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Boruah AP, Thakur KT, Gadani SP, Kothari KU, Chomba M, Guekht A, Heydari K, Hoo FK, Hwang S, Michael BD, Pandit MV, Pardo CA, Prasad K, Sardar Z, Seeher K, Solomon T, Winkler AS, Wood GK, Schiess N. Pre-existing neurological conditions and COVID-19 co-infection: Data from systematic reviews, meta-analyses, and scoping reviews. J Neurol Sci 2023; 455:120858. [PMID: 37948972 PMCID: PMC10751535 DOI: 10.1016/j.jns.2023.120858] [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: 08/10/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Pre-existing neurological diseases have been identified as risk factors for severe COVID-19 infection and death. There is a lack of comprehensive literature review assessing the relationship between pre-existing neurological conditions and COVID-19 outcomes. Identification of high risk groups is critical for optimal treatment and care. METHODS A literature review was conducted for systematic reviews, meta-analyses, and scoping reviews published between January 1, 2020 and January 1, 2023. Literature assessing individuals with pre-existing neurological diseases and COVID-19 infection was included. Information regarding infection severity was extracted, and potential limitations were identified. RESULTS Thirty-nine articles met inclusion criteria, with data assessing >3 million patients from 51 countries. 26/51 (50.9%) of countries analyzed were classified as high income, while the remaining represented middle-low income countries (25/51; 49.0%). A majority of evidence focused on the impact of cerebrovascular disease (17/39; 43.5%) and dementia (5/39; 12.8%) on COVID-19 severity and mortality. 92.3% of the articles (36/39) suggested a significant association between neurological conditions and increased risk of severe COVID-19 and mortality. Cerebrovascular disease, dementia, Parkinson's disease, and epilepsy were associated with increased COVID severity and mortality. CONCLUSION Pre-existing neurological diseases including cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, and Parkinson's disease are significant risk factors for severity of COVID-19 infection and mortality in the acute infectious period. Given that 61.5% (24/39) of the current evidence only includes data from 2020, further updated literature is crucial to identify the relationship between chronic neurological conditions and clinical characteristics of COVID-19 variants.
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Affiliation(s)
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, USA
| | | | - Kavita U Kothari
- Consultant to Library & Digital Information Networks, World Health Organization, Geneva, Switzerland
| | | | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian Medical Research University, Moscow, Russia
| | | | - Fan Kee Hoo
- Faculty of Medicine and Health Sciences, University Putra Malaysia, Kuala Lumpur, Malaysia
| | | | - Benedict D Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Department of Neurology, Walton Centre NHS Foundation Trust, NIHR Health Protection Research Unit for Emerging and Zoonotic Infection, Liverpool, UK
| | | | | | - Kameshwar Prasad
- Department of Neurology Fortis Flt Lt, Rajan Dhall Hospital, Vasant Kunj, New Delhi, India
| | - Zomer Sardar
- Columbia University Irving Medical Center, New York, NY, USA
| | - Katrin Seeher
- Brain Health Unit, World Health Organization, Geneva, Switzerland
| | - Tom Solomon
- The Pandemic Institute, The Spine, Liverpool L7 3FA, UK; National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool L69 7BE, UK; Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool L69 7BE, UK; Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Greta K Wood
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK
| | - Nicoline Schiess
- Brain Health Unit, World Health Organization, Geneva, Switzerland.
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Mehta D, Kelkar R, Patel N, Trivedi PD, Dawoodi S, Patel D, Solanki D, Hussain A, Nagaraj S, Khayat A, Samala Venkata V, Mansuri U, Patel UK, Sacks H, Atreja A. Gastrointestinal Manifestations and Outcomes of COVID-19: A Comprehensive Systematic Review and Meta-analysis. Cureus 2023; 15:e47028. [PMID: 37965386 PMCID: PMC10642711 DOI: 10.7759/cureus.47028] [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: 04/08/2022] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Pulmonary symptoms are the most prominent manifestations of Coronavirus disease 2019 (COVID-19). However, gastrointestinal (GI) symptoms have been reported widely as well. Literature describing the relation of these symptoms with outcomes of COVID-19 patients is limited in terms of sample size, geographic diversity, and the spectrum of GI symptoms included. We aim to evaluate the association of GI symptoms with outcomes of hospitalized COVID-19 patients. Methods A systematic review and meta-analysis of observational studies assessing GI symptoms and outcomes in COVID-19 patients were undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) checklist. Details on outcomes included ICU vs. non-ICU admission, severe vs. non-severe disease, invasive mechanical ventilation (IMV) vs. no-IMV use, oxygen saturation <90% vs. >90%, in-hospital mortality vs. discharged alive and survivors. We obtained the odds ratio (OR), 95% confidence interval (95%CI), and forest plots. Sensitivity analysis was used to analyze publication bias and heterogeneity. Results In 35 studies with 7931 confirmed COVID-19 patients, we found that anorexia (pooled OR:2.05; 95%CI: 1.36-3.09, p=0.0006) and abdominal pain (OR 2.80; 95%CI: 1.41-5.54, p=0.003) were associated with a higher risk of poor outcomes and no such association was found for diarrhea (OR 1.04; 95%CI: 0.85-1.26, p=0.71), nausea (OR 0.73; 95%CI: 0.38-1.39, p=0.34) and vomiting (OR 1.24; 95%CI 0.86-1.79, p=0.25). Conclusion The meta-analysis concludes that anorexia and abdominal pain are associated with poor outcomes in hospitalized COVID-19 patients, while diarrhea, nausea, and vomiting have no association. Future research should focus on whether detecting GI invasion in conjunction with fecal polymerase chain reaction (PCR) testing can aid in the early triage of high-risk individuals and improve outcomes.
