVID-19 Division, A.O.R.N. Ospedali dei Colli, Naples, Italy (A.C., G.F.)
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Conte C, Cipponeri E, Roden M. Diabetes Mellitus, Energy Metabolism, and COVID-19. Endocr Rev 2024; 45:281-308. [PMID: 37934800 PMCID: PMC10911957 DOI: 10.1210/endrev/bnad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/30/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023]
Abstract
Obesity, diabetes mellitus (mostly type 2), and COVID-19 show mutual interactions because they are not only risk factors for both acute and chronic COVID-19 manifestations, but also because COVID-19 alters energy metabolism. Such metabolic alterations can lead to dysglycemia and long-lasting effects. Thus, the COVID-19 pandemic has the potential for a further rise of the diabetes pandemic. This review outlines how preexisting metabolic alterations spanning from excess visceral adipose tissue to hyperglycemia and overt diabetes may exacerbate COVID-19 severity. We also summarize the different effects of SARS-CoV-2 infection on the key organs and tissues orchestrating energy metabolism, including adipose tissue, liver, skeletal muscle, and pancreas. Last, we provide an integrative view of the metabolic derangements that occur during COVID-19. Altogether, this review allows for better understanding of the metabolic derangements occurring when a fire starts from a small flame, and thereby help reducing the impact of the COVID-19 pandemic.
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Affiliation(s)
- Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome 00166, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan 20099, Italy
| | - Elisa Cipponeri
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan 20099, Italy
| | - Michael Roden
- Department of Endocrinology and Diabetology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf 40225, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Neuherberg 85764, Germany
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3
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Hansotte E, Andrea SB, Weathers TD, Stone C, Jessup A, Staten LK. Impact of community health workers on diabetes management in an urban United States Community with high diabetes burden through the COVID pandemic. Prev Med Rep 2024; 39:102645. [PMID: 38370984 PMCID: PMC10869924 DOI: 10.1016/j.pmedr.2024.102645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Objective Community Health Worker (CHW) interventions are promising approaches to increasing access to health care, garnering better health outcomes, and decreasing health inequities for historically marginalized populations. This study examines the impact of a health system-based CHW program embedded in the Diabetes Impact Project - Indianapolis Neighborhoods (DIP-IN), a large, place-based, multi-year intervention to reduce diabetes burden. We assessed the CHW program's effectiveness in managing glucose control and reducing diabetes-associated complications across the COVID timeline. Methods We examined the association between the CHW intervention and diabetes management in 454 CHW patients and 1,020 propensity score-matched comparison patients. Using electronic medical records for encounters between January 1, 2017, and March 31, 2022, we estimated the CHW program effect using a difference-in-difference approach through generalized linear mixed models. Results Participation was associated with a significant reduction (-0.54-unit (95 % CI: -0.73, -0.35) in glycosylated hemoglobin (A1C) on average over time that was beyond the change observed among comparison patients, higher odds of having ≥ 2 A1C measures in a year (OR = 2.32, 95 % CI: 1.79, 3.00), lower odds of ED visits (OR: 0.88; 95 % CI: 0.73, 1.05), and lower odds of hospital admission (OR: 0.81; 95 % CI: 0.60,1.09). When analyses were restricted to a pre-pandemic timeframe, the pattern of results were similar. Conclusion This program was effective in improving diabetes management among patients living in diabetes-burdened communities, and the effects were persistent throughout the pandemic timeline. CHW programs offer crucial reinforcement for diabetes management during periods when routine healthcare access is constrained.
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Affiliation(s)
- Elinor Hansotte
- Marion County Public Health Department, 3838 N. Rural St., Indianapolis, IN 46205, United States
| | - Sarah B. Andrea
- Oregon Health & Science University-Portland State University School of Public Health, Vanport Building, 1810 SW 5 Ave., Suite 510, Portland, OR 97201, United States
| | - Tess D. Weathers
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Cynthia Stone
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
| | - Alisha Jessup
- Eskenazi Health, 720 Eskenazi Ave., Indianapolis, IN 46202, United States
| | - Lisa K. Staten
- Indiana University Richard M. Fairbanks School of Public Health, Health Sciences Building, 1050 Wishard Blvd., Indianapolis, IN 46202, United States
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Wolff M, Charpentier P, Canals A, Vial C, Hormazábal J, Cortés J, Silva M. Humoral immune response in people living with HIV after administration of SARS-CoV-2 vaccine CoronaVac or BNT162b2 or CoronaVac/BNT162b2 booster sequence: A cross-sectional study. Vaccine 2024; 42:671-676. [PMID: 38123398 DOI: 10.1016/j.vaccine.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 12/02/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The evidence of SARS-CoV-2 vaccine effectiveness in people living with HIV (PLWH) is limited. This study evaluated the humoral immune response to CoronaVac™ (virus inactivated) and BNT162b2 (mRNA- based) vaccines in PLWH and HIV-negative controls, with and without a booster sequence. METHODS We conducted a cross-sectional study on PLWH and HIV-negative controls who received CoronaVac or BNT162b2, with a subgroup receiving a CoronaVac/BNT162b2 booster. Blood samples were collected 4-6 months after primary vaccination and tested for anti-SARS-CoV-2 protein S (aSAb) and neutralizing antibodies (NtAb) using validated assays. Immune response was evaluated by age, sex, previous COVID-19 history, and CD4 + cell count. FINDINGS One hundred and eighty nine participants were enrolled with 161 (85%) being PLWH. Among participants without previous known COVID-19, median aSAb levels were significantly lower in PLWH who received CoronaVac compared to BNT162b2 (32 U/mL vs. 587 U/mL, p < 0.001), with similar results in HIV-negative controls. NtAb presence was also significantly lower after CoronaVac compared to BNT162b2 (30% vs. 93%, p < 0.001). The booster sequence group showed a significant increase in aSAb titers in both PLWH and HIV-negative controls (from 33 U/ml to 2500 U/ml, p < 0.001), and NtAb positivity increased from 20% to 95 % in PLWH, and 27% to 100% in HIV-negative controls. Prior COVID-19 led to significantly higher post-vaccine antibody titers particularly in the BNT162b2 group. PLWH with CD4 + count < 200 cells/mL showed a weaker immune response to both vaccines. INTERPRETATION CoronaVac resulted in a weaker immune response in both PLWH and HIV-negative controls compared to BNT162b2, particularly in immunosuppressed PLWH without prior COVID-19. Hybrid immunity and heterologous booster vaccination increased antibody levels. FUNDING Local funding.
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Affiliation(s)
- Marcelo Wolff
- University of Chile, School of Medicine, Santiago, Chile; Infectious Disease Unit, San Borja Arriarán Hospital, Santiago, Chile; Arriarán Foundation, Santiago, Chile.
| | - Paulo Charpentier
- University of Chile, School of Medicine, Santiago, Chile; Infectious Disease Unit, San Borja Arriarán Hospital, Santiago, Chile
| | - Andrea Canals
- Public Health School, University of Chile, Santiago, Chile
| | - Cecilia Vial
- Hantavirus and Zoonosis Program, Institute of Science and Innovation in Medicine, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Juan Hormazábal
- Hantavirus and Zoonosis Program, Institute of Science and Innovation in Medicine, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Jimena Cortés
- Hantavirus and Zoonosis Program, Institute of Science and Innovation in Medicine, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Macarena Silva
- Infectious Disease Unit, San Borja Arriarán Hospital, Santiago, Chile; Arriarán Foundation, Santiago, Chile
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Jabakhanji SB, Ogungbe O, Angell SY, Appel L, Byrne D, Mehta R, McCaffrey J, Rosman L, Gregg EW, Matsushita K. Disruption of diabetes and hypertension care during the COVID-19 pandemic and recovery approaches in the Latin America and Caribbean region: a scoping review protocol. BMJ Open 2024; 14:e074443. [PMID: 38262656 PMCID: PMC10806801 DOI: 10.1136/bmjopen-2023-074443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/05/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic significantly disrupted primary healthcare globally, with particular impacts on diabetes and hypertension care. This review will examine the impact of pandemic disruptions of diabetes and hypertension care services and the evidence for interventions to mitigate or reverse pandemic disruptions in the Latin America and Caribbean (LAC) region. METHODS AND ANALYSES This scoping review will examine care delivery disruption and approaches for recovery of primary healthcare in the LAC region during the COVID-19 pandemic, focusing on diabetes and hypertension awareness, detection, treatment and control. Guided by Arksey and O'Malley's scoping review methodology framework, this protocol adheres to the Joanna Briggs Institute guidelines for scoping review protocols and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance for protocol development and scoping reviews. We searched MEDLINE, CINAHL, Global Health, Embase, Cochrane, Scopus, Web of Science and LILACS for peer-reviewed literature published from 2020 to 12 December 2022 in English, Spanish or Portuguese. Studies will be considered eligible if reporting data on pandemic disruptions to primary care services within LAC, or interventions implemented to mitigate or reverse pandemic disruptions globally. Studies on COVID-19 or acute care will be excluded. Two reviewers will independently screen each title/abstract for eligibility, screen full texts of titles/abstracts deemed relevant and extract data from eligible full-text publications. Conflicts will be resolved through discussion and with the help of a third reviewer. Appropriate analytical techniques will be employed to synthesise the data, for example, frequency counts and descriptive statistics. Quality will be assessed using the Newcastle Ottawa Quality Assessment Scale. ETHICS AND DISSEMINATION No ethics approval was needed as this is a scoping review of published literature. Results will be disseminated in a report to the World Bank and the Pan American Health Organization, in peer-reviewed scientific journals, and at national and international conferences.
