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Cancarevic I, Nassar M, Foster A, Umar Z, Parikh A, Ahammed MR, Shaban L, Abosheaishaa H, Mergen D, Amin T, Ozkan BI, Sánchez Ruiz AM, Hosna A, ul Rasool MH, Ahmed N, Ayotunde F, Ashfaq S, Lopez R, Rizzo V. Electrolyte disturbances in patients hospitalized for COVID-19 infection: An observational study. Medicine (Baltimore) 2024; 103:e37749. [PMID: 38758907 PMCID: PMC11098206 DOI: 10.1097/md.0000000000037749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/07/2024] [Indexed: 05/19/2024] Open
Abstract
There are multiple mechanisms by which The Coronavirus-19 (COVID-19) infection can cause electrolyte abnormalities, which may not be the case for bacterial causes of pneumonia. This study aimed to assess the differences in electrolyte levels between patients suffering from COVID-19 and bacterial pneumonia. This is an original, retrospective study. Two cohorts of hospitalized patients were included, 1 suffering from COVID-19 and the other from bacterial pneumonia. Their day 1 and day 3 levels of sodium, potassium, magnesium, and phosphorus, as well as their outcomes, were extracted from the charts. Statistical analysis was subsequently performed. Mean admission levels of sodium, potassium, phosphorus, and magnesium were 135.64 ± 6.13, 4.38 ± 0.69, 3.53 ± 0.69, and 2.03 ± 0.51, respectively. The mean day 3 levels of these electrolytes were 138.3 ± 5.06, 4.18 ± 0.59, 3.578 ± 0.59, and 2.11 ± 0.64, respectively. Patients suffering from bacterial pneumonia were significantly older (N = 219, mean = 64.88 ± 15.99) than patients with COVID-19 pneumonia (N = 240, mean = 57.63 ± 17.87). Bacterial pneumonia group had significantly higher serum potassium (N = 211, mean = 4.51 ± 0.76), and magnesium (N = 115, mean = 2.12 ± 0.60) levels compared to COVID-19 group (N = 227, mean = 4.254 ± 0.60 for potassium and N = 118, mean = 1.933 ± 0.38 for magnesium). Only magnesium was significantly higher among day 3 electrolytes in the bacterial pneumonia group. No significant association between electrolyte levels and outcomes was seen. We found that COVID-19 patients had lower potassium and magnesium levels on admission, possibly due to the effect of COVID-19 on the renin-angiotensin-aldosterone system as well as patient characteristics and management. We did not find enough evidence to recommend using electrolyte levels as a determinator of prognosis, but more research is needed.
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Affiliation(s)
- Ivan Cancarevic
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Mahmoud Nassar
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, NY, USA
| | - Allison Foster
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Zaryab Umar
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Avish Parikh
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Md Ripon Ahammed
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Lilia Shaban
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Hazem Abosheaishaa
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Damla Mergen
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Toka Amin
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Bike Ilayda Ozkan
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | | | - Asma Hosna
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | | | - Nazaakat Ahmed
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Fatima Ayotunde
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Salman Ashfaq
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Ricardo Lopez
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
| | - Vincent Rizzo
- Icahn School of Medicine at Mount Sinai, NYC Health and Hospitals, Queens, NY, USA
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Wijewickrama A, Idampitiya D, Karunarathne M, Pahalagamage S, Sellahewa K, Govindapala D, Kalambarachchi H, Sooriyarachchi R, Chandrarathne N, Goonaratna C, Perera J. Efficacy and safety of Link Natural Sudarshana, an Ayurvedic herbal preparation in COVID-19 patients: A phase II multicenter double-blind randomized placebo-controlled trial. J Ethnopharmacol 2024; 323:117535. [PMID: 38070837 DOI: 10.1016/j.jep.2023.117535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In vitro and in vivo studies have shown anti-viral and immunomodulatory actions in components of many traditional medicines. Various constituents of traditional medicines have been found to be effective against coronavirus disease (COVID-19) in several clinical trials and in-silico studies. Sudarshana