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Affiliation(s)
- Deep Mehta
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Raveena Kelkar
- Internal Medicine, Cleveland Clinic Akron General, Akron, USA
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neel Patel
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Parth D Trivedi
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Sameer Dawoodi
- Gastroenterology, State University of New York Downstate Medical Center, New York, USA
- Internal Medicine, Yale New Haven Hospital, New Haven, USA
| | - Dhruvan Patel
- Gastroenterology, Mercy Fitzgerald Hospital, Darby, USA
- Gastroenterology, University of Pennsylvania, Philadelphia, USA
| | | | - Akbar Hussain
- Internal Medicine, Appalachian Regional Healthcare, Hazard, USA
| | | | - Azadeh Khayat
- Pathology and Laboratory Medicine, Brown University, Providence, USA
| | | | - Uvesh Mansuri
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Henry Sacks
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ashish Atreja
- Internal Medicine (Division of Gastroenterology), Icahn School of Medicine at Mount Sinai, New York, USA
- Digital Health, University of California Davis Health, Sacramento, USA
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Caldeira D, Brito J, Gregório C, Plácido R, Pinto FJ. Short- and long-term effects of the COVID-19 pandemic on patients with cardiovascular diseases: A mini-review. HEART AND MIND 2023; 7:217-223. [DOI: 10.4103/hm.hm-d-23-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2025] Open
Abstract
The COVID-19 pandemic had profound implications for patients with cardiovascular diseases (CVDs), both in the short- and long-term. In this article, we provide an overview of the effects of the pandemic on individuals with preexisting cardiovascular conditions. In the short term, the severe acute respiratory syndrome coronavirus 2 infection increased the risk of many cardiovascular events. Furthermore, the pandemic has disrupted health-care systems worldwide, leading to constraints in routine care, and limited access to specialized cardiovascular services and procedure. This has resulted in increased morbidity and mortality rates among patients with CVD (coronary artery disease, hypertrophic cardiomyopathy, heart failure (HF), heart transplant recipients, atrial fibrillation, atrial flutter, previous stroke, or previous peripheral artery disease). In the long term, the COVID-19 impact on patients with CVD extends beyond the acute phase of the disease. Studies have highlighted the development of long-term cardiovascular complications in COVID-19 survivors, such as acute coronary syndrome myocarditis, HF, stroke, venous thromboembolism, and arrhythmias, which may lead to a surge of new cases associated with CVD in the postpandemic era. Health-care systems must prioritize cardiovascular care, developing strategies to identify the patients at higher risk and provide the care to minimize the impact of the pandemic on patients with CVD.
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Affiliation(s)
- Daniel Caldeira
- Department of Cardiology, Santa Maria Hospital, CHULN, CAML, CCUL@RISE, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Evidence-Based Medicine Center (CEMBE), Faculty of Medicine, University of Lisbon (Faculdade de Medicina, Universidade de Lisboa), Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Joana Brito
- Department of Cardiology, Santa Maria Hospital, CHULN, CAML, CCUL@RISE, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Catarina Gregório
- Department of Cardiology, Santa Maria Hospital, CHULN, CAML, CCUL@RISE, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Rui Plácido
- Department of Cardiology, Santa Maria Hospital, CHULN, CAML, CCUL@RISE, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Fausto J. Pinto
- Department of Cardiology, Santa Maria Hospital, CHULN, CAML, CCUL@RISE, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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Portuondo-Jiménez J, Barrio I, España PP, García J, Villanueva A, Gascón M, Rodríguez L, Larrea N, García-Gutierrez S, Quintana JM. Clinical prediction rules for adverse evolution in patients with COVID-19 by the Omicron variant. Int J Med Inform 2023; 173:105039. [PMID: 36921481 PMCID: PMC9988314 DOI: 10.1016/j.ijmedinf.2023.105039] [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: 11/17/2022] [Revised: 02/03/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE We identify factors related to SARS-CoV-2 infection linked to hospitalization, ICU admission, and mortality and develop clinical prediction rules. METHODS Retrospective cohort study of 380,081 patients with SARS-CoV-2 infection from March 1, 2020 to January 9, 2022, including a subsample of 46,402 patients who attended Emergency Departments (EDs) having data on vital signs. For derivation and external validation of the prediction rule, two different periods were considered: before and after emergence of the Omicron variant, respectively. Data collected included sociodemographic data, COVID-19 vaccination status, baseline comorbidities and treatments, other background data and vital signs at triage at EDs. The predictive models for the EDs and the whole samples were developed using multivariate logistic regression models using Lasso penalization. RESULTS In the multivariable models, common predictive factors of death among EDs patients were greater age; being male; having no vaccination, dementia; heart failure; liver and kidney disease; hemiplegia or paraplegia; coagulopathy; interstitial pulmonary disease; malignant tumors; use chronic systemic use of steroids, higher temperature, low O2 saturation and altered blood pressure-heart rate. The predictors of an adverse evolution were the same, with the exception of liver disease and the inclusion of cystic fibrosis. Similar predictors were found to be related to hospital admission, including liver disease, arterial hypertension, and basal prescription of immunosuppressants. Similarly, models for the whole sample, without vital signs, are presented. CONCLUSIONS We propose risk scales, based on basic information, easily-calculable, high-predictive that also function with the current Omicron variant and may help manage such patients in primary, emergency, and hospital care.
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Affiliation(s)
- Janire Portuondo-Jiménez
- Osakidetza Basque Health Service, Sub-Directorate for Primary Care Coordination, Vitoria-Gasteiz, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Irantzu Barrio
- University of the Basque Country UPV/EHU, Department of Mathematics, Leioa, Spain; Basque Center for Applied Mathematics, BCAM, Spain.
| | - Pedro P España
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain; Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Respiratory Unit, Galdakao, Spain
| | - Julia García
- Basque Government Department of Health, Office of Healthcare Planning, Organization and Evaluation, Basque Country, Spain
| | - Ane Villanueva
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - María Gascón
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | | | - Nere Larrea
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Susana García-Gutierrez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - José M Quintana
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain; Osakidetza Basque Health Service, Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain; Health Service Research Network on Chronic Diseases (REDISSEC), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
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5
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Chen J, Mi B, Yan M, Wang Y, Zhu K, Yu C, Zhang Y, Koyama S, Ren X. The effects of comorbidities on the change of taste and smell in COVID-19 patients. Laryngoscope Investig Otolaryngol 2023; 8:25-33. [PMID: 36846410 PMCID: PMC9948579 DOI: 10.1002/lio2.1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/31/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023] Open
Abstract
Background Sudden chemosensory changes were considered an early predictor of COVID-19. Here, the effects of comorbidities on changes in taste and smell in COVID-19 patients were investigated based on a worldwide study. Methods Data analyzed here were collected from the Global Consortium for Chemosensory Research (GCCR) core questionnaire, including questions regarding preexisting disease conditions. Overall, the final sample of 12,438 participants who were diagnosed with COVID-19 included patients with preexisting conditions. Mixed linear regression models were used to test our hypothesis, and the p-value of interaction was examined. Results A total of 61,067 participants completed the GCCR questionnaire, including 16,016 participants had preexisting diseases. The multivariate regression analysis showed that individuals with high blood pressure, lung disease, or sinus problems, or neurological diseases exhibited worse self-reported smell loss (p < .05), but no apparent significant differences in the smell or taste recovery. COVID-19 patients with seasonal allergy/hay fever lost their olfactory ability more than patients who did not have it (with 11.90 [9.67, 14.13] vs. without 6.97 [6.04, 7.91], p < .0001). The taste ability, smell loss and taste loss after COVID-19 recovery also decreased in the COVID-19 patients with seasonal allergy/hay fever (p < .001). Preexisting condition of diabetes did not worsen to chemosensory disorder but also had no obvious impact on the chemosensory recovery after acute infection. Preexisting diseases also affected the type of smell change in the COVID-19 patients with seasonal allergy/hay fever or sinus problems (p < .05). Conclusions COVID-19 patients with high blood pressure, lung disease, or sinus problems, or neurological diseases exhibited worse self-reported smell loss, but no differences in the smell or taste recovery. COVID-19 patients with seasonal allergy/hay fever had greater loss of smell and taste, poorer smell and taste recovery. Level of Evidence 4.