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Affiliation(s)
- Samira Barbara Jabakhanji
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Center for Preventive Medicine and Digital Health, Heidelberg University Medical Faculty, Mannheim, Germany
| | | | - Sonia Y Angell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Medicine, Columbia University Medical Center, New York City, New York, USA
| | - Lawrence Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - David Byrne
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Roopa Mehta
- Departamento de Endocrinología y Metabolismo, Unidad de Investigación en Enfermedades Metabolicas, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de Mexico, Mexico
| | - John McCaffrey
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lori Rosman
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Edward W Gregg
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Lumu W, Mutebi RK, Nakireka S, Muyanja D, Eleku S, Kaddu D, Nunda E, Kabugo D, Kinene H, Nambago S, Ninsiima C, Kifuba I, Edemaga D, Atwiine E, Mutebi B, Nandawula M, Nakigudde N, Kataike Z, Nakachwa J, Nakaayi C, Lukyamuzi P, Ssebuufu R, Mutumba R. Association of triglyceride-glucose index with vascular risk factors and clinical outcomes among COVID-19 patients: a retrospective cross-sectional study in Mengo Hospital, Kampala, Uganda. Pan Afr Med J 2023; 46:113. [PMID: 38465013 PMCID: PMC10924613 DOI: 10.11604/pamj.2023.46.113.41795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/06/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction triglyceride-glucose (TyG) index is a reliable surrogate marker of insulin resistance. We assessed the association between triglyceride-glucose (TyG) index and vascular risk factors and clinical outcomes of critically ill adult COVID-19 patients. Methods data from the charts of all patients with a confirmed diagnosis of COVID-19 who were hospitalized at Mengo Hospital Uganda from December 2020 to August 2021 was used for this study. Data on demographics, past medical history, clinical presentation, laboratory findings and clinical outcomes within the first 10 days of admission was extracted. TyG index was calculated as Inverse (triglyceride (mg/dl) x fasting glucose level (mg/dl)/2 and defined vascular risk factors using standard methods. Bivariate and multivariate logistic regression was conducted to establish a significant association. Statistical significance was set at p< 0.05. Results out of 314 patients, 176 (56%) were females. The mean age ± SD was 58.2 years ± 16.82. The median TyG index was 9.76 (9.29-10.33). A high TyG index was found among 85.4% (n= 268, 95% CI: 0.809-0.889) of patients. Elevated total cholesterol was in 55.4% (n=174), triglycerides 70.7% (n=222), LDL 64.7% (n=203), blood glucose 80.6% (n=253), systolic blood pressure 43% (n=135) and 24.8% (n=78) diastolic blood pressure. The majority 49.7% ( n=156) were discharged, 22.0% (n=69) needed admission to the intensive care unit (ICU), 15.3% (n=48) died in the unit and 13.0% (n=41) had a composite outcome. The TyG index was significantly associated with glycated hemoglobin (AOR=1.029, 95%CI 0.561-1.496, p<0.001), low-density lipoprotein cholesterol (AOR=0.121,95%CI 0.023-0.219, p=0.016), high-density cholesterol (AOR=1.956, 95%CI 1.299-2.945, p=0.001), total cholesterol (AOR=2.177, 95%CI 1.5222-3.144, p<0.001, hospital death (AOR=0.778, 95%CI 0.623-0.972, p=0.028) and composite outcome (AOR=1.823, 95% CI 1.221-2.559, p=0.023). There was no association between hypertension and TyG index. Conclusion a high TyG index was associated with vascular risk factors and clinical outcomes.
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Affiliation(s)
- William Lumu
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | | | - Susan Nakireka
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - David Muyanja
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Simon Eleku
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Denis Kaddu
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Ezra Nunda
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Deus Kabugo
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Henry Kinene
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Simon Nambago
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | | | - Isa Kifuba
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | | | - Edgar Atwiine
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | - Brian Mutebi
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | | | | | - Zubeda Kataike
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | | | | | - Paul Lukyamuzi
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
| | | | - Rose Mutumba
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
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Gharaibeh BA, Abuhammad S, Haneyah O, Mehrass AAKO. Role of inflammation in determining the severity of COVID-19 infection in patients with diabetes: A comparative study. Medicine (Baltimore) 2023; 102:e36641. [PMID: 38115274 PMCID: PMC10727631 DOI: 10.1097/md.0000000000036641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
There is a need to consider the geographical origins when studying the association between COVID-19 and the comorbid conditions. To examine the role of inflammation in determining the severity of COVID-19 among hospitalized patients with diabetes and compare these roles with those who does not have diabetes. A cross sectional comparative design was used with a convenience sample of 352 patients. Samples were collected from hospitalized patients with COVID-19 who were divided into 2 groups (diabetes and non-diabetes). Data regarding results of selected inflammatory markers and sociodemographic were collected. The severity of COVID-19 differed significantly between the diabetes and non-diabetes groups (Chi square = 25.58 P < .05). There was significant difference in the mean scores of neutrophil counts, monocyte count, Basophil count, erythrocyte sedimentation rate, partial thromboplastin time, C-creative protein, platelets, white blood cells, and mean cellular hemoglobin center between those with and those without diabetes. The diabetes were shown more increased in the predictors and severity of the COVID-19 disease. However, neutrophil to lymphocyte ratio, neutrophil count, and age were the significant predictors of the severity level of COVID-19 among patients with diabetes. In conclusion, our study addressed the influence of having diabetes among hospitalized patients with moderate and severe COVID-19 infection. The results showed that severity of COVID-19 infection was affected by diabetes where those with diabetes had more tendency to suffer from the severe form of the disease rather that the moderate level.
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Affiliation(s)
- Besher A. Gharaibeh
- Department of Adult Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sawsan Abuhammad
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Obieda Haneyah
- Department of Adult Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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Li C, Islam N, Gutierrez JP, Gutiérrez-Barreto SE, Castañeda Prado A, Moolenaar RL, Lacey B, Richter P. Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis. BMJ Glob Health 2023; 8:e012581. [PMID: 38097276 PMCID: PMC10729095 DOI: 10.1136/bmjgh-2023-012581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/04/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Despite a growing body of scholarly research on the risks of severe COVID-19 associated with diabetes, hypertension and obesity, there is a need for estimating pooled risk estimates with adjustment for confounding effects. We conducted a systematic review and meta-analysis to estimate the pooled adjusted risk ratios of diabetes, hypertension and obesity on COVID-19 mortality. METHODS We searched 16 literature databases for original studies published between 1 December 2019 and 31 December 2020. We used the adapted Newcastle-Ottawa Scale to assess the risk of bias. Pooled risk ratios were estimated based on the adjusted effect sizes. We applied random-effects meta-analysis to account for the uncertainty in residual heterogeneity. We used contour-funnel plots and Egger's test to assess possible publication bias. RESULTS We reviewed 34 830 records identified in literature search, of which 145 original studies were included in the meta-analysis. Pooled adjusted risk ratios were 1.43 (95% CI 1.32 to 1.54), 1.19 (95% CI 1.09 to 1.30) and 1.39 (95% CI 1.27 to 1.52) for diabetes, hypertension and obesity (body mass index ≥30 kg/m2) on COVID-19 mortality, respectively. The pooled adjusted risk ratios appeared to be stronger in studies conducted before April 2020, Western Pacific Region, low- and middle-income countries, and countries with low Global Health Security Index scores, when compared with their counterparts. CONCLUSIONS Diabetes, hypertension and obesity were associated with an increased risk of COVID-19 mortality independent of other known risk factors, particularly in low-resource settings. Addressing these chronic diseases could be important for global pandemic preparedness and mortality prevention. PROSPERO REGISTRATION NUMBER CRD42021204371.
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Affiliation(s)
- Chaoyang Li
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nazrul Islam
- Faculty of Medicine, University of Southampton, Southampton, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Juan Pablo Gutierrez
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | | | - Andrés Castañeda Prado
- Center for Policy, Population & Health Research, Universidad Nacional Autónoma de México, Coyoacan, Mexico
| | - Ronald L Moolenaar
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Patricia Richter
- Division of Global Health Protection, Global Health Center, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Mina J, Samaha NL, Fleifel M, Nasr J, Haykal T, Dimassi H, Harb R, Hout GE, Franjieh E, Mahdi A, Mokhbat J, Farra A, Husni R. Lower odds of COVID-19-related mortality in hospitalised patients with type II diabetes mellitus: A single-centre study. PLoS One 2023; 18:e0287968. [PMID: 37976296 PMCID: PMC10656017 DOI: 10.1371/journal.pone.0287968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 06/01/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND COVID-19 infection in patients with type 2 diabetes mellitus (T2DM) -a chronic illness in Lebanon-is not well described. METHODS This was a single-centre retrospective observational study of 491 patients, including 152 patients with T2DM, who were hospitalised for COVID-19 between 20 August 2020 and 21 April 2021. Data on clinical characteristics, laboratory and radiological findings and outcomes were collected from the electronic medical records. Clinical characteristics and in-hospital mortality between patients with and without T2DM infected with COVID-19 using multivariate analysis were compared. RESULTS Patients with T2DM were significantly older than those without T2DM (mean age, 68.7 vs. 60.3 years). Patients with T2DM were more likely to present with a body temperature of <38.3°C (83.9% vs. 69.9%) and less likely to present with chest pain (3.9% vs. 9.1%) and sore throat (2.0% vs. 6.8%). Patients with T2DM were more likely to be hypertensive (76.35% vs. 41%) and dyslipidaemic (58.6% vs. 25.7%) and had more frequent underlying coronary artery disease (33.6% vs. 12.4%). The rates of patients with creatinine levels of ≥1.17 mg/L and troponin T levels of ≥4 ng/dL were higher in the T2DM group than in the non-T2DM group (30.4% vs. 15% and 93.3% vs. 83.1%, respectively). Patients with T2DM were more likely to be admitted to the intensive care unit (ICU) (34.2% vs. 22.1%), require invasive ventilation (18.4% vs. 10.3%) and receive vasopressors (16.4% vs. 10.0%). Increasing age and the use of invasive ventilation and vasopressors were associated with higher odds of mortality (odds ratio (OR), 1.08, 9.95 and 19.83, respectively), whereas longer ICU stay was associated with lower odds of mortality (OR, 0.38). The odds of mortality were lower in the T2DM group than in the non-T2DM group (OR, 0.27). CONCLUSION Among patients hospitalised for COVID-19, those with T2DM were older, presented with milder symptoms and had more comorbidities and higher troponin T levels compared with those without T2DM. Despite the worse clinical course, the patients with T2DM had lower odds of mortality than those without T2DM.