cúrna, a polyherbal Ayurvedic medicine, has been used over thousands of years for a variety of infectious fevers. AIMS OF THE STUDY This study aimed to evaluate the efficacy and safety of Link Natural Sudarshana (LNS) tablets, in patients with COVID 19 disease. LNS is a polyherbal preparation comprising 49 medicinal plants included in the Sudarshana cúrna. MATERIALS AND METHODS A randomized parallel-group double-blind placebo-controlled multi-center phase II clinical trial was conducted in patients with mild to moderate COVID-19 disease. They were randomly allocated to intervention and control groups. The intervention group received LNS tablets whereas the control group received placebo tablets for 10 days or until the patient was discharged from the hospital. All patients received standard symptomatic treatment. The primary outcome, a reduction in mean log viral load was assessed at day 5 of treatment. The secondary outcomes, clinical progression and safety, were assessed by, monitoring changes in symptoms daily on a Likert scale ranging from 1 to 4 and laboratory tests respectively. RESULTS A total of 171 patients (treatment group 83, control group 88) completed the trial. There were no significant differences between the baseline status of the two groups except that body mass index was significantly higher in the placebo group. The mean log viral load reduction at day 5 was higher in the treatment group (2.20 ± 1.67) compared to the placebo group (1.93 ± 1.80), with a mean difference of -0.278. This difference was not statistically significant at the 5% significant level. Reduction of mean cumulative symptom score, which included 16 symptoms graded according to severity, was higher in the treatment group compared to the placebo group. This difference was not statistically significant. None of the study participants developed hypoxia. Among the 7 lymphopenia patients in the placebo group, 3 continued to have lymphopenia at day 10, whereas 9 lymphopenia patients in the treatment group, reverted to normal counts. C reactive proteins (CRP) showed a greater reduction in the treatment group. None reported adverse effects. No significant changes occurred in hematological and biochemical parameters that assessed safety. CONCLUSIONS LNS is safe to use in COVID-19 patients and accelerated the decline in viral load, relieved symptoms, reduced CRP levels and reversed lymphopenia earlier, when compared to the placebo.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nadeeka Chandrarathne
- Faculty of Medicine, Department of Community Medicine, University of Colombo, Sri Lanka
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AlShehhi A, Almansoori TM, Alsuwaidi AR, Alblooshi H. Utilizing machine learning for survival analysis to identify risk factors for COVID-19 intensive care unit admission: A retrospective cohort study from the United Arab Emirates. PLoS One 2024; 19:e0291373. [PMID: 38206939 PMCID: PMC10783720 DOI: 10.1371/journal.pone.0291373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 08/26/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The current situation of the unprecedented COVID-19 pandemic leverages Artificial Intelligence (AI) as an innovative tool for addressing the evolving clinical challenges. An example is utilizing Machine Learning (ML) models-a subfield of AI that take advantage of observational data/Electronic Health Records (EHRs) to support clinical decision-making for COVID-19 cases. This study aimed to evaluate the clinical characteristics and risk factors for COVID-19 patients in the United Arab Emirates utilizing EHRs and ML for survival analysis models. METHODS We tested various ML models for survival analysis in this work we trained those models using a different subset of features extracted by several feature selection methods. Finally, the best model was evaluated and interpreted using goodness-of-fit based on calibration curves,Partial Dependence Plots and concordance index. RESULTS The risk of severe disease increases with elevated levels of C-reactive protein, ferritin, lactate dehydrogenase, Modified Early Warning Score, respiratory rate and troponin. The risk also increases with hypokalemia, oxygen desaturation and lower estimated glomerular filtration rate and hypocalcemia and lymphopenia. CONCLUSION Analyzing clinical data using AI models can provide vital information for clinician to measure the risk of morbidity and mortality of COVID-19 patients. Further validation is crucial to implement the model in real clinical settings.