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Affiliation(s)
- Jingguo Chen
- Department of Otolaryngology‐Head and Neck SurgerySecond Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital)Xi'anChina
| | - Baibing Mi
- Department of Epidemiology and Health Statistics, School of Public Health, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Miaojia Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Yutong Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Health Science CenterXi'an Jiaotong UniversityXi'anChina
| | - Kang Zhu
- Department of Otolaryngology‐Head and Neck SurgerySecond Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital)Xi'anChina
| | - Chao Yu
- Department of Otolaryngology‐Head and Neck SurgerySecond Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital)Xi'anChina
| | - Yanni Zhang
- Department of Otolaryngology‐Head and Neck SurgerySecond Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital)Xi'anChina
| | - Sachiko Koyama
- Department of ChemistryIndiana UniversityBloomingtonIndianaUSA
| | - Xiaoyong Ren
- Department of Otolaryngology‐Head and Neck SurgerySecond Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital)Xi'anChina
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Zsichla L, Müller V. Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors. Viruses 2023; 15:175. [PMID: 36680215 PMCID: PMC9863423 DOI: 10.3390/v15010175] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.
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Affiliation(s)
- Levente Zsichla
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
| | - Viktor Müller
- Institute of Biology, Eötvös Loránd University, 1117 Budapest, Hungary
- National Laboratory for Health Security, Eötvös Loránd University, 1117 Budapest, Hungary
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McCulloch L, Mouat IC, South K, McColl BW, Allan SM, Smith CJ. Stroke-induced changes to immune function and their relevance to increased risk of severe COVID-19 disease. DISCOVERY IMMUNOLOGY 2022; 1:kyac004. [PMID: 38566903 PMCID: PMC10917238 DOI: 10.1093/discim/kyac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/07/2022] [Accepted: 08/01/2022] [Indexed: 04/04/2024]
Abstract
As the COVID-19 pandemic moves towards endemic disease, it remains of key importance to identify groups of individuals vulnerable to severe infection and understand the biological factors that mediate this risk. Stroke patients are at increased risk of developing severe COVID-19, likely due to stroke-induced alterations to systemic immune function. Furthermore, immune responses associated with severe COVID-19 in patients without a history of stroke parallel many of the immune alterations induced by stroke, possibly resulting in a compounding effect that contributes to worsened disease severity. In this review, we discuss the changes to systemic immune function that likely contribute to augmented COVID-19 severity in patients with a history of stroke and the effects of COVID-19 on the immune system that may exacerbate these effects.
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Affiliation(s)
- Laura McCulloch
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Isobel C Mouat
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
| | - Kieron South
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Barry W McColl
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Stuart M Allan
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Craig J Smith
- Lydia Becker Institute of Immunology and Inflammation, Division of Immunology, Immunity to Infection and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, UK
- Greater Manchester Comprehensive Stroke Centre, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
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8
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Huang H, Chen J, Fang S, Chen X, Pan X, Lei H, Zhang Y, Lin H, Yuan Q, Xia P, Liu N, Du H. Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis. Front Neurol 2022; 13:922936. [PMID: 35911884 PMCID: PMC9327441 DOI: 10.3389/fneur.2022.922936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The objective of this study was to investigate the association between previous stroke and the risk of severe coronavirus disease 2019 (COVID-19). Methods We included 164 (61.8 ± 13.6 years) patients with COVID-19 in a retrospective study. We evaluated the unadjusted and adjusted associations between previous stroke and severe COVID-19, using a Cox regression model. We conducted an overall review of systematic review and meta-analysis to investigate the relationship of previous stroke with the unfavorable COVID-19 outcomes. Results The rate of severe COVID-19 in patients with previous stroke was 28.37 per 1,000 patient days (95% confidence interval [CI]: 10.65–75.59), compared to 3.94 per 1,000 patient days (95% CI: 2.66–5.82) in those without previous stroke (p < 0.001). Previous stroke was significantly associated with severe COVID-19 using a Cox regression model (unadjusted [hazard ratio, HR]: 6.98, 95% CI: 2.42–20.16, p < 0.001; adjusted HR [per additional 10 years]: 4.62, 95% CI: 1.52–14.04, p = 0.007). An overall review of systematic review and meta-analysis showed that previous stroke was significantly associated with severe COVID-19, mortality, need for intensive care unit admission, use of mechanical ventilation, and an unfavorable composite outcome. Conclusion Previous stroke seems to influence the course of COVID-19 infection; such patients are at high risk of severe COVID-19 and might benefit from early hospital treatment measures and preventive strategies.