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Affiliation(s)
- Jonathan Mina
- Department of Internal Medicine, Staten Island University Hospital, Staten Island, New York, United States of America
| | - Nadia L. Samaha
- Georgetown University School of Medicine, Washington, D.C., United States of America
| | - Mohamad Fleifel
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Janane Nasr
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Tony Haykal
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Ghida El Hout
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
| | - Elissar Franjieh
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
| | - Ahmad Mahdi
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Jacques Mokhbat
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
| | - Anna Farra
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
| | - Rola Husni
- Department of Internal Medicine, Lebanese American University Medical Centre-Rizk Hospital, Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
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11
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Khaltaev N, Axelrod S. Decline of the chronic respiratory disease mortality in the WHO Western Pacific Region. J Thorac Dis 2023; 15:5801-5810. [PMID: 37969316 PMCID: PMC10636449 DOI: 10.21037/jtd-22-1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/01/2023] [Indexed: 11/17/2023]
Abstract
Background Non-communicable diseases (NCDs) are major cause of death all over the world killing 41 million of the 57 million deaths (72%) in 2016. According to World Health Organization (WHO) Director General the biggest decrease in NCD mortality between 2000 and 2019 globally were for chronic respiratory diseases (CRDs) a 37% decline. The WHO Western Pacific Region (WPRO) made the biggest gains against CRD a 55.9% drop. We analysed CRD mortality in the WPRO comparing with other WHO regions. Methods Assessment of the risk factors was made in all WHO countries mainly in 2016. Lifestyle modifications concerning tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol in 2020. We used WHO assessment of ambient and household air pollution attributable to chronic obstructive pulmonary disease (COPD) mortality. Results WPRO comprises 27 countries, 10 high-income countries (HIC) and 17 middle-income countries (MIC). A total of 52 countries in other WHO regions belong to HIC and 86 countries to MIC. No difference was found in the tobacco demand-reduction measures. Clear difference was demonstrated in the prevalence of the raised blood pressure (RBP) which was lower in the WPRO. In the WPRO HIC every fifth has RBP while in other regions it was every forth. Similar difference was observed for MIC. COPD mortality linked to air pollution was twice higher in the WPRO. It was highest in MIC. CRD management probably plays a crucial role in the decline of the observed mortality in the region since numerous WHO global, regional and national prevention and management CRD approaches and activities have been successfully initiated and implemented there. WHO Global Alliance against Chronic Respiratory Diseases (GARD) was successfully initiated in Beijing in 2006. Two subsequent global GARD meetings held in Seoul [2007] and Beijing [2019] had a tremendous impact on the CRD awareness, prevention and control strategies in the region. These events have stimulated development of the national CRD programmes. Beijing's declaration "Call for action for lung health" stressed the better management of CRD at primary healthcare level. Conclusions Better RBP control, improved prevention, diagnosis and treatment of CRD could contribute to the observed decline of premature CRD mortality in the region.
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Affiliation(s)
- Nikolai Khaltaev
- Global Alliance against Chronic Respiratory Diseases, Geneva, Switzerland
| | - Svetlana Axelrod
- Institute for Leadership and Health Management, I. M. Sechenov First Moscow State University (Sechenov University), Moscow, Russia
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12
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Baptista A, Vieira AM, Capela E, Julião P, Macedo A. COVID-19 fatality rates in hospitalized patients: A new systematic review and meta-analysis. J Infect Public Health 2023; 16:1606-1612. [PMID: 37579698 DOI: 10.1016/j.jiph.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/21/2023] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND SARS-COV2 or COVID-19 disease is an infectious illness that emerged for the first time at the end of 2019, in Wuhan, China and rapidly turned out to be an international pandemic with deleterious effects all over the world. In March 2021, A. Macedo et al., has published the first meta-analysis of hospital mortality, so the authors decided to update those data at a time of emergence of new therapies and increasing vaccination rates. METHODS As the outcome of interest was the mortality in hospitalized general patients, the authors looked for articles evaluating the clinical characteristics of those patients, consulting PUBMED (The US National Library of Medicine) and EMBASE (Medical database) in an independent selection using predefined terms of search. A meta-analysis random-effect model was estimated using Mantel-Haenszel method. Heterogeneity among studies was tested using Tau2 statistics and Chi2 statistics. RESULTS In a first instance 25 articles were included for final analysis with a total of 103,840 patients, but as the goal was to update the anterior data, these studies were analysed together with the 21 studies of the previous meta-analysis, with a total of 114609 patients. The mortality rate of COVID-19 general patients admitted to the hospital was 16% (95% CI 12; 21, I2 =100%). CONCLUSION Global hospital mortality of COVID-19 of general patients was 16%, with quite different rates according to the different geographic areas analysed.
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Affiliation(s)
- Alexandre Baptista
- Faculdade de Medicina e Ciências Biomédicas Universidade Algarve, Faro, Portugal
| | - Ana M Vieira
- Faculdade de Medicina e Ciências Biomédicas Universidade Algarve, Faro, Portugal
| | - Eunice Capela
- Faculdade de Medicina e Ciências Biomédicas Universidade Algarve, Faro, Portugal
| | - Pedro Julião
- Faculdade de Medicina e Ciências Biomédicas Universidade Algarve, Faro, Portugal
| | - Ana Macedo
- Faculdade de Medicina e Ciências Biomédicas Universidade Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal.
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Van Hauwermeiren C, Claessens M, Berland M, Dumoulin B, Lieten S, Surquin M, Benoit F. Comparison of different prognostic scores in estimating short- and long-term mortality in COVID-19 patients above 60 years old in a university hospital in Belgium. Eur Geriatr Med 2023; 14:1125-1133. [PMID: 37535234 DOI: 10.1007/s41999-023-00836-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple scoring systems were used for risk stratification in COVID-19 patients. The objective was to determine among 6 scores which performed the best in predicting short-and long-term mortality in hospitalized COVID-19 patients ≥ 60 years. METHODS An observational, retrospective cohort study conducted between 21/10/2020 and 20/01/2021. 6 scores were calculated (Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), 4C Mortality Score (4CMS), NEWS score (NEWS), quick-SOFA score (qSOFA), and Quick COVID-19 Severity Index (qCSI)). We included unvaccinated hospitalized patients with COVID-19 ≥ 60 years old in Brugmann hospital, detected by PCR and/or suggestive CT thorax images. Old and nosocomial infections, and patients admitted immediately at the intensive care unit were excluded. RESULTS 199 patients were included, mean age was 76.2 years (60-99). 47.2% were female. 56 patients (28%) died within 1 year after the first day of hospitalization. The 4CMS predicted the best intrahospital, 30 days and 6 months mortality, with area under the ROC curve (AUROC) 0.695 (0.58-0.81), 0.76 (0.65-0.86) and 0.72 (0.63-0.82) respectively. The CCI came right after with respectively AUROC of 0.69 (0.59-0.79), 0.74 (0.65-0.83) and 0.71 (0.64-0.8). To predict mortality at 12 months after hospitalization, the CCI had the highest AUROC with 0.77 (0.69-0.85), before the 4CMS with 0.69 (0.60-0.79). DISCUSSION Among 6 scores, the 4CMS was the best to predict intrahospital, 30-day and 6-month mortality. To predict mortality at 12 months, CCI had the best performance before 4CMS. This reflects the importance of considering comorbidities for short- and long-term mortality after COVID 19. REGISTRATION This study was approved by the ethical committee of Brugmann University Hospital (reference CE 2020/228).
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Affiliation(s)
- C Van Hauwermeiren
- UZ Brussels Hospital, Geriatric Medicine, Vrije Universiteit Brussel, Brussels, Belgium.
| | - M Claessens
- Brugmann University Hospital, Geriatric Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - M Berland
- Brugmann University Hospital, Geriatric Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - B Dumoulin
- Brugmann University Hospital, Geriatric Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - S Lieten
- UZ Brussels Hospital, Geriatric Medicine, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Surquin
- Brugmann University Hospital, Geriatric Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - F Benoit
- Brugmann University Hospital, Geriatric Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Liao LD, Hubbard AE, Gutierrez JP, Juárez-Flores A, Kikkawa K, Gupta R, Yarmolich Y, de Jesús Ascencio-Montiel I, Bertozzi SM. Who is most at risk of dying if infected with SARS-CoV-2? A mortality risk factor analysis using machine learning of patients with COVID-19 over time: a large population-based cohort study in Mexico. BMJ Open 2023; 13:e072436. [PMID: 37739469 PMCID: PMC10533798 DOI: 10.1136/bmjopen-2023-072436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE COVID-19 would kill fewer people if health programmes can predict who is at higher risk of mortality because resources can be targeted to protect those people from infection. We predict mortality in a very large population in Mexico with machine learning using demographic variables and pre-existing conditions. DESIGN Cohort study. SETTING March 2020 to November 2021 in Mexico, nationally represented. PARTICIPANTS 1.4 million laboratory-confirmed patients with COVID-19 in Mexico at or over 20 years of age. PRIMARY AND SECONDARY OUTCOME MEASURES Analysis is performed on data from March 2020 to November 2021 and over three phases: (1) from March to October in 2020, (2) from November 2020 to March 2021 and (3) from April to November 2021. We predict mortality using an ensemble machine learning method, super learner, and independently estimate the adjusted mortality relative risk of each pre-existing condition using targeted maximum likelihood estimation. RESULTS Super learner fit has a high predictive performance (C-statistic: 0.907), where age is the most predictive factor for mortality. After adjusting for demographic factors, renal disease, hypertension, diabetes and obesity are the most impactful pre-existing conditions. Phase analysis shows that the adjusted mortality risk decreased over time while relative risk increased for each pre-existing condition. CONCLUSIONS While age is the most important predictor of mortality, younger individuals with hypertension, diabetes and obesity are at comparable mortality risk as individuals who are 20 years older without any of the three conditions. Our model can be continuously updated to identify individuals who should most be protected against infection as the pandemic evolves.