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Affiliation(s)
- Aamna AlShehhi
- Biomedical Engineering Department,College of Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
- Healthcare Engineering Innovation Center (HEIC), Khalifa University, Abu Dhabi, United Arab Emirates
| | - Taleb M. Almansoori
- Department of Radiology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ahmed R. Alsuwaidi
- Department of Pediatrics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hiba Alblooshi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Chowdhury AA, Rodgers K, Godbole NM, Awasthi S. Stability and structure-activity relationship of the SPA4 peptide under ambient and stressed conditions of lung injury. RSC Adv 2023; 13:18864-18877. [PMID: 37350860 PMCID: PMC10282593 DOI: 10.1039/d3ra02918b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
Lung inflammation and injuries are major health problems. The SPA4 peptide (amino acid sequence GDFRYSDGTPVNYTNWYRGE) binds to Toll-like receptor-4 and exerts anti-inflammatory activity. In this study, we have determined the stability of the structure and structure-activity relationship of the SPA4 peptide under ambient and stressed conditions of lung injury. The SPA4 peptide was maintained at different pH and temperatures, in solutions of different ionic strengths, and simulated lung fluids. The primary and secondary structure of the SPA4 peptide was determined by ultraviolet-visible (UV-VIS) and circular dichroism (CD) spectroscopy. The activity of the SPA4 peptide was determined by measurement of secreted levels of chemokine C-X-C motif ligand 1/keratinocyte-derived chemokine (CXCL1/KC) and lactate by primary mouse lung epithelial cells against lipopolysaccharide (LPS) stimuli. Our results demonstrate the stability of the structure of the SPA4 peptide at room temperature and 4 °C over 10 days. The original UV-VIS spectra of the SPA4 peptide followed a typical pattern when incubated in solutions of pH 5.7, 7.0, and 8.0 at different temperatures, simulated lung fluids, and most of the chemical components. Slight shifts in the absorbance peaks, derivative values, and vibrational fine structures were noted in the fourth-derivative spectra of the SPA4 peptide under some conditions. An increased level of lactate is the hallmark of lung injury. The SPA4 peptide on its own and in the presence of lactate exerts anti-inflammatory activity. The primary and secondary structure and the activity of the SPA4 peptide remain intact when pre-incubated in 2 mM sodium lactate solution. The results provide important insights about the stability and structure-activity relationship of the SPA4 peptide.
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Affiliation(s)
- Asif Alam Chowdhury
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center 1110 N. Stonewall Avenue Oklahoma City OK-73117 USA +1-405-271-7505 +1-405-271-6593 extn 47332
| | - Karla Rodgers
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center 940 Stanton L. Young Blvd Oklahoma City OK-73104 USA
| | - Nachiket M Godbole
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center 1110 N. Stonewall Avenue Oklahoma City OK-73117 USA +1-405-271-7505 +1-405-271-6593 extn 47332
| | - Shanjana Awasthi
- Department of Pharmaceutical Sciences, University of Oklahoma Health Sciences Center 1110 N. Stonewall Avenue Oklahoma City OK-73117 USA +1-405-271-7505 +1-405-271-6593 extn 47332
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Singh P, Hernandez‐Rauda R, Peña‐Rodas O. Preventative and therapeutic potential of animal milk components against COVID-19: A comprehensive review. Food Sci Nutr 2023; 11:2547-2579. [PMID: 37324885 PMCID: PMC10261805 DOI: 10.1002/fsn3.3314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 06/17/2023] Open
Abstract
The global pandemic of COVID-19 is considered one of the most catastrophic events on earth. During the pandemic, food ingredients may play crucial roles in preventing infectious diseases and sustaining people's general health and well-being. Animal milk acts as a super food since it has the capacity to minimize the occurrence of viral infections due to inherent antiviral properties of its ingredients. SARS-CoV-2 virus infection can be prevented by immune-enhancing and antiviral properties of caseins, α-lactalbumin, β-lactoglobulin, mucin, lactoferrin, lysozyme, lactoperoxidase, oligosaccharides, glycosaminoglycans, and glycerol monolaurate. Some of the milk proteins (i.e., lactoferrin) may work synergistically with antiviral medications (e.g., remdesivir), and enhance the effectiveness of treatment in this disease. Cytokine storm during COVID-19 can be managed by casein hydrolyzates, lactoferrin, lysozyme, and lactoperoxidase. Thrombus formation can be prevented by casoplatelins as these can inhibit human platelet aggregation. Milk vitamins (i.e., A, D, E, and B complexes) and minerals (i.e., Ca, P, Mg, Zn, and Se) can have significantly positive effects on boosting the immunity and health status of individuals. In addition, certain vitamins and minerals can also act as antioxidants, anti-inflammatory, and antivirals. Thus, the overall effect of milk might be a result of synergistic antiviral effects and host immunomodulator activities from multiple components. Due to multiple overlapping functions of milk ingredients, they can play vital and synergistic roles in prevention as well as supportive agents during principle therapy of COVID-19.