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Affiliation(s)
- Huayao Huang
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China
| | - Junnian Chen
- Department of Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shuangfang Fang
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoling Chen
- Department of Infectious Disease, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaobin Pan
- Department of Critical Care Medicine, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Hanhan Lei
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yixian Zhang
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hailong Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qilin Yuan
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Pincang Xia
- Fujian Center for Disease Control and Prevention, Fuzhou, China
| | - Nan Liu
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
| | - Houwei Du
- Department of Neurology, Stroke Research Center, Fujian Medical University Union Hospital, Fuzhou, China
- *Correspondence: Houwei Du
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Niu J, Sareli C, Mayer D, Visbal A, Sareli A. Lymphopenia as a Predictor for Adverse Clinical Outcomes in Hospitalized Patients with COVID-19: A Single Center Retrospective Study of 4485 Cases. J Clin Med 2022; 11:jcm11030700. [PMID: 35160150 PMCID: PMC8837002 DOI: 10.3390/jcm11030700] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 01/27/2023] Open
Abstract
Lymphopenia is commonly present in patients with COVID-19. We sought to determine if lymphopenia on admission predicts COVID-19 clinical outcomes. A retrospective chart review was performed on 4485 patients with laboratory-confirmed COVID-19, who were admitted to the hospital. Of those, 2409 (57.3%) patients presented with lymphopenia (absolute lymphocyte count < 1.1 × 109/L) on admission, and had higher incidences of ICU admission (17.9% versus 9.5%, p < 0.001), invasive mechanical ventilation (14.4% versus 6.5%, p < 0.001), dialysis (3.4% versus 1.8%, p < 0.001) and in-hospital mortality (16.6% versus 6.6%, p < 0.001), with multivariable-adjusted odds ratios of 1.86 (95% confidence interval [CI], 1.55–2.25), 2.09 (95% CI, 1.69–2.59), 1.77 (95% CI, 1.19–2.68), and 2.19 (95% CI 1.76–2.72) for the corresponding outcomes, respectively, compared to those without lymphopenia. The restricted cubic spline models showed a non-linear relationship between lymphocyte count and adverse outcomes, with an increase in the risk of adverse outcomes for lower lymphocyte counts in patients with lymphopenia. The predictive powers of lymphopenia, expressed as areas under the receiver operating characteristic curves, were 0.68, 0.69, 0.78, and 0.79 for the corresponding adverse outcomes, respectively, after incorporating age, gender, race, and comorbidities. In conclusion, lymphopenia is a useful metric in prognosticating outcomes in hospitalized COVID-19 patients.
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Affiliation(s)
- Jianli Niu
- Office of Human Research, Memorial Healthcare System, Hollywood, FL 33021, USA; (J.N.); (C.S.)
| | - Candice Sareli
- Office of Human Research, Memorial Healthcare System, Hollywood, FL 33021, USA; (J.N.); (C.S.)
| | - Daniel Mayer
- Adult Critical Care Service, Memorial Healthcare System, Hollywood, FL 33021, USA; (D.M.); (A.V.)
| | - Alvaro Visbal
- Adult Critical Care Service, Memorial Healthcare System, Hollywood, FL 33021, USA; (D.M.); (A.V.)
| | - Aharon Sareli
- Adult Critical Care Service, Memorial Healthcare System, Hollywood, FL 33021, USA; (D.M.); (A.V.)
- Correspondence: ; Tel.: +1-954-265-9976
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10
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Arman A, Tajik M, Nazemipour M, Ahmadinejad Z, Shahrestanaki SK, Hazrati E, Mansournia N, Mansournia MA. Risk factors of developing critical conditions in Iranian patients with COVID-19. GLOBAL EPIDEMIOLOGY 2021; 3:100046. [PMID: 33521624 PMCID: PMC7833422 DOI: 10.1016/j.gloepi.2020.100046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Abstract
COVID-19 due to novel Coronavirus was first reported in Wuhan, China. Nowadays, the Islamic Republic of Iran stands among countries with high COVID-19 prevalence and high burden of disease. Since the medical resources are limited, we aimed to identify the risk factors for patients developing critical conditions. This can help to improve resource management and treatment outcomes. In this retrospective study, we included 12,677 patients who were from 26 hospitals, supervised by Tehran University of Medical Sciences with signs and symptoms of COVID-19, until April 12. University integrated IT system was adopted to collect the data. We performed Logistic regression to evaluate the association between death in COVID-19 positive patients and other variables. Cough, respiratory distress and fever were the most common symptoms in our patients, respectively. Cancer, chronic lung diseases and chronic neurologic diseases were the strongest risk factors for death in COVID-19 patients.
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Affiliation(s)
- Alireza Arman
- Medical-Surgical Department School of Nursing & Midwifery Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajik
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Keyvanloo Shahrestanaki
- Nursing Care Research Center(NCRC), School of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran
| | - Ebrahim Hazrati
- Department of Anesthesiology, AJA University of Medical Sciences, Tehran, Iran
| | - Nasrin Mansournia
- Department of Endocrinology, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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11
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Treskova-Schwarzbach M, Haas L, Reda S, Pilic A, Borodova A, Karimi K, Koch J, Nygren T, Scholz S, Schönfeld V, Vygen-Bonnet S, Wichmann O, Harder T. Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence. BMC Med 2021; 19:212. [PMID: 34446016 PMCID: PMC8390115 DOI: 10.1186/s12916-021-02058-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. METHODS Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. RESULTS In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2-2.0 (CI range 1.1-2.8)), obesity (OR range 1.5-1.75 (CI range 1.1-2.3)), heart failure (HR range 1.3-3.3 (CI range 0.9-8.2)), COPD (HR range 1.12-2.2 (CI range 1.1-3.2)) and dementia (HR range 1.4-7.7 (CI range 1.2-39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2-5.9 (CI range 0.9-27.7)) and active cancer (OR range 1.6-4.7 (CI range 0.5-14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3-2.2)). GRADE certainty was moderate to high for most associations. CONCLUSION Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.
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Affiliation(s)
| | - Laura Haas
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sarah Reda
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Antonia Pilic
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Anna Borodova
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Kasra Karimi
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Judith Koch
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Teresa Nygren
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Stefan Scholz
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Viktoria Schönfeld
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Sabine Vygen-Bonnet
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Ole Wichmann
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, The Robert Koch Institute, Seestrasse 10, 13353, Berlin, Germany
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12
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Neurological comorbidities and COVID-19-related case fatality: A cohort study. J Neurol Sci 2021; 428:117610. [PMID: 34384971 PMCID: PMC8339457 DOI: 10.1016/j.jns.2021.117610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/21/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
Background Neurological involvement in Coronavirus disease-2019 (COVID-19) is widely recognized. However, the role of pre-existing neurological comorbidities in modulating COVID-19-related mortality still remains unclear. This cohort study evaluates the COVID-19-related case fatality rate (CFR) of patients with pre-existing neurological diseases. Methods We retrospectively evaluated all patients consecutively admitted to our hospital with a diagnosis of COVID-19 between March and April 2020. We used a multivariate regression analysis to estimate the association between pre-existing neurological diseases and COVID-19-related mortality. Then, we compared the CFR and survival curves of two cohorts (patients suffering vs. those not suffering from pre-existing neurological disease), matched trough the propensity score (PS). Age and other comorbidities were considered for PS calculation. We applied a 1:1 matching for the entire neurological cohort and, separately, for cerebrovascular, neurodegenerative, and other neurological diseases. Results Among 332 patients, 75 (22.6%) were affected by pre-existing neurological disease (n = 29 cerebrovascular, n = 26 neurodegenerative, n = 20 others). From the multivariate regression analysis, they resulted with a significant increase of COVID-19-related mortality (OR:2.559; 95%CI 1.181–5.545; p < 0.017). From the cohort analysis, CFR resulted 2-fold higher in patients with neurological disease (48.0% vs. 24.0%; p = 0.002). CFR was significantly higher in patients with neurodegenerative diseases compared to matched individuals (73.9% vs. 39.1%; p = 0.017), while CFR increase in patients with cerebrovascular diseases did not reach statistical significance (48.3% vs. 41.4%; p = 0.597). Conclusions Pre-existing neurological comorbidities, in particular neurodegenerative diseases, increase significantly COVID-19-related case fatality, indicating a clear priority for viral screening, access to care facilities and vaccination in these populations.