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Affiliation(s)
- Lauren D Liao
- Division of Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Alan E Hubbard
- Division of Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Juan Pablo Gutierrez
- Center for Policy, Population and Health Research, School of Medicine, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Arturo Juárez-Flores
- Center for Policy, Population and Health Research, School of Medicine, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | | | - Ronit Gupta
- College of Computing, Data Science, and Society, University of California Berkeley, Berkeley, California, USA
| | - Yana Yarmolich
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, California, USA
| | | | - Stefano M Bertozzi
- Division of Health Policy and Management, University of California, Berkeley, Berkeley, California, USA
- School of Public Health, University of Washington, Seattle, Washington, USA
- Instituto Nacional de Salud Pública, Cuernavaca, MOR, Mexico
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Friedman S, Insaf TZ, Adeyeye T, Lee JW. Spatial Variation in COVID-19 Mortality in New York City and Its Association with Neighborhood Race, Ethnicity, and Nativity Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6702. [PMID: 37681842 PMCID: PMC10487809 DOI: 10.3390/ijerph20176702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
We examined the association between variation in COVID-19 deaths and spatial differences in the racial, ethnic, and nativity-status composition of New York City neighborhoods, which has received little scholarly attention. Using COVID-19 mortality data (through 31 May 2021) and socioeconomic and demographic data from the American Community Survey at the Zip Code Tabulation Area level as well as United-Hospital-Fund-level neighborhood data from the Community Health Survey of the New York City Department of Health and Mental Hygiene, we employed multivariable Poisson generalized estimating equation models and assessed the association between COVID-19 mortality, racial/ethnic/nativity-status composition, and other ecological factors. Our results showed an association between neighborhood-level racial and ethnic composition and COVID-19 mortality rates that is contingent upon the neighborhood-level nativity-status composition. After multivariable adjustment, ZCTAs with large shares of native-born Blacks and foreign-born Hispanics and Asians were more likely to have higher COVID-19 mortality rates than areas with large shares of native-born Whites. Areas with more older adults and essential workers, higher levels of household crowding, and population with diabetes were also at high risk. Small-area analyses of COVID-19 mortality can inform health policy responses to neighborhood inequalities on the basis of race, ethnicity, and immigration status.
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Affiliation(s)
- Samantha Friedman
- Department of Sociology, University at Albany, SUNY, 348 Arts & Sciences Building 1400 Washington Avenue, Albany, NY 12222, USA
| | - Tabassum Z. Insaf
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, 1203 Corning Tower, Empire State Plaza, Albany, NY 12223, USA; (T.Z.I.); (T.A.)
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, SUNY, 1 University Place, Rensselaer, NY 12144, USA
| | - Temilayo Adeyeye
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, 1203 Corning Tower, Empire State Plaza, Albany, NY 12223, USA; (T.Z.I.); (T.A.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, SUNY, 1 University Place, Rensselaer, NY 12144, USA
| | - Jin-Wook Lee
- Center for Social and Demographic Analysis, University at Albany, SUNY, 321 University Administration Building, Albany, NY 12222, USA;
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Alawadi F, Bashier A, Bin Hussain AA, Al-Hashmi N, Bachet FAT, Hassanein MMA, Zidan MA, Soued R, Khamis AH, Mukhopadhyay D, Abdul F, Osama A, Sulaiman F, Farooqi MH, Bayoumi RAL. Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai. World J Diabetes 2023; 14:1259-1270. [PMID: 37664471 PMCID: PMC10473944 DOI: 10.4239/wjd.v14.i8.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Globally, patients with diabetes suffer from increased disease severity and mortality due to coronavirus disease 2019 (COVID-19). Old age, high body mass index (BMI), comorbidities, and complications of diabetes are recognized as major risk factors for infection severity and mortality. AIM To investigate the risk and predictors of higher severity and mortality among in-hospital patients with COVID-19 and type 2 diabetes (T2D) during the first wave of the pandemic in Dubai (March-September 2020). METHODS In this cross-sectional nested case-control study, a total of 1083 patients with COVID-19 were recruited. This study included 890 men and 193 women. Of these, 427 had T2D and 656 were non-diabetic. The clinical, radiographic, and laboratory data of the patients with and without T2D were compared. Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D. RESULTS T2D patients with COVID-19 were older and had higher BMI than those without T2D. They had higher rates of comorbidities such as hypertension, ischemic heart disease, heart failure, and more life-threatening complications. All laboratory parameters of disease severity were significantly higher than in those without T2D. Therefore, these patients had a longer hospital stay and a significantly higher mortality rate. They died from COVID-19 at a rate three times higher than patients without. Most laboratory and radiographic severity indices in non-survivors were high in patients with and without T2D. In the univariate analysis of the predictors of mortality among all COVID-19 non-survivors, significant associations were identified with old age, increased white blood cell count, lym-phopenia, and elevated serum troponin levels. In multivariate analysis, only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors. CONCLUSION Patients with COVID-19 and T2D were older with higher BMI, more comorbidities, higher disease severity indices, more severe proinflammatory state with cardiac involvement, and died from COVID-19 at three times the rate of patients without T2D. The identified mortality predictors will help healthcare workers prioritize the management of patients with COVID-19.
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Affiliation(s)
- Fatheya Alawadi
- Department of Endocrinology, Dubai Academic Health Corporation, Dubai, United Arab Emirates
| | - Alaaeldin Bashier
- Department of Endocrinology, Dubai Academic Health Corporation, Dubai, United Arab Emirates
| | | | - Nada Al-Hashmi
- Department of Endocrinology, Dubai Academic Health Corporation, Dubai, United Arab Emirates
| | - Fawzi Al Tayb Bachet
- Department of Endocrinology, Dubai Academic Health Corporation, Dubai, United Arab Emirates
| | | | - Marwan Abdelrahim Zidan
- Department of Medical Education and Research, Dubai Academic Health Corporation, Dubai, United Arab Emirates
| | - Rania Soued
- Department of Radiology, Mediclinic City Hospital, Dubai, United Arab Emirates
| | - Amar Hassan Khamis
- College of Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Debasmita Mukhopadhyay
- College of Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Fatima Abdul
- College of Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Aya Osama
- College of Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Fatima Sulaiman
- College of Medicine, Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Riad Abdel Latif Bayoumi
- Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Katzmarzyk PT, Myers CA, Nelson MR, Denstel KD, Mire EF, Newton RL, Broyles ST, Kirwan JP. Exploring barriers to SARS-CoV-2 testing uptake in underserved black communities in Louisiana. Am J Hum Biol 2023; 35:e23879. [PMID: 36807397 PMCID: PMC10591290 DOI: 10.1002/ajhb.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To collect qualitative data on approaches that can potentially reduce barriers to, and create strategies for, increasing SARS-CoV-2 testing uptake in underserved Black communities in Louisiana. METHODS A series of eight focus groups, including 41 participants, were conducted in primarily Black communities. The Nominal Group Technique (NGT) was used to determine perceptions of COVID-19 as a disease, access to testing, and barriers limiting testing uptake. RESULTS Common barriers to SARS-CoV-2 testing were identified as lack of transportation, misinformation/lack of information, lack of time/long wait times, fear of the test being uncomfortable and/or testing positive, the cost of testing, and lack of computer/smartphone/internet. The most impactful approaches identified to increase testing uptake included providing testing within the local communities; testing specifically in heavily traveled areas such as supermarkets, churches, schools, and so forth; providing incentives; engaging local celebrities; and providing information to the community through health fairs, or through churches and schools. The strategies that were deemed to be the easiest to implement revolved around communication about testing, with suggested strategies involving churches, local celebrities or expert leaders, social media, text messages, public service announcements, post cards, or putting up signs in neighborhoods. Providing transportation to testing sites, providing incentives, and bringing the testing to neighborhoods and schools were also identified as easy to implement strategies. CONCLUSIONS Several strategies to increase testing uptake were identified in this population. These strategies need to be tested for effectiveness in real-world settings using experimental and observational study designs.
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Affiliation(s)
| | - Candice A. Myers
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Michelle R. Nelson
- Surgeons Group of Baton Rouge, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, USA
| | - Kara D. Denstel
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Emily F. Mire
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Robert L. Newton
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | - John P. Kirwan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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18
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Abstract
Convergence of the two pandemics: metabolic syndrome and COVID-19 over last two years has posed unprecedented challenges to individuals as well as healthcare systems. Epidemiological data suggest a close association between metabolic syndrome and COVID-19 while variety of possible pathogenic connections have been proposed while some have been proven. Despite the evidence of high risk for adverse COVID-19 outcomes in people with metabolic syndrome, little is known about the differences in efficacy and safety among people with metabolic syndrome and without. It is important to recognize that among people with metabolic syndrome This review summarizes the current knowledge and epidemiological evidence on the association between metabolic syndrome and adverse COVID-19 outcomes, pathogenic interrelationships, management considerations for acute COVID-19 and post-COVID sequalae and sustaining care of people living with metabolic syndrome with appraisal of evidence and gaps in knowledge.