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Affiliation(s)
- Parminder Singh
- Department of Animal Husbandry AmritsarGovernment of PunjabAmritsarIndia
| | - Roberto Hernandez‐Rauda
- Laboratorio de Inocuidad de AlimentosUniversidad Doctor Andres BelloSan SalvadorEl Salvador, América Central
| | - Oscar Peña‐Rodas
- Laboratorio de Inocuidad de AlimentosUniversidad Doctor Andres BelloSan SalvadorEl Salvador, América Central
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Song HJJMD, Chia AZQ, Tan BKJ, Teo CB, Lim V, Chua HR, Samuel M, Kee A. Electrolyte imbalances as poor prognostic markers in COVID-19: a systemic review and meta-analysis. J Endocrinol Invest 2023; 46:235-259. [PMID: 36070177 PMCID: PMC9449297 DOI: 10.1007/s40618-022-01877-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Serum electrolyte imbalances are highly prevalent in COVID-19 patients. However, their associations with COVID-19 outcomes are inconsistent, and of unknown prognostic value. We aim to systematically clarify the associations and prognostic accuracy of electrolyte imbalances (sodium, calcium, potassium, magnesium, chloride and phosphate) in predicting poor COVID-19 clinical outcome. METHODS PubMed, Embase and Cochrane Library were searched. Odds of poor clinical outcome (a composite of mortality, intensive-care unit (ICU) admission, need for respiratory support and acute respiratory distress syndrome) were pooled using mixed-effects models. The associated prognostic sensitivity, positive and negative likelihood ratios (LR + , LR-) and predictive values (PPV, NPV; assuming 25% pre-test probability), and area under the curve (AUC) were computed. RESULTS We included 28 observational studies from 953 records with low to moderate risk-of-bias. Hyponatremia (OR = 2.08, 95% CI = 1.48-2.94, I2 = 93%, N = 8), hypernatremia (OR = 4.32, 95% CI = 3.17-5.88, I2 = 45%, N = 7) and hypocalcemia (OR = 3.31, 95% CI = 2.24-4.88, I2 = 25%, N = 6) were associated with poor COVID-19 outcome. These associations remained significant on adjustment for covariates such as demographics and comorbidities. Hypernatremia was 97% specific in predicting poor outcome (LR + 4.0, PPV = 55%, AUC = 0.80) despite no differences in CRP and IL-6 levels between hypernatremic and normonatremic patients. Hypocalcemia was 76% sensitive in predicting poor outcome (LR- 0.44, NPV = 87%, AUC = 0.71). Overall quality of evidence ranged from very low to moderate. CONCLUSION Hyponatremia, hypernatremia and hypocalcemia are associated with poor COVID-19 clinical outcome. Hypernatremia is 97% specific for a poor outcome, and the association is independent of inflammatory marker levels. Further studies should evaluate if correcting these imbalances help improve clinical outcome.
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Affiliation(s)
- H J J M D Song
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - A Z Q Chia
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - B K J Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - C B Teo
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - V Lim
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - H R Chua
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore
| | - M Samuel
- Systematic Review Unit, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - A Kee
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Department of Medicine, National University Hospital (NUH), Singapore, Singapore.