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13
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Nassar M, Nso N, Alfishawy M, Novikov A, Yaghi S, Medina L, Toz B, Lakhdar S, Idrees Z, Kim Y, Gurung DO, Siddiqui RS, Zheng D, Agladze M, Sumbly V, Sandhu J, Castillo FC, Chowdhury N, Kondaveeti R, Bhuiyan S, Perez LG, Ranat R, Gonzalez C, Bhangoo H, Williams J, Osman AE, Kong J, Ariyaratnam J, Mohamed M, Omran I, Lopez M, Nyabera A, Landry I, Iqbal S, Gondal AZ, Hassan S, Daoud A, Baraka B, Trandafirescu T, Rizzo V. Current systematic reviews and meta-analyses of COVID-19. World J Virol 2021; 10:182-208. [PMID: 34367933 PMCID: PMC8316876 DOI: 10.5501/wjv.v10.i4.182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/13/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has left a significant impact on the world's health, economic and political systems; as of November 20, 2020, more than 57 million people have been infected worldwide, with over 1.3 million deaths. While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life. AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence, highlight gaps in knowledge, and elucidate further meta-analyses and umbrella reviews that are yet to be performed. METHODS We explored studies based on systematic reviews and meta-analyses with the key-terms, including severe acute respiratory syndrome (SARS), SARS virus, coronavirus disease, COVID-19, and SARS coronavirus-2. The included studies were extracted from Embase, Medline, and Cochrane databases. The publication timeframe of included studies ranged between January 01, 2020, to October 30, 2020. Studies that were published in languages other than English were not considered for this systematic review. The finalized full-text articles are freely accessible in the public domain. RESULTS Searching Embase, Medline, and Cochrane databases resulted in 1906, 669, and 19 results, respectively, that comprised 2594 studies. 515 duplicates were subsequently removed, leaving 2079 studies. The inclusion criteria were systematic reviews or meta-analyses. 860 results were excluded for being a review article, scope review, rapid review, panel review, or guideline that produced a total of 1219 studies. After screening articles were categorized, the included articles were put into main groups of clinical presentation, epidemiology, screening and diagnosis, severity assessment, special populations, and treatment. Subsequently, there was a second subclassification into the following groups: gastrointestinal, cardiovascular, neurological, stroke, thrombosis, anosmia and dysgeusia, ocular manifestations, nephrology, cutaneous manifestations, D-dimer, lymphocyte, anticoagulation, antivirals, convalescent plasma, immunosuppressants, corticosteroids, hydroxychloroquine, renin-angiotensin-aldosterone system, technology, diabetes mellitus, obesity, pregnancy, children, mental health, smoking, cancer, and transplant. CONCLUSION Among the included articles, it is clear that further research is needed regarding treatment options and vaccines. With more studies, data will be less heterogeneous, and statistical analysis can be better applied to provide more robust clinical evidence. This study was not designed to give recommendations regarding the management of COVID-19.
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Affiliation(s)
- Mahmoud Nassar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nso Nso
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mostafa Alfishawy
- Department of Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo 11221, Outside of the US, Egypt
| | - Anastasia Novikov
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Salim Yaghi
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Luis Medina
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Bahtiyar Toz
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sofia Lakhdar
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Zarwa Idrees
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Yungmin Kim
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Dawa Ongyal Gurung
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Raheel S Siddiqui
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - David Zheng
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariam Agladze
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vikram Sumbly
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jasmine Sandhu
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Francisco Cuevas Castillo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Nadya Chowdhury
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ravali Kondaveeti
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sakil Bhuiyan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Laura Guzman Perez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Riki Ranat
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Carlos Gonzalez
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Harangad Bhangoo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - John Williams
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Alaa Eldin Osman
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Joyce Kong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Jonathan Ariyaratnam
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mahmoud Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Knoxville City, TN 38103, United States
| | - Ismail Omran
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Mariely Lopez
- Department of Medical, St. George's University, West Indies 38901, Grenada
| | - Akwe Nyabera
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ian Landry
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Saba Iqbal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Anoosh Zafar Gondal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Sameen Hassan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Ahmed Daoud
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo 11221, Egypt
| | - Bahaaeldin Baraka
- Department of Oncology, Broomfiled Hospital, Mid and South Essex NHS Foundation Trust, ESSEX, Chelmsford 12422, United Kingdom
| | - Theo Trandafirescu
- Department of Critical Care Unit, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
| | - Vincent Rizzo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC H&H Queens, New York, NY 11432, United States
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14
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Bai Y, Liang Y, Wang F, Chen L, Zhao Y, Zhao S, Zhu Y, Dong Y, Liang G, Chen D, Liu L. Clinical course and outcomes of COVID-19 patients with a history of cerebrovascular disease: a retrospective study in Wuhan. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:988. [PMID: 34277788 PMCID: PMC8267260 DOI: 10.21037/atm-21-2237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 01/08/2023]
Abstract
Background Data on patients with coronavirus disease 2019 (COVID-19) who have pre-existing cerebrovascular disease (CVD) are scarce. This study set out to describe the clinical course and outcomes of these patients. Methods This single-center retrospective study was performed at Huoshenshan Hospital in Wuhan, China. Patients with confirmed COVID-19 who had pre-existing CVD (N=69) were identified. COVID-19 patients without CVD were randomly selected and matched by age and sex to the patients with CVD. Clinical data were analyzed and compared between the 2 groups. The composite endpoint included intensive care unit admission, use of mechanical ventilation, and death. Multivariable Cox regression analyses with control for medical comorbidities were used to examine the relationship between pre-existing CVD and clinical outcome of COVID-19. Results Compared with patients without CVD, patients with pre-existing CVD were more likely to present with unapparent symptoms at first; however, at admission, these patients tended to be in a severer condition than those without CVD, with more underlying hypertension and diabetes. The levels of interleukin-6, creative kinase MB, aspartate transaminase, and creatinine, as well as prothrombin time, were also markedly higher in patients with CVD. Patients with pre-existing CVD were more likely to develop multi-organ dysfunction, deteriorate to critical condition, and yield poorer clinical outcomes than patients without CVD. Concerning therapeutics, greater proportions of patients with pre-existing CVD required mechanical ventilation, higher-order anti-bacterials, and drugs targeting underlying diseases and complications. In the multivariable analysis, pre-existing CVD was significantly associated with a poor clinical outcome. Conclusions Patients with a history of CVD are more vulnerable to an over-activated inflammatory response and subsequent multi-organ dysfunction, resulting in a poor clinical outcome. Close monitoring is advisable for these patients.