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Affiliation(s)
- Harsha Dissanayake
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Sri Lanka; Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
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19
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Hu Z, Youn HM, Quan J, Lee LLS, Mak IL, Yu EYT, Chao DVK, Ko WWK, Wong ICK, Lau GKK, Lau CS, Lam CLK, Wan EYF. The indirect impact of the COVID-19 pandemic on people with type 2 diabetes mellitus and without COVID-19 infection: Systematic review and meta-analysis. Prim Care Diabetes 2023; 17:229-237. [PMID: 36872178 PMCID: PMC9977626 DOI: 10.1016/j.pcd.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The effect directly from the coronavirus disease 2019 (COVID-19) infection on health and fatality has received considerable attention, particularly among people with type 2 diabetes mellitus (T2DM). However, evidence on the indirect impact of disrupted healthcare services during the pandemic on people with T2DM is limited. This systematic review aims to assess the indirect impact of the pandemic on the metabolic management of T2DM people without a history of COVID-19 infection. METHODS PubMed, Web of Science, and Scopus were systematically searched for studies that compared diabetes-related health outcomes between pre-pandemic and during-pandemic periods in people with T2DM and without the COVID-19 infection and published from January 1, 2020, to July 13, 2022. A meta-analysis was performed to estimate the overall effect on the diabetes indicators, including hemoglobin A1c (HbA1c), lipid profiles, and weight control, with different effect models according to the heterogeneity. RESULTS Eleven observational studies were included in the final review. No significant changes in HbA1c levels [weighted mean difference (WMD), 0.06 (95% CI -0.12 to 0.24)] and body weight index (BMI) [0.15 (95% CI -0.24 to 0.53)] between the pre-pandemic and during-pandemic were found in the meta-analysis. Four studies reported lipid indicators; most reported insignificant changes in low-density lipoprotein (LDL, n = 2) and high-density lipoprotein (HDL, n = 3); two studies reported an increase in total cholesterol and triglyceride. CONCLUSIONS This review did not find significant changes in HbA1c and BMI among people with T2DM after data pooling, but a possible worsening in lipids parameters during the COVID-19 pandemic. There were limited data on long-term outcomes and healthcare utilization, which warrants further research. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022360433.
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Affiliation(s)
- Zhuoran Hu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Hin Moi Youn
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Jianchao Quan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Lily Luk Siu Lee
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ivy Lynn Mak
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - David Vai-Kiong Chao
- Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Hong Kong Hospital Authority, Hong Kong Special Administrative Region of China
| | - Welchie Wai Kit Ko
- Department of Family Medicine and Primary Health Care, Hong Kong Hospital Authority West Cluster, Hong Kong Special Administrative Region of China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Gary Kui Kai Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region of China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong Special Administrative Region of China.
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20
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Ekpor E, Akyirem S. Global acceptance of COVID-19 vaccine among persons with diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract 2023; 201:110731. [PMID: 37236364 DOI: 10.1016/j.diabres.2023.110731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/28/2023]
Abstract
AIM This review aimed to estimate the level of acceptance of COVID-19 vaccine among persons with diabetes. METHODS A systematic search was conducted on PubMed, MEDLINE, Embase, and CINAHL to identify relevant studies for this review. A random-effects meta-analysis was performed to generate an overall estimate of vaccine acceptance. The I2 statistic was used to quantify the degree of variation across studies, and subgroup analysis was conducted to identify the sources of heterogeneity. The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). RESULTS This review included 18 studies involving 11,292 diabetes patients. The pooled prevalence of COVID-19 vaccine acceptance among persons with diabetes was 76.1% (95% CI: 66.7% - 83.5%). The pooled prevalence across the continent ranged from 68.9% (95% CI: 47.8% - 84.3%) in Asia to 82.1% (95% CI: 80.2% - 83.8%) in Europe. Barriers to vaccine acceptance included misinformation, lack of information, mistrust, health concerns, and external influences. CONCLUSION The barriers to vaccine acceptance identified in this review, could inform the formulation of health policies and public health interventions that are specifically tailored to address the needs of persons with diabetes.
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Affiliation(s)
- Emmanuel Ekpor
- School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana; Christian Health Association of Ghana, Accra, Ghana.
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, Connecticut, USA
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21
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Vojtková J, Bánovčin P, Ďurdíková A, Nováková E, Jeseňák M. Mild Hyperglycaemia in Hospitalised Children with Moderate COVID-19 Infection. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050944. [PMID: 37241176 DOI: 10.3390/medicina59050944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/30/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: COVID-19 infection may influence many physiological processes, including glucose metabolism. Acute hyperglycaemia has been related to a worse prognosis in patients with severe COVID-19 infection. The aim of our study was to find out if moderate COVID-19 infection is associated with hyperglycaemia. Materials and Methods: A total of 235 children were enrolled in the study between October 2021 and October 2022, 112 with confirmed COVID-19 infection and 123 with other RNA viral infection. In all patients, types of symptoms, glycaemia at the time of admission, and basic anthropometric and biochemical parameters were recorded. Results: Average glycaemia was significantly higher in COVID-19 patients compared to other viral infections (5.7 ± 1.12 vs. 5.31 ± 1.4 mmol/L, p = 0.011). This difference was more obvious in subgroups with gastrointestinal manifestations (5.6 ± 1.11 vs. 4.81 ± 1.38 mmol/L, p = 0.0006) and with fever (5.76±1.22 vs. 5.11±1.37 mmol/L, p = 0.002), while no significant difference was found in subgroups with mainly respiratory symptoms. The risk of hyperglycaemia (>5.6 mmol/L) was higher in COVID-19 patients compared to other viral infections (OR = 1.86, 95%CI = 1.10-3.14, p = 0.02). The risk of hyperglycaemia was significantly higher in COVID-19 compared to other viral infections in the subgroups of patients with fever (OR = 3.59, 95% CI 1.755-7.345, p = 0.0005) and with gastrointestinal manifestations (OR = 2.48, 95% CI 1.058-5.791, p = 0.036). Conclusion: According to our results, mild hyperglycaemia was significantly more common in children with moderate COVID-19 infection compared to other RNA virus respiratory and gastrointestinal infections, especially when accompanied by fever or gastrointestinal symptoms.
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Affiliation(s)
- Jarmila Vojtková
- Department of Paediatrics, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Peter Bánovčin
- Department of Paediatrics, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Anna Ďurdíková
- Department of Paediatrics, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
| | - Elena Nováková
- Department of Microbiology and Immunology, Comenius University in Bratislava, Jessenius Faculty of Medicine, 036 01 Martin, Slovakia
| | - Miloš Jeseňák
- Department of Paediatrics, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
- Department of Clinical Immunology and Allergology, University Hospital in Martin, 036 01 Martin, Slovakia
- Department of Pulmonology and Phthisiology, Comenius University in Bratislava, Jessenius Faculty of Medicine and University Hospital, 036 01 Martin, Slovakia
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22
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Lavrentieva A, Kaimakamis E, Voutsas V, Bitzani M. An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature. Sci Rep 2023; 13:7804. [PMID: 37179397 PMCID: PMC10182846 DOI: 10.1038/s41598-023-34613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The novel pandemic caused by SARS-CoV-2 has been associated with increased burden on healthcare system. Recognizing the variables that independently predict death in COVID-19 is of great importance. The study was carried out prospectively in a single ICU in northern Greece. It was based on the collection of data during clinical practice in 375 adult patients who were tested positive for SARS-CoV-2 between April 2020 and February 2022. All patients were intubated due to acute respiratory insufficiency and received Invasive Mechanical Ventilation. The primary outcome was ICU mortality. Secondary outcomes were 28-day mortality and independent predictors of mortality at 28 days and during ICU hospitalization. For continuous variables with normal distribution, t-test was used for means comparison between two groups and one-way ANOVA for multiple comparisons. When the distribution was not normal, comparisons were performed using the Mann-Whitney test. Comparisons between discrete variables were made using the x2 test, whereas the binary logistic regression was employed for the definition of factors affecting survival inside the ICU and after 28 days. Of the total number of patients intubated due to COVID-19 during the study period, 239 (63.7%) were male. Overall, the ICU survival was 49.6%, whereas the 28-day survival reached 46.9%. The survival rates inside the ICU for the four main viral variants were 54.9%, 50.3%, 39.7% and 50% for the Alpha, Beta, Delta and Omicron variants, respectively. Logistic regressions for outcome revealed that the following parameters were independently associated with ICU survival: wave, SOFA @day1, Remdesivir use, AKI, Sepsis, Enteral Insufficiency, Duration of ICU stay and WBC. Similarly, the parameters affecting the 28-days survival were: duration of stay in ICU, SOFA @day1, WBC, Wave, AKI and Enteral Insufficiency. In this observational cohort study of critically ill COVID-19 patients we report an association between mortality and the wave sequence, SOFA score on admission, the use of Remdesivir, presence of AKI, presence of gastrointestinal failure, sepsis and WBC levels. Strengths of this study are the large number of critically ill COVID-19 patients included, and the comparison of the adjusted mortality rates between pandemic waves within a two year-study period.