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Martí-Pastor A, Moreno-Perez O, Lobato-Martínez E, Valero-Sempere F, Amo-Lozano A, Martínez-García MÁ, Merino E, Sanchez-Martinez R, Ramos-Rincon JM. Association between Clinical Frailty Scale (CFS) and clinical presentation and outcomes in older inpatients with COVID-19. BMC Geriatr 2023; 23:1. [PMID: 36593448 DOI: 10.1186/s12877-022-03642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/21/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Frailty is a physiological condition characterized by a decreased reserve to stressors. In patients with COVID-19, frailty is a risk factor for in-hospital mortality. The aim of this study was to assess the relationship between clinical presentation, analytical and radiological parameters at admission, and clinical outcomes according to frailty, as defined by the Clinical Frailty Scale (CFS), in old people hospitalized with COVID-19. MATERIALS AND METHODS This retrospective cohort study included people aged 65 years and older and admitted with community-acquired COVID-19 from 3 March 2020 to 31 April 2021. Patients were categorized using the CFS. Primary outcomes were symptoms of COVID-19 prior to admission, mortality, readmission, admission in intensive care unit (ICU), and need for invasive mechanical ventilation. Analysis of clinical symptoms, clinical outcomes, and CFS was performed using multivariable logistic regression, and results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Of the 785 included patients, 326 (41.5%, 95% CI 38.1%-45.0%) were defined as frail (CFS ≥ 5 points): 208 (26.5%, 95% CI 23.5%-29.7%) presented mild-moderate frailty (CFS 5-6 points) and 118 (15.0%, 95% CI 12.7%-17.7%), severe frailty (7-9 points). After adjusting for epidemiological variables (age, gender, residence in a nursing home, and Charlson comorbidity index), frail patients were significantly less likely to present dry cough (OR 0.58, 95% CI 0.40-0.83), myalgia-arthralgia (OR 0.46, 95% CI 0.29-0.75), and anosmia-dysgeusia (OR 0.46, 95% CI 0.23-0.94). Confusion was more common in severely frail patients (OR 3.14; 95% CI 1.64-5.97). After adjusting for epidemiological variables, the risk of in-hospital mortality was higher in frail patients (OR 2.79, 95% CI 1.79-4.25), including both those with mild-moderate frailty (OR 1.98, 95% CI 1.23-3.19) and severe frailty (OR 5.44, 95% CI 3.14-9.42). Readmission was higher in frail patients (OR 2.11, 95% CI 1.07-4.16), but only in mild-moderate frailty (OR 2.35, 95% CI 1.17-4.75).. CONCLUSION Frail patients presented atypical symptoms (less dry cough, myalgia-arthralgia, and anosmia-dysgeusia, and more confusion). Frailty was an independent predictor for death, regardless of severity, and mild-moderate frailty was associated with readmission.
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Okwor CJ, Meka IA, Nto-Ezimah UA, Nto NJ, Nduka NS, Akinwande KS, Edem VF. Association of SARS-CoV-2 viral load with biochemical profile of COVID-19 patients: A nigerian experience. Niger J Clin Pract 2023; 26:109-115. [PMID: 36751832 DOI: 10.4103/njcp.njcp_1828_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Kidney involvement in coronavirus disease 2019 (COVID-19) pathology has been supported by high frequency of angiotensin-converting enzyme 2 (ACE2) expression on renal cells and reports of acute kidney injury. However, the association between host viral load and kidney function is not clear. Aim In this study, plasma levels of renal markers (urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR)) and electrolytes (sodium, potassium, chlorine, and bicarbonate) were assessed in relation to SARS-CoV-2 viral load of COVID-19 patients. Patients and Methods This cross-sectional study involved 144 consenting COVID-19 patients admitted to the Ogun state COVID-19 isolation center between May and December 2020. All participants presented with mild respiratory symptoms and did not require ICU admission or ventilation support. Data included reverse transcriptase polymerase chain reaction (RT-PCR) cycle threshold (CT) value, blood urea nitrogen (BUN), creatinine, sodium, potassium, chlorine, bicarbonate measurements, and glomerular filtration rate. Reference intervals were used as comparators, and multiple linear regression model was fitted. Statistical significance was set at P < 0.05. Results BUN level and creatinine were elevated in 4 (2.8%) and 42 (29.2%) patients, respectively, with lowered eGFR observed in 37 (25.7%) patients. Hyponatremia and hypokalemia were observed in 35 (24.3%) and 21 (14.6%) patients, respectively, while hypochloremia was observed in 21 (14.6%) patients. Lowered bicarbonate was observed in 29 (20.1%) patients. Linear regression showed statistically significant association (R2 = 0.340, P = 0.032) between RT-PCR CT value and eGFR (β = 0.006, P = 0.017) as well as HCO3 (β = -0.262, P = 0.036). Conclusion COVID-19 patients with mild respiratory symptoms exhibited renal abnormalities, electrolytes, and acid-base imbalances which were partly associated with SARS-CoV-2 viral load.