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Affiliation(s)
- Yang Bai
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China.,Department of Gastroenterology, Daping Hospital of Third Military Medical University, Chongqing, China
| | - Yong Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Fang Wang
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ligang Chen
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Yulong Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Shoujie Zhao
- Department of General Surgery, Tangdu Hospital of Fourth Military Medical University, Xi'an, China
| | - Yejing Zhu
- Department of General Surgery, Tangdu Hospital of Fourth Military Medical University, Xi'an, China
| | - Yushu Dong
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Dongfeng Chen
- Department of Gastroenterology, Daping Hospital of Third Military Medical University, Chongqing, China
| | - Lei Liu
- Department of Gastroenterology, Daping Hospital of Third Military Medical University, Chongqing, China.,Department of Gastroenterology, Tangdu Hospital of Fourth Military Medical University, Xi'an, China
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15
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Alhumaid S, Al Mutair A, Al Alawi Z, Al Salman K, Al Dossary N, Omar A, Alismail M, Al Ghazal AM, Jubarah MB, Al Shaikh H, Al Mahdi MM, Alsabati SY, Philip DK, Alyousef MY, Al Brahim AH, Al Athan MS, Alomran SA, Ahmed HS, Al-Shammari H, Elhazmi A, Rabaan AA, Al-Tawfiq JA, Al-Omari A. Clinical features and prognostic factors of intensive and non-intensive 1014 COVID-19 patients: an experience cohort from Alahsa, Saudi Arabia. Eur J Med Res 2021; 26:47. [PMID: 34030733 PMCID: PMC8142074 DOI: 10.1186/s40001-021-00517-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/10/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND COVID-19 is a worldwide pandemic and has placed significant demand for acute and critical care services on hospitals in many countries. OBJECTIVES To determine the predictors of severe COVID-19 disease requiring admission to an ICU by comparing patients who were ICU admitted to non-ICU groups. METHODS A cohort study was conducted for the laboratory-confirmed COVID-19 patients who were admitted to six Saudi Ministry of Health's hospitals in Alahsa, between March 1, 2020, and July 30, 2020, by reviewing patient's medical records retrospectively. RESULTS This cohort included 1014 patients with an overall mean age of 47.2 ± 19.3 years and 582 (57%) were males. A total of 205 (20%) of the hospitalized patients were admitted to the ICU. Hypertension, diabetes and obesity were the most common comorbidities in all study patients (27.2, 19.9, and 9%, respectively). The most prevalent symptoms were cough (47.7%), shortness of breath (35.7%) and fever (34.3%). Compared with non-ICU group, ICU patients had older age (p ≤ 0.0005) and comprised a higher proportion of the current smokers and had higher respiratory rates (p ≤ 0.0005), and more percentage of body temperatures in the range of 37.3-38.0 °C (p ≥ 0.0005); and had more comorbidities including diabetes (p ≤ 0.0005), hypertension (p ≥ 0.0005), obesity (p = 0.048), and sickle cell disease (p = 0.039). There were significant differences between the non-ICU and ICU groups for fever, shortness of breath, cough, fatigue, vomiting, dizziness; elevated white blood cells, neutrophils, alanine aminotransferase and alkaline aminotransferase, lactate dehydrogenase, and ferritin, and decreased hemoglobin; and proportion of abnormal bilateral chest CT images (p < 0.05). Significant differences were also found for multiple treatments (p < 0.05). ICU patients group had a much higher mortality rate than those with non-ICU admission (p ≤ 0.0005). CONCLUSION Identifying key clinical characteristics of COVID-19 that predict ICU admission and high mortality can be useful for frontline healthcare providers in making the right clinical decision under time-sensitive and resource-constricted environment.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Alahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Alahsa, 31982 Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Alahsa, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, Australia
- College of Nursing, Princess Norah
Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, Alahsa, Saudi Arabia
| | - Khulud Al Salman
- Nursing Department, Al Jaber Hospital for Eye, Ear, Nose and Throat, Ministry of Health, Al-Hofuf, Saudi Arabia
| | - Nourah Al Dossary
- General Surgery Department, Alomran General Hospital, Alahsa, Saudi Arabia
| | - Ahmed Omar
- Internal Medicine Department, Alomran General Hospital, Alahsa, Saudi Arabia
| | - Mossa Alismail
- Pharmacy Department, King Faisal General Hospital, Alahsa, Saudi Arabia
| | - Ali M. Al Ghazal
- Infection Prevention and Control Department, Prince Saud Bin Jalawi Hospital, Alahsa, Saudi Arabia
| | - Mahdi Bu Jubarah
- Pharmacy Department, King Faisal General Hospital, Alahsa, Saudi Arabia
| | - Hanan Al Shaikh
- Pharmacy Department, King Faisal General Hospital, Alahsa, Saudi Arabia
| | - Maher M. Al Mahdi
- Infection Prevention and Control Department, Prince Saud Bin Jalawi Hospital, Alahsa, Saudi Arabia
| | - Sarah Y. Alsabati
- Nursing Department, Maternity and Children Hospital, Alahsa, Saudi Arabia
| | - Dayas K. Philip
- Nursing Education Department, Maternity and Children Hospital, Alahsa, Saudi Arabia
| | - Mohammed Y. Alyousef
- Administration of Academic Affairs and Research, Ministry of Health, Alahsa, Saudi Arabia
| | | | | | | | - Hatim S. Ahmed
- Planning and Research Department, Ministry of Health, Alahsa, Saudi Arabia
| | - Haifa Al-Shammari
- Histopathology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Alyaa Elhazmi
- Intensive Care Unit Department, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Ali A. Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A. Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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16
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Mukaetova-Ladinska EB, Kronenberg G. Psychological and neuropsychiatric implications of COVID-19. Eur Arch Psychiatry Clin Neurosci 2021; 271:235-248. [PMID: 33221936 PMCID: PMC7680256 DOI: 10.1007/s00406-020-01210-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 10/27/2020] [Indexed: 01/08/2023]
Abstract
COVID-19 infections have spread quickly, resulting in massive healthcare burden to societies worldwide. The most urgent interventions needed in the present climate include epidemiological measures to reduce the spread of infection, efficient treatment of patients with severe illness to reduce mortality rates, as well as development of diagnostic tests. Alongside this, the acute, medium, and long-term mental-health consequences of the COVID-19 outbreak for patients, their family members, medical professionals, and the public at large should not be underestimated. Here, we draw on evidence from previous coronavirus outbreaks (i.e., SARS, MERS) and emerging evidence from China, Europe, Asia and the US to synthesize the current knowledge regarding the psychological and neuropsychiatric implications of the COVID-19 pandemic.