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Affiliation(s)
- Athina Lavrentieva
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Evangelos Kaimakamis
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece.
| | - Vassileios Voutsas
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
| | - Militsa Bitzani
- 1st Intensive Care Unit, "G. Papanikolaou" General Hospital, 57010, Thessaloniki, Greece
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23
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Brice AN, Vanderlinden LA, Marker KM, Mayer D, Lin M, Rafaels N, Shortt JA, Romero A, Lowery JT, Gignoux CR, Johnson RK. COVID-19 Mortality in the Colorado Center for Personalized Medicine Biobank. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2368. [PMID: 36767733 PMCID: PMC9916246 DOI: 10.3390/ijerph20032368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Over 6.37 million people have died from COVID-19 worldwide, but factors influencing COVID-19-related mortality remain understudied. We aimed to describe and identify risk factors for COVID-19 mortality in the Colorado Center for Personalized Medicine (CCPM) Biobank using integrated data sources, including Electronic Health Records (EHRs). We calculated cause-specific mortality and case-fatality rates for COVID-19 and common pre-existing health conditions defined by diagnostic phecodes and encounters in EHRs. We performed multivariable logistic regression analyses of the association between each pre-existing condition and COVID-19 mortality. Of the 155,859 Biobank participants enrolled as of July 2022, 20,797 had been diagnosed with COVID-19. Of 5334 Biobank participants who had died, 190 were attributed to COVID-19. The case-fatality rate was 0.91% and the COVID-19 mortality rate was 122 per 100,000 persons. The odds of dying from COVID-19 were significantly increased among older men, and those with 14 of the 61 pre-existing conditions tested, including hypertensive chronic kidney disease (OR: 10.14, 95% CI: 5.48, 19.16) and type 2 diabetes with renal manifestations (OR: 5.59, 95% CI: 3.42, 8.97). Male patients who are older and have pre-existing kidney diseases may be at higher risk for death from COVID-19 and may require special care.
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Affiliation(s)
- Amanda N. Brice
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
| | | | - Katie M. Marker
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - David Mayer
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
| | - Meng Lin
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
| | - Nicholas Rafaels
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
| | - Jonathan A. Shortt
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
| | - Alex Romero
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jan T. Lowery
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
| | - Christopher R. Gignoux
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
| | - Randi K. Johnson
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO 80045, USA
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, Aurora, CO 80045, USA
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24
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Permana H, Audi Yanto T, Ivan Hariyanto T. Pre-admission use of sodium glucose transporter-2 inhibitor (SGLT-2i) may significantly improves Covid-19 outcomes in patients with diabetes: A systematic review, meta-analysis, and meta-regression. Diabetes Res Clin Pract 2023; 195:110205. [PMID: 36502891 PMCID: PMC9731816 DOI: 10.1016/j.diabres.2022.110205] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
AIMS This study aims to examine the effectiveness of using sodium glucose transporter-2 inhibitor (SGLT-2i) before hospital admission on Covid-19 outcomes in diabetic patients. METHODS A literature search was conducted using specific keywords until October 24th, 2022 on 4 databases: Medline, Scopus, Cochrane Library, and ClinicalTrials.gov. All articles regarding SGLT-2i in diabetic patients with Covid-19 were included in the study. Outcomes in this study were calculated using random-effect models to generate pooled odds ratio (OR) with 95% confidence intervals (CI). RESULTS A total of 17 studies were included in the analysis. Our meta-analysis showed that pre-admission use of SGLT-2i was associated with reduced mortality (OR 0.69; 95 %CI: 0.56 - 0.87, p = 0.001, I2 = 91 %) and severity of Covid-19 (OR 0.88; 95 %CI: 0.80 - 0.97, p = 0.008, I2 = 13 %). This benefit of SGLT-2i on Covid-19 mortality was not significantly affected by patient's factors such as age (p = 0.2335), sex (p = 0.2742), hypertension (p = 0.2165), heart failure (p = 0.1616), HbA1c levels (p = 0.4924), metformin use (p = 0.6617), duration of diabetes (p = 0.7233), and BMI (p = 0.1797). CONCLUSIONS This study suggests that SGLT-2i as glucose lowering treatment in patients with diabetes has a positive effect on Covid-19 outcomes, therefore can be considered as an antidiabetic drug of choice, especially during the Covid-19 pandemic. Short Title: SGLT-2i in diabetes and Covid-19. REGISTRATION DETAILS CRD42022369784.
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Affiliation(s)
- Hikmat Permana
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Padjadjaran University, Bandung, West Java 45363, Indonesia
| | - Theo Audi Yanto
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang 15811, Indonesia
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25
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Asaduzzaman M, Romel Bhuia M, Zabed Jillul Bari M, Nazmul Alam Z, Rahman K, Hossain E, Alam MMJ. Predictors of mortality and ICU requirement in hospitalized COVID-19 patients with diabetes: A multicentre study. Nurs Open 2022; 10:3178-3190. [PMID: 36575597 PMCID: PMC9880734 DOI: 10.1002/nop2.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/15/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
AIM This study aimed to identify the predictors of mortality and ICU requirements in hospitalized COVID-19 Patients with Diabetes. DESIGN Cross-sectional study. METHODS It was a retrospective study of patients hospitalized with COVID-19 infection from October 2020-February 2021 in four hospitals in Sylhet, Bangladesh. Logistic regression analysis was applied to explore the predictors of ICU requirement and in-hospital mortality. RESULTS In the whole cohort (n = 500), 11% of patients died and 24% of patients required intensive care unit (ICU) support. Non-survivors had significantly higher prevalence of lymphopenia, thrombocytopenia and leukocytosis. Significant predictors of in-hospital mortality were older age, neutrophil count, platelet count and admission peripheral capillary oxygen saturation (SpO2). Older age, ischemic heart disease, WBC count, D-dimer and admission SpO2 were identified as significant predictors for ICU requirement. PATIENT OR PUBLIC CONTRIBUTION No.
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Affiliation(s)
- Md Asaduzzaman
- Department of MedicineSylhet MAG Osmani Medical College HospitalSylhetBangladesh
| | - Mohammad Romel Bhuia
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | | | - Zhm Nazmul Alam
- Department of MedicineSylhet MAG Osmani Medical College HospitalSylhetBangladesh
| | - Khalidur Rahman
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | - Enayet Hossain
- Department of MedicineSylhet MAG Osmani Medical CollegeSylhetBangladesh
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Association between 25-OH Vitamin D Deficiency and COVID-19 Severity in Pregnant Women. Int J Mol Sci 2022; 23:ijms232315188. [PMID: 36499537 PMCID: PMC9735729 DOI: 10.3390/ijms232315188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022] Open
Abstract
Evidence from studies in the general population suggests an association between vitamin D insufficiency/deficiency and COVID-19 susceptibility and disease severity. The present study was performed on 165 third-trimester pregnant women at the time of delivery. Seventy-nine women tested negative for SARS-CoV-2. From 86 women testing positive, 32 were asymptomatic, 44 presented a mild form of the disease, and 10 experienced severe symptoms. Serum 25-OH vitamin D levels were measured on blood samples collected on admission. Low vitamin D levels were detected in symptomatic but not asymptomatic COVID-19 patients compared to healthy women (p = 0.0227). In addition, 20 (45.4%) pregnant women in the mild COVID-19 group and 6 (60%) in the severe group were vitamin D deficient (p = 0.030). On the other hand, lasso regression analysis showed that 25-OH vitamin D deficiency is an independent predictor of severe COVID-19 with an odds ratio (OR) of 5.81 (95% CI: 1.108-30.541; p = 0.037). These results show the relationship between vitamin D deficiency in pregnant women and the severity of COVID-19 infection and support the recommendation to supplement with vitamin D to avoid worse COVID-19 outcomes during pregnancy.
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Mokrysheva NG, Shestakova MV, Vikulova OK, Elfimova AR, Isakov MA, Gins NA, Deviatkin AA, Dedov II. Analysis of risk factors for COVID-19-related fatal outcome in 337991 patients with type 1 and type 2 diabetes mellitus in 2020–2022 years: Russian nationwide retrospective study. DIABETES MELLITUS 2022. [DOI: 10.14341/dm12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND: The coronavirus pandemic has had an extremely negative impact on the patients with diabetes mellitus (DM both in terms of a more severe course of COVID -19 and an increased risk of death.AIM: Analysis of risk factors for death due to COVID -19 in patients with DM type 1 and type 2 (DM1 and DM2).MATERIALS AND METHODS: Retrospective analysis of the database of the national diabetes register (NDR), which included DM patients with COVID-19 and reported virus infection outcome (recovery/or death) in 15 712 DM1 and 322 279 DM2 patients during a 2-year follow-up period (01/02/2020 to 03/04/2022) (discharge date)).RESULTS: Case fatality rate in patients with DM, who underwent COVID -19 was 17.1% (DM1–8.8%; DM2–17.5%). As a result of multivariate regression analysis of seven significant factors in DM1 and thirteen in DM2 (evaluated by univariate anlisys), a number of the most important predictors of risk for fatal outcome were identified: in DM1 these were age ≥65 years (OR =4.01, 95% CI: 1.42–11.36), presence of arterial hypertension (AH) (OR =2.72, 95% CI: 1.03 -7.16) and diabetic foot syndrome (DFS) (OR = 7.22, 95% CI: 1.98–26.29); for T2DM: age ≥ 65 years (OR =2.53, 95% CI: 1.96–3.27), male (OR =1.51, 95% CI: 1.23–1.84), duration DM ≥10 years (OR =2.01, 95% CI: 1.61–2.51), BMI ≥ 30 kg/m2 (OR =1.26, 95% CI: 1.02–1.55), ASCVD/CKD (OR =1.49, 95% CI: 1.01–2.04), history of diabetic coma (OR =12.97, 95% CI: 1.89–88.99) and presence of disability ( OR =1.40, 95% CI: 1.14–1.73). In T2DM, the type of antidiabetic therapy (ADT) prior to COVID -19 (last visit before the development of infection) had a significant impact: Insulin therapy (OR = 1.64, 95% CI: 1.30–2.07), sulfonylureas (SU) (OR =1.51, 95% CI: 1.23–1.84)); dipeptidyl peptidase-4 inhibitor (iDPP-4) therapy (OR =0.57, 95% CI: 0.39–0.83) and sodium-glucose cotransporter-2 inhibitor (iSGLT2) therapy (OR =0.64, 95% CI: 0.46–0.88). Vaccination was the most important protective factor in both types of DM: DM1 OR =0.19, 95% CI: 0.06–0.59; SD2 OR =0.20, 95% CI: 0.16–0.26.CONCLUSION: The common risk factor for fatal outcome in both DM1 and DM2 was age ≥65 years; in DM1 — history of hypertension and DFS, in DM2 — male sex, diabetes duration ≥10 years, BMI ≥30 kg/m2, history of ASCVD/CKD and diabetic coma, disability. In T2DM, significant differences in risk were observed depending on the type of ADT: insulin and SU therapy were factors that increased the risk of death, whereas therapy with iDPP-4 and iSGLT2 reduced the risk of death. Vaccination reduced the risk of death in DM1 and DM2 by 5.2 and 5-fold, respectively.