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Affiliation(s)
- C J Okwor
- Department of Chemical Pathology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
| | - I A Meka
- Department of Chemical Pathology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
| | - U A Nto-Ezimah
- Department of Chemical Pathology, College of Medicine, University of Nigeria/University of Nigeria Teaching Hospital, Ituku/Ozalla, Nigeria
| | - N J Nto
- Department of Anatomy, University of Nigeria, Enugu Campus, Nigeria
| | - N S Nduka
- 54gene Biotechnology, Lagos, Nigeria
| | - K S Akinwande
- Department of Chemical Pathology and Immunology, Federal Medical Center, Abeokuta, Nigeria
| | - V F Edem
- Department of Immunology, University of Ibadan, Ibadan, Nigeria
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Sebastião CS, Cogle A, Teixeira AD, Cândido AM, Tchoni C, Amorim MJ, Loureiro N, Parimbelli P, Penha-Gonçalves C, Demengeot J, Sacomboio E, Mendes M, Arrais M, Morais J, Vasconcelos JN, Brito M. Clinical Features Related to Severity and Mortality among COVID-19 Patients in a Pre-Vaccine Period in Luanda, Angola. Trop Med Infect Dis 2022; 7. [PMID: 36355881 DOI: 10.3390/tropicalmed7110338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with clinical features of diverse severity. Few studies investigated the severity and mortality predictors of coronavirus disease 2019 (COVID-19) in Africa. Herein, we investigated the clinical features of severity and mortality among COVID-19 patients in Luanda, Angola. Methods: This multicenter cohort study involved 101 COVID-19 patients, between December 2020 and April 2021, with clinical and laboratory data collected. Analysis was done using independent-sample t-tests and Chi-square tests. The results were deemed significant when p < 0.05. Results: The mean age of patients was 51 years (ranging from 18 to 80 years) and 60.4% were male. Fever (46%), cough (47%), gastrointestinal symptoms (26.7%), and asthenia (26.7%), were the most common symptoms. About 64.4% of the patients presented coexistent disorders, including hypertension (42%), diabetes (17%), and chronic renal diseases (6%). About 23% were non-severe, 77% were severe, and 10% died during hospitalization. Variations in the concentration of neutrophil, urea, creatinine, c-reactive protein, sodium, creatine kinase, and chloride were independently associated with severity and/or mortality (p < 0.05). Conclusion: Several factors contributed to the severity and mortality among COVID-19 patients in Angola. Further studies related to clinical features should be carried out to help clinical decision-making and follow-up of COVID-19 patients in Angola.
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Moreno-Perez O, Nuñez J, Sandin-Rollan M, Arrarte V, Boix V, Reus S, Pinargote-Celorio H, Ribes I, Alfayate R, Llorca-Santos MB, Martinez-Garcia MA, Chico-Sánchez P, Merino E. Early carbohydrate antigen 125 as a mortality predictor in hospitalized patients with coronavirus disease 2019. Front Cardiovasc Med 2022; 9:941512. [PMCID: PMC9631479 DOI: 10.3389/fcvm.2022.941512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Carbohydrate antigen 125 (CA125) is an indicator of inflammation, immune response, and impaired cardiac function. The aim was to investigate whether CA125 behaves as a biomarker of severity and poor clinical outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). Methods Serum CA125 [Elecsys CA125 II assay-(Roche Diagnostics GmbH)] was measured in stored biobank samples from COVID-19 hospitalized patients between 01 March 2020 and 17 October 2021. Multiple logistic regression models were built to explore the association between CA125 and clinical outcomes [in-hospital all-cause mortality, need for invasive mechanical ventilation (IMV), or non-invasive respiratory support (non-IRS)], estimating odds ratios (ORs; 95% CI). The gradient of risk of CA125 was evaluated by fractional polynomials. Results A total of 691 patients were included, median age of 63 years (50–76), men (57.2%), with high comorbidity. At admission, 85.8% had pneumonia. Median CA125 was 10.33 U/ml (7.48–15.50). The in-hospital mortality rate was 7.2%. After adjusting for confounding factors, CA125 ≥ 15.5 U/ml (75th percentile) showed an increased risk of death [OR 2.85(1.21–6.71)], as age ≥ 65 years, diabetes, and immunosuppression. Furthermore, CA125 as a continuous variable was positive and significantly associated with the risk of death after multivariate adjustment. The mean hospital stay of the patients with CA125 ≥ 15.5 U/ml was longer than the rest of the study population. Conclusion CA125 in the first 72 h of hospital admission seems a useful biomarker of mortality in hospitalized patients with moderate–severe COVID-19. If our findings are confirmed, the wide availability of this biomarker would make easy its widespread implementation in clinical practice.