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Affiliation(s)
- E B Mukaetova-Ladinska
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, UK.
- The Evington Centre, Leicestershire Partnership NHS Trust, Gwendolen Road, Leicester, LE5 4QF, Leicestershire, UK.
| | - G Kronenberg
- College of Life Sciences, University of Leicester, Glenfield, Groby Road, Leicester, LE3 9QP, UK
- Leicestershire Partnership NHS Trust, Farm Lodge, Farm Drive, Leicester, LE3 9Q4, UK
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17
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Chakinala RC, Shah CD, Rakholiya JH, Martin M, Kaur N, Singh H, Okafor TL, Nwodika C, Raval P, Yousuf S, Lakhani K, Yogarajah A, Malik P, Singh J, Kichloo A, Patel UK. COVID-19 Outcomes Amongst Patients With Pre-existing Cardiovascular Disease and Hypertension. Cureus 2021; 13:e13420. [PMID: 33763316 PMCID: PMC7980770 DOI: 10.7759/cureus.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/18/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has multiorgan involvement and its severity varies with the presence of pre-existing risk factors like cardiovascular disease (CVD) and hypertension (HTN). Therefore, it is important to evaluate their effect on outcomes of COVID-19 patients. The objective of this meta-analysis and meta-regression is to evaluate outcomes of COVID-19 amongst patients with CVD and HTN. METHODS English full-text observational studies having data on epidemiological characteristics of patients with COVID-19 were identified searching PubMed from December 1, 2019, to July 31, 2020, following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) protocol. Studies having pre-existing CVD and HTN data that described outcomes including mortality and invasive mechanical ventilation (IMV) utilization were selected. Using random-effects models, risk of composite poor outcomes (meta-analysis) and isolated mortality and IMV utilization (meta-regression) were evaluated. Pooled prevalence of CVD and HTN, correlation coefficient (r) and odds ratio (OR) were estimated. The forest plots and correlation plots were created using random-effects models. RESULTS Out of 29 studies (n=27,950) that met the criteria, 28 and 27 studies had data on CVD and HTN, respectively. Pooled prevalence of CVD was 18.2% and HTN was 32.7%. In meta-analysis, CVD (OR: 3.36; 95% CI: 2.29-4.94) and HTN (OR: 1.94; 95% CI: 1.57-2.40) were associated with composite poor outcome. In age-adjusted meta-regression, pre-existing CVD was having significantly higher correlation of IMV utilization (r: 0.28; OR: 1.3; 95% CI: 1.1-1.6) without having any association with mortality (r: -0.01; OR: 0.9; 95% CI: 0.9-1.1) among COVID-19 hospitalizations. HTN was neither correlated with higher IMV utilization (r: 0.01; OR: 1.0; 95% CI: 0.9-1.1) nor correlated with higher mortality (r: 0.001; OR: 1.0; 95% CI: 0.9-1.1). CONCLUSION In age-adjusted analysis, though we identified pre-existing CVD as a risk factor for higher utilization of mechanical ventilation, pre-existing CVD and HTN had no independent role in increasing mortality.
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Affiliation(s)
- Raja Chandra Chakinala
- Medicine, Geisinger Commonwealth School of Medicine, Danville, USA
- Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Chail D Shah
- Medicine, Mahatma Gandhi Medical College and Research Institute, Navi Mumbai, IND
| | | | - Mehwish Martin
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nirmaljot Kaur
- Internal Medicine, Sri Guru Ramdas Institute of Medical Sciences and Research, Amritsar, IND
| | - Harmandeep Singh
- Internal Medicine, Sri Guru Ramdas University of Health Sciences, Amritsar, IND
| | | | - Chika Nwodika
- Internal Medicine, Oba Okunade Sijuwade College of Medicine, Igbinedion University, Okada, NGA
| | - Payu Raval
- Internal Medicine, siParadigm Diagnostic Informatics, Pine Brook, USA
| | - Salma Yousuf
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Komal Lakhani
- Internal Medicine, Lenox Hill Hospital, New York, USA
| | | | - Preeti Malik
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
- Neurology, Massachusetts General Hospital, Andover, USA
| | - Jagmeet Singh
- Nephrology, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Asim Kichloo
- Internal Medicine, Central Michigan University, Saginaw, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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18
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Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis. Epidemiol Infect 2021; 149:e66. [PMID: 33583450 PMCID: PMC7985867 DOI: 10.1017/s0950268821000376] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has become a global pandemic. Previous studies showed that comorbidities in patients with COVID-19 are risk factors for adverse outcomes. This study aimed to clarify the association between nervous system diseases and severity or mortality in patients with COVID-19. We performed a systematic literature search of four electronic databases and included studies reporting the prevalence of nervous system diseases in COVID-19 patients with severe and non-severe disease or among survivors and non-survivors. The included studies were pooled into a meta-analysis to calculate the odds ratio (OR) with 95% confidence intervals (95%CI). We included 69 studies involving 17 879 patients. The nervous system diseases were associated with COVID-19 severity (OR = 3.19, 95%CI: 2.37 to 4.30, P < 0.001) and mortality (OR = 3.75, 95%CI: 2.68 to 5.25, P < 0.001). Specifically, compared with the patients without cerebrovascular disease, patients with cerebrovascular disease infected with COVID-19 had a higher risk of severity (OR = 3.10, 95%CI: 2.21 to 4.36, P < 0.001) and mortality (OR = 3.45, 95% CI: 2.46 to 4.84, P < 0.001). Stroke was associated with severe COVID-19 disease (OR = 1.95, 95%CI: 1.11 to 3.42, P = 0.020). No significant differences were found for the prevalence of epilepsy (OR = 1.00, 95%CI: 0.42 to 2.35, P = 0.994) and dementia (OR = 2.39, 95%CI: 0.55 to 10.48, P = 0.247) between non-severe and severe COVID-19 patients. There was no significant association between stroke (OR = 1.79, 95%CI: 0.76 to 4.23, P = 0.185), epilepsy (OR = 2.08, 95%CI: 0.08 to 50.91, P = 0.654) and COVID-19 mortality. In conclusion, nervous system diseases and cerebrovascular disease were associated with severity and mortality of patients with COVID-19. There might be confounding factors that influence the relationship between nervous system diseases and COVID-19 severity as well as mortality.