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Alkhemeiri A, Al Zaabi S, Lakshmanan J, El-Khatib Z, Awofeso N. COVID-19 Case Management Outcomes Amongst Diabetes and Hypertensive Patients in the United Arab Emirates: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15967. [PMID: 36498037 PMCID: PMC9738357 DOI: 10.3390/ijerph192315967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The global pandemic of the novel Coronavirus infection 2019 (COVID-19) challenged the care of comorbid patients. The risk imposed by COVID-19 on diabetes patients is multisystemic, exponential, and involves glucose dysregulation. The increased burden for diabetes patients infected with COVID-19 is substantial in countries with a high prevalence of diabetics, such as the United Arab Emirates (UAE). This study aims to explore the prevalence of diabetes, clinical characteristic, and outcomes of patients admitted for COVID-19 treatment with or without a concurrent preadmission diagnosis of diabetes. A prospective study was performed on 1199 adults admitted with confirmed COVID-19 from December 2020 to April 2021 to a single hospital in the UAE. The study compared the demographics, clinical characteristics, and outcomes in COVID-19-infected patients with diabetes to patients without diabetes. The study endpoints include the development of new-onset diabetes, admission to ICU, trends in the blood glucose levels, and death. A total of 1199 patients (390 with diabetes) were included in the study. A diabetes prevalence was detected among 9.8% of the study population. Among the diabetes group, 10.8% were morbidly obese, 65.4% had associated hypertension, and 18.9% had coronary artery disease. Diabetes patients showed higher rates of ICU admission (11.1% vs. 7.1%), NIV requirement (9.6% vs. 6.4%), and intubation (5.45% vs. 2%) compared to the non-diabetes group. Advanced age was a predictor of a worsening COVID-19 course, while diabetes (p < 0.050) and hypertension (p < 0.025) were significant predictors of death from COVID-19. Nearly three-fourths (284 (73.4%)) of the diabetic patients developed worsened hyperglycemia as compared to one-fifth (171 (20.9%)) of the nondiabetic patients. New-onset diabetes was detected in 9.8% of COVID-19 patients. COVID-19 severity is higher in the presence of diabetes and is associated with worsening hyperglycemia and poor clinical outcomes. Preexisting hypertension is a predictor of COVID-19 severity and death.
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Affiliation(s)
- Aysha Alkhemeiri
- Department of Medicine, Tawam Hospital, Abu Dhabi P.O. Box 15258, United Arab Emirates
| | - Shaikha Al Zaabi
- Internal Medicine Department, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Jeyaseelan Lakshmanan
- Biostatistics Department, Mohammed Bin Rashed University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Ziad El-Khatib
- Department of Global Public Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Niyi Awofeso
- School of Health and Environmental Studies, Hamdan Bin Muhammed Smart University, Dubai P.O. Box 71400, United Arab Emirates
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The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19). Cardiovasc Diabetol 2022; 21:216. [PMID: 36261811 DOI: 10.1186/s12933-022-01657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. METHODS We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020-October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. RESULTS Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83-2.45 with an I2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29-1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31-0.75], I2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40-0.68], I2 37%) were significantly lower for people with previous macrovascular disease. CONCLUSIONS This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup.
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Association of Patients' Epidemiological Characteristics and Comorbidities with Severity and Related Mortality Risk of SARS-CoV-2 Infection: Results of an Umbrella Systematic Review and Meta-Analysis. Biomedicines 2022; 10:biomedicines10102437. [PMID: 36289699 PMCID: PMC9598435 DOI: 10.3390/biomedicines10102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to assess the association between patients’ epidemiological characteristics and comorbidities with SARS-CoV-2 infection severity and related mortality risk. An umbrella systematic review, including a meta-analysis examining the association between patients’ underlying conditions and severity (defined as need for hospitalization) and mortality of COVID-19, was performed. Studies were included if they reported pooled risk estimates of at least three underlying determinants for hospitalization, critical disease (ICU admission, mechanical ventilation), and hospital mortality in patients diagnosed with SARS-CoV-2 infection. Evidence was summarized as pooled odds ratios (pOR) for disease outcomes with 95% confidence intervals (95% CI). Sixteen systematic reviews investigating the possible associations of comorbidities with severity or death from COVID-19 disease were included. Hospitalization was associated with age > 60 years (pOR 3.50; 95% CI 2.97−4.36), smoking habit (pOR 3.50; 95% CI 2.97−4.36), and chronic pulmonary disease (pOR 2.94; 95% CI 2.14−4.04). Chronic pulmonary disease (pOR 2.82; 95% CI 1.92−4.14), cerebrovascular disease (pOR 2.74; 95% CI 1.59−4.74), and cardiovascular disease (pOR 2.44; 95% CI 1.97−3.01) were likely to be associated with increased risk of critical COVID-19. The highest risk of mortality was associated with cardiovascular disease (pOR 3.59; 95% CI 2.83−4.56), cerebrovascular disease (pOR 3.11; 95% CI 2.35−4.11), and chronic renal disease (pOR 3.02; 95% CI 2.61−3.49). In conclusion, this umbrella systematic review provides a comprehensive summary of meta-analyses examining the impact of patients’ characteristics on COVID-19 outcomes. Elderly patients and those cardiovascular, cerebrovascular, and chronic renal disease should be prioritized for pre-exposure and post-exposure prophylaxis and early treatment.
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Pandrea I, Brooks K, Desai RP, Tare M, Brenchley JM, Apetrei C. I’ve looked at gut from both sides now: Gastrointestinal tract involvement in the pathogenesis of SARS-CoV-2 and HIV/SIV infections. Front Immunol 2022; 13:899559. [PMID: 36032119 PMCID: PMC9411647 DOI: 10.3389/fimmu.2022.899559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
The lumen of the gastrointestinal (GI) tract contains an incredibly diverse and extensive collection of microorganisms that can directly stimulate the immune system. There are significant data to demonstrate that the spatial localization of the microbiome can impact viral disease pathogenesis. Here we discuss recent studies that have investigated causes and consequences of GI tract pathologies in HIV, SIV, and SARS-CoV-2 infections with HIV and SIV initiating GI pathology from the basal side and SARS-CoV-2 from the luminal side. Both these infections result in alterations of the intestinal barrier, leading to microbial translocation, persistent inflammation, and T-cell immune activation. GI tract damage is one of the major contributors to multisystem inflammatory syndrome in SARS-CoV-2-infected individuals and to the incomplete immune restoration in HIV-infected subjects, even in those with robust viral control with antiretroviral therapy. While the causes of GI tract pathologies differ between these virus families, therapeutic interventions to reduce microbial translocation-induced inflammation and improve the integrity of the GI tract may improve the prognoses of infected individuals.
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Affiliation(s)
- Ivona Pandrea
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kelsie Brooks
- Barrier Immunity Section, Laboratory of Viral Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Rahul P. Desai
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Minali Tare
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jason M. Brenchley
- Barrier Immunity Section, Laboratory of Viral Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Cristian Apetrei
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Cristian Apetrei,
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Gonçalves CA, Sesterheim P, Wartchow KM, Bobermin LD, Leipnitz G, Quincozes-Santos A. Why antidiabetic drugs are potentially neuroprotective during the Sars-CoV-2 pandemic: The focus on astroglial UPR and calcium-binding proteins. Front Cell Neurosci 2022; 16:905218. [PMID: 35966209 PMCID: PMC9374064 DOI: 10.3389/fncel.2022.905218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
We are living in a terrifying pandemic caused by Sars-CoV-2, in which patients with diabetes mellitus have, from the beginning, been identified as having a high risk of hospitalization and mortality. This viral disease is not limited to the respiratory system, but also affects, among other organs, the central nervous system. Furthermore, we already know that individuals with diabetes mellitus exhibit signs of astrocyte dysfunction and are more likely to develop cognitive deficits and even dementia. It is now being realized that COVID-19 incurs long-term effects and that those infected can develop several neurological and psychiatric manifestations. As this virus seriously compromises cell metabolism by triggering several mechanisms leading to the unfolded protein response (UPR), which involves endoplasmic reticulum Ca2+ depletion, we review here the basis involved in this response that are intimately associated with the development of neurodegenerative diseases. The discussion aims to highlight two aspects—the role of calcium-binding proteins and the role of astrocytes, glial cells that integrate energy metabolism with neurotransmission and with neuroinflammation. Among the proteins discussed are calpain, calcineurin, and sorcin. These proteins are emphasized as markers of the UPR and are potential therapeutic targets. Finally, we discuss the role of drugs widely prescribed to patients with diabetes mellitus, such as statins, metformin, and calcium channel blockers. The review assesses potential neuroprotection mechanisms, focusing on the UPR and the restoration of reticular Ca2+ homeostasis, based on both clinical and experimental data.