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Affiliation(s)
- Oscar Moreno-Perez
- Department of Endocrinology and Nutrition, Alicante General University Hospital - Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, Miguel Hernández University of Elche, Elche, Spain
| | - Julio Nuñez
- Department of Cardiology Valencia Clinic University Hospital – INCLIVA, Valencia, Spain
- Department of Medicine, Valencia University, Valencia, Spain
- CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Miriam Sandin-Rollan
- Department of Cardiology, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Arrarte
- Department of Clinical Medicine, Miguel Hernández University of Elche, Elche, Spain
- Department of Cardiology, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Department of Clinical Medicine, Miguel Hernández University of Elche, Elche, Spain
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Sergio Reus
- Department of Clinical Medicine, Miguel Hernández University of Elche, Elche, Spain
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Hector Pinargote-Celorio
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Isabel Ribes
- Department of Internal Medicine, Alicante General University Hospital - Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rocio Alfayate
- Department of Clinical Analysis, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Maria Belen Llorca-Santos
- Department of Clinical Analysis, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Maria Angeles Martinez-Garcia
- Department of Pneumology, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pablo Chico-Sánchez
- Department of Preventive, Alicante General University Hospital - Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
- *Correspondence: Esperanza Merino,
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11
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Sen R, Sengupta D, Mukherjee A. Mechanical dependency of the SARS-CoV-2 virus and the renin-angiotensin-aldosterone (RAAS) axis: a possible new threat. Environ Sci Pollut Res Int 2022; 29:62235-62247. [PMID: 34859345 PMCID: PMC8638800 DOI: 10.1007/s11356-021-16356-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/01/2021] [Indexed: 04/12/2023]
Abstract
Pathogens in our environment can act as agents capable of inflicting severe human diseases. Among them, the SARS-CoV-2 virus has recently plagued the globe and paralyzed the functioning of ordinary human life. The virus enters the cell through the angiotensin-converting enzyme-2 (ACE-2) receptor, an integral part of the renin-angiotensin system (RAAS). Reports on hypertension and its relation to the modulation of the RAAS are generating interest in the scientific community. This short review focuses on the SARS-CoV-2 infection's direct and indirect effects on our body through modulation of the RAAS axis. A patient having severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, which causes COVID-19 relates to hypertension as a pre-existing disease or develops it in a post-COVID scenario. Several studies on how SARS-CoV-2 modulates the RAAS axis indicate that it alters our body's physiological balance. This review seeks to establish a hypothesis on the mechanical dependency of SARS-CoV-2 and RAAS modulation in the human body. This study intends to impart ideas on drug development and designing by targeting the modulation of the RAAS axis to inactivate the pathogenicity of the SARS-CoV-2 virus. A systematic hypothesis can severely attenuate the pathogenicity of the dreadful viruses of the future.