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Clinical Characteristics of the COVID-19 Patients with Pneumonia Detected by Computerized Tomography but Negative for Infiltration by X-ray. Healthcare (Basel) 2020; 8:healthcare8040518. [PMID: 33260480 PMCID: PMC7711504 DOI: 10.3390/healthcare8040518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) has rapidly spread to all corners of the globe. Different diagnostic tools, such as Chest X-ray (CXR), lung ultrasound (LUS), and computerized tomography (CT), have been used to detect active pneumonic lesions associated with COVID-19 with their varying degrees of sensitivity and specificity. This study was undertaken to investigate the clinical characteristics of COVID-19 patients with a pneumonic lung lesion detected by CT that is not detected by CXR. A total of 156 COVID-19 patients hospitalized at three nationally designated South Korean hospitals with no active lesion detected by CXR but on clinical suspicion of pneumonia underwent the CT examination and were enrolled. Medical records, which included demographic and clinical features, including comorbidity, symptoms, radiological, and laboratory findings on admission, were reviewed and analyzed. The risk factors of pneumonia detected by CT for patients without an active lesion detected by CXR were investigated. Of the 156 patients without an active lesion detected by CXR, 35 (22.44%) patients were found to have pneumonia by CT. The patients with pneumonia defined by CT were older than those without (64.1 years vs. 41.2 years). Comorbidities such as hypertension, diabetes, cardiovascular disease, preexisting stroke, and dementia were more common among patients with pneumonia defined by CT than those without. Serum albumin level, C-reactive protein (CRP), stroke, and age ≥ 70 years were significantly associated with pneumonia defined by CT after adjustment for age. In multivariable regression analysis, serum albumin level (adjusted odds ratio (AOR) = 0.123, 95% CI = (0.035-0.429)) and preexisting stroke (AOR = 11.447, 95% CI = (1.168-112.220)) significantly and independently predicted pneumonia detection by CT. Our results suggest that CT scans should be performed on COVID-19 patients negative for a pneumonic lung lesion by CXR who are suspected to be pneumonic on clinical grounds. In addition, older patients with a lower albumin level and a preexisting stroke should be checked for the presence of pneumonia despite a negative CXR finding for an active lesion.
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Is Dysphagia Under Diagnosed or is Normal Swallowing More Variable than We Think? Reported Swallowing Problems in People Aged 18-65 Years. Dysphagia 2020; 36:910-918. [PMID: 33226473 PMCID: PMC7680995 DOI: 10.1007/s00455-020-10213-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
Purpose Dysphagia prevalence in younger community dwelling adults and across nations is sparse. We investigated the prevalence of swallowing problems in an unselected cohort of people aged 18–65 years. Methods The EAT-10 Assessment Tool was converted into an anonymized online survey. Invitations were e-mailed to author contacts and onwards dispersal encouraged. Analysis was performed using non-parametric test for group comparison (Mann–Whitney U) and Spearman’s rho correlation. Results From March 2014 to October 2017: 2054 responses (32 reported ages outside of 18–65 or undeclared) from Africa, Asia, Australasia/Oceania, Europe, and North and South America. Responses: 1,648 female, 364 male, (10 reported as both), median age 34, (range 18–65, mean 37.12, SD 12.40) years. Total EAT-10 scores: median 0 (range 0–36, mean 1.57, SD 3.49). EAT-10 score ≥ 3 (337) median 5 (range 3–36, mean 7.02 SD 5.91). Median age 36 (range 19–65, mean 37.81, SD 13.21) years. Declared sex was not statistically significantly associated with non-pathological vs. pathological EAT-10 score (p = 0.665). Female scores (median 0.00, mean 1.56, SD 3.338) were significantly higher than for males (median 0.00, mean 1.62, SD 4.161): U (Nfemale = 1648, Nmale = 364) = 275,420.000, z = − 2.677, p = 0.007. Age and EAT-10 score were not associated: females rs = − 0.043, p = 0.079, N = 1648, males rs = − 0.003, p = 0.952, N = 364. Considerable impact on people: “I take ages to eat a main course … This is embarrassing and I often leave food even though I am still hungry.” (no diagnosis, EAT-10 = 17). Conclusion Concerns regarding swallowing exist in people undiagnosed with dysphagia, who may feel uncomfortable seeking professional help. Dysphagia may be under reported resulting in a hidden population. Subtle changes are currently seen as subtle markers of COVID-19. Further work is required to ensure that what is an essentially normal swallow does not become medicalized.
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Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis. ACTA ACUST UNITED AC 2020; 2:1740-1749. [PMID: 32904541 PMCID: PMC7456201 DOI: 10.1007/s42399-020-00476-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient (r), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI: 17.1–30.9%), and mortality was 13% (9.3–18%). The age-adjusted meta-regression models showed significant association of mortality with male (r: 0.14; OR: 1.15; 95% CI: 1.07–1.23; I2: 95.2%), comorbidities including pre-existing cerebrovascular disease (r: 0.35; 1.42 (1.14–1.77); I2: 96.1%), and chronic liver disease (r: 0.08; 1.08 (1.01–1.17); I2: 96.23%), complications like septic shock (r: 0.099; 1.10 (1.02–1.2); I2: 78.12%) and ARDS (r: 0.04; 1.04 (1.02–1.06); I2: 90.3%), ICU admissions (r: 0.03; 1.03 (1.03–1.05); I2: 95.21%), and IMV utilization (r: 0.05; 1.05 (1.03–1.07); I2: 89.80%). Similarly, male (r: 0.08; 1.08 (1.02–1.15); I2: 95%), comorbidities like pre-existing cerebrovascular disease (r: 0.29; 1.34 (1.09–1.63); I2:93.4%), and cardiovascular disease (r: 0.28; 1.32 (1.1–1.58); I2: 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most.
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