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Affiliation(s)
- Carlos-Alberto Gonçalves
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- *Correspondence: Carlos-Alberto Gonçalves
| | - Patrícia Sesterheim
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Krista M. Wartchow
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Larissa Daniele Bobermin
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Guilhian Leipnitz
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - André Quincozes-Santos
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Hung KC, Huang YT, Chang YJ, Yu CH, Wang LK, Wu CY, Liu PH, Chiu SF, Sun CK. Association between Fibrinogen-to-Albumin Ratio and Prognosis of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12071678. [PMID: 35885582 PMCID: PMC9317445 DOI: 10.3390/diagnostics12071678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 01/08/2023] Open
Abstract
Although the fibrinogen-to-albumin ratio (F/R ratio) has been used as an inflammation marker to predict clinical outcomes in patients with cardiovascular diseases, its association with the prognosis of patients with coronavirus disease 2019 (COVID-19) remains unclear. Electronic databases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library were searched from inception to 20 June 2022. The associations of F/R ratio with poor prognosis (defined as the occurrence of mortality or severe disease) were investigated in patients with COVID-19. A total of 10 studies (seven from Turkey, two from China, one from Croatia) involving 3675 patients published between 2020 and 2022 were eligible for quantitative syntheses. Merged results revealed a higher F/R ratio in the poor prognosis group (standardized mean difference: 0.529, p < 0.001, I2 = 84.8%, eight studies) than that in the good prognosis group. In addition, a high F/R ratio was associated with an increased risk of poor prognosis (odds ratio: 2.684, I2 = 59.5%, five studies). Pooled analysis showed a sensitivity of 0.75, specificity of 0.66, and area under curve of 0.77 for poor prognosis prediction. In conclusion, this meta-analysis revealed a positive correlation between F/A ratio and poor prognostic outcomes of COVID-19. Because of the limited number of studies included, further investigations are warranted to support our findings.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-J.C.); (C.-H.Y.); (L.-K.W.); (C.-Y.W.)
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan;
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-J.C.); (C.-H.Y.); (L.-K.W.); (C.-Y.W.)
- Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-J.C.); (C.-H.Y.); (L.-K.W.); (C.-Y.W.)
| | - Li-Kai Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-J.C.); (C.-H.Y.); (L.-K.W.); (C.-Y.W.)
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Chung-Yi Wu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan; (K.-C.H.); (Y.-J.C.); (C.-H.Y.); (L.-K.W.); (C.-Y.W.)
| | - Ping-Hsin Liu
- Department of Anesthesiology, E-Da Hospital, Kaohsiung City 82445, Taiwan;
| | - Sheng-Fu Chiu
- Department of Oral and Maxillofacial Surgery, Chi Mei Medical Center, Liouying, Tainan City 73657, Taiwan
- Correspondence: (S.-F.C.); (C.-K.S.)
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City 84001, Taiwan
- Correspondence: (S.-F.C.); (C.-K.S.)
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Impact of Type 2 Diabetes Mellitus on the Incidence and Outcomes of COVID-19 Needing Hospital Admission According to Sex: Retrospective Cohort Study Using Hospital Discharge Data in Spain, Year 2020. J Clin Med 2022; 11:jcm11092654. [PMID: 35566794 PMCID: PMC9104185 DOI: 10.3390/jcm11092654] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To analyze incidence and in-hospital mortality (IHM) of COVID-19 needing hospital admission in Spain (2020) in patients with T2DM. (2) Methods: We conducted a retrospective cohort study. Using the Spanish Register of Specialized Care-Basic Minimum Database we estimated age-adjusted incidence rates (IR). (3) Results: We included 203,488 patients (56.77% men), of whom 45,620 (22.41%) had T2DM. Age-adjusted IRs/1000 for men with and without T2DM was 12.90 and 5.87, respectively (IRR 2.20; 95% CI 2.18−2.22; p < 0.001), and for women with and without T2DM was 9.23 and 4.27, respectively (IRR 2.16; 95% CI 2.13−2.19; p < 0.001). Crude IHM was 23.86% in people with T2DM, and 15.94% in non-T2DM people (p < 0.001). After matching, intensive-care admission (7.37% vs. 6.15%; p < 0.001) and IHM (23.37% vs. 20.41%; p < 0.001) remained higher in women with T2DM. After matching, IHM among T2DM men was 1.5% higher than among non-T2DM men (24.27% vs. 22.72%; p < 0.001). Men with T2DM had a 34% higher IHM than women with T2DM. Prevalent T2DM increased IHM among women (1.09; 95% 1.03−1.16) and men (1.05; 95% 1.01−1.10). (4) Conclusions: Incidence rates of COVID-19 needing hospital admission were higher in men vs. women, and for people with T2DM vs. non-T2DM. Men had higher IHM beside T2DM status. Prevalent T2DM was associated with higher IHM for both sexes.
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Kastora S, Patel M, Carter B, Delibegovic M, Myint PK. Impact of diabetes on COVID-19 mortality and hospital outcomes from a global perspective: An umbrella systematic review and meta-analysis. Endocrinol Diabetes Metab 2022; 5:e00338. [PMID: 35441801 PMCID: PMC9094465 DOI: 10.1002/edm2.338] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION To date, COVID-19 has claimed 4.9 million lives. Diabetes has been identified as an independent risk factor of serious outcomes in people with COVID-19 infection. Whether that holds true across world regions uniformly has not been previously assessed. METHODS This study offers the first umbrella systematic review and meta-analysis to analyse the collective and geographically stratified mortality, ICU admission, ventilation requirement, illness severity and discharge rate amongst patients with diabetes. Five databases (EMBASE, MEDLINE, CAB Abstracts, PsychInfo and Web of Science) and 3 additional sources (SSRN's eLibrary, Research Square and MedRxiv) were searched from inception to 30 August 2021. Prospective and retrospective cohort studies, reporting the association between diabetes and one or more COVID-19 hospitalization outcomes, were included. This meta-analysis was registered on PROSPERO, CRD42021278579. Abbreviated MeSH terms used for search were as follows: (Diabetes) AND (2019 Novel Coronavirus Disease), adapted per database requirements. Exclusion criteria exclusion criteria were as follows: (1) none of the primary or secondary outcomes of meta-analysis reported, (2) no confirmed COVID-19 infection (laboratory or clinical) and (3) no unexposed population (solely patients with diabetes included). Quality of the included studies were assessed using the Newcastle-Ottawa Scale (NOS) whilst quality of evidence by the GRADE framework. Studies that were clinically homogeneous were pooled. Summative data and heterogeneity were generated by the Cochrane platform RevMan (V. 5.4). RESULTS Overall, 158 observational studies were included, with a total of 270,212 of participants, median age 59 [53-65 IQR] of who 56.5% were male. A total of 22 studies originated from EU, 90 from Far East, 16 from Middle East and 30 from America. Data were synthesized with mixed heterogeneity across outcomes. Pooled results highlighted those patients with diabetes were at a higher risk of COVID-19-related mortality, OR 1.87 [95%CI 1.61, 2.17]. ICU admissions increased across all studies for patients with diabetes, OR 1.59 [95%CI 1.15, 2.18], a result that was mainly skewed by Far East-originating studies, OR 1.94 [95%CI 1.51, 2.49]. Ventilation requirements were also increased amongst patients with diabetes worldwide, OR 1.44 [95%CI 1.20, 1.73] as well as their presentation with severe or critical condition, OR 2.88 [95%CI 2.29, 3.63]. HbA1C levels under <70 mmol and metformin use constituted protective factors in view of COVID-19 mortality, whilst the inverse was true for concurrent insulin use. CONCLUSIONS Whilst diabetes constitutes a poor prognosticator for various COVID-19 infection outcomes, variability across world regions is significant and may skew overall trends.
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Affiliation(s)
- Stavroula Kastora
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Manisha Patel
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mirela Delibegovic
- Aberdeen Cardiovascular and Diabetes Centre (ACDC), Institute of Medical Sciences (IMS), University of Aberdeen, Aberdeen, UK
| | - Phyo Kyaw Myint
- Aberdeen Cardiovascular and Diabetes Centre (ACDC), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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36
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Piccolo G, De Rose EL, Bassi M, Napoli F, Minuto N, Maghnie M, Patti G, d’Annunzio G. Infectious diseases associated with pediatric type 1 diabetes mellitus: A narrative review. Front Endocrinol (Lausanne) 2022; 13:966344. [PMID: 36093078 PMCID: PMC9449538 DOI: 10.3389/fendo.2022.966344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus (DM) has been frequently associated with an impaired immune response against infectious agents, making affected patients at risk for more severe disease and sometimes causing worse outcomes. The recent COVID-19 pandemic has seriously affected patients with both diabetes, in particular those carrying comorbidities or with poor glycemic control. As regards pediatric diabetes mellitus, the availability of more accurate and technological tools for glycemic management and the improved markers of metabolic control might mitigate the negative impact of infections. Notably, good metabolic control of diabetes since its diagnosis reduces not only the risk of microangiopathic complications but also of impaired immune response to infectious diseases. Therefore, vaccinations are strongly recommended. Our paper aims to provide the most updated evidence regarding infectious diseases in type 1 pediatric DM.
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Affiliation(s)
- Gianluca Piccolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neuro-oncology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Gianluca Piccolo, ; Giuseppa Patti,
| | - Elena Lucia De Rose
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Marta Bassi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Flavia Napoli
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicola Minuto
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Mohamad Maghnie
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giuseppa Patti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- *Correspondence: Gianluca Piccolo, ; Giuseppa Patti,
| | - Giuseppe d’Annunzio
- Pediatric Clinic and Endocrinology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Pediatric Clinic and Endocrinology Unit, Regional Center for Pediatric Diabetes, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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