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Affiliation(s)
- Rohit Sen
- Department of Zoology, Charuchandra College, University of Calcutta, 22, Lake Road, Kolkata, 700029 India
| | | | - Avinaba Mukherjee
- Department of Zoology, Charuchandra College, University of Calcutta, 22, Lake Road, Kolkata, 700029 India
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12
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Dastenae ZH, Bahadori A, Dehghani M, Asadi-Samani M, Izadi I, Shahraki HR. Comparison of the effect of intravenous dexamethasone and methylprednisolone on the treatment of hospitalized patients with COVID-19: a randomized clinical trial. Int J Infect Dis 2022; 122:659-64. [PMID: 35817286 DOI: 10.1016/j.ijid.2022.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/21/2022] [Accepted: 07/05/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE In this study, we aimed to compare the effects of intravenous dexamethasone and methylprednisolone on the treatment of inpatients with COVID-19. METHODS In this randomized clinical trial, 143 patients under 80 years of age with moderate to severe COVID-19 were enrolled and randomly assigned to two groups: dexamethasone (8 mg/day) and methylprednisolone (60 mg/day in two divided doses). The primary outcome was the length of hospital stay. The secondary outcomes included: duration of oxygen therapy, absolute leukocyte and lymphocyte count, hypokalemia, hyperglycemia, intensive care unit admission, and mortality in the two groups for 28 days. Data were analyzed by SPSS version 26 using t-test, chi-square, and analysis of variance. RESULTS The duration of hospitalization was significantly (P <0.001) shorter in the dexamethasone group than in the methylprednisolone group (8 [95% confidence interval [CI]:6-10] and 11 [95% CI: 7-14], respectively). In addition, the duration of oxygen therapy in the dexamethasone group (7 [95% CI: 5-9]) was significantly (P <0.001) shorter than in the methylprednisolone group (10 [95% CI: 5.5-14]). The mortality rate was 17.1% (95% CI: 8.1-26.1) in the dexamethasone group and 12.3% (95% CI: 4.6-20.0) in the methylprednisolone group, which was not statistically significant (P = 0.46). CONCLUSION Results showed better effectiveness of 8 mg/day dexamethasone compared with 60 mg/day methylprednisolone based on the shorter hospital stay, which can be considered in the therapeutic protocol of COVID-19. TRIAL REGISTRATION IRCT20210223050466N1.
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13
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Brown RB. Low dietary sodium potentially mediates COVID-19 prevention associated with whole-food plant-based diets. Br J Nutr 2022; 129:1-6. [PMID: 35912674 PMCID: PMC10011594 DOI: 10.1017/s0007114522002252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/11/2022] [Accepted: 07/12/2022] [Indexed: 11/07/2022]
Abstract
Compared with an omnivorous Western diet, plant-based diets containing mostly fruits, vegetables, grains, legumes, nuts and seeds, with restricted amounts of foods of animal origin, are associated with reduced risk and severity of COVID-19. Additionally, inflammatory immune responses and severe acute respiratory symptoms of COVID-19, including pulmonary oedema, shortness of breath, fever and nasopharyngeal infections, are associated with Na toxicity from excessive dietary Na. High dietary Na is also associated with increased risks of diseases and conditions that are co-morbid with COVID-19, including chronic kidney disease, hypertension, stroke, diabetes and obesity. This article presents evidence that low dietary Na potentially mediates the association of plant-based diets with COVID-19 prevention. Processed meats and poultry injected with sodium chloride contribute considerable amounts of dietary Na in the Western diet, and the avoidance or reduction of these and other processed foods in whole-food plant-based (WFPB) diets could help lower overall dietary Na intake. Moreover, high amounts of K in plant-based diets increase urinary Na excretion, and preagricultural diets high in plant-based foods were estimated to contain much lower ratios of dietary Na to K compared with modern diets. Further research should investigate low Na in WFPB diets for protection against COVID-19 and co-morbid conditions.
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Affiliation(s)
- Ronald B. Brown
- School of Public Health Sciences, University of Waterloo, Waterloo, ONN2L3G1, Canada
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14
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Yin J, Yuan N, Huang Z, Hu Z, Bao Q, Shao Z, Mei Q, Xu Y, Wang W, Liu D, Zhao L, Wan S. Assessment of hypokalemia and clinical prognosis in Patients with COVID-19 in Yangzhou, China. PLoS One 2022; 17:e0271132. [PMID: 35802669 PMCID: PMC9269409 DOI: 10.1371/journal.pone.0271132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
Background Hypokalemia is a frequent electrolyte imbalance in patients with COVID-19. The aim of this study was to estimate the association between hypokalemia and clinical prognosis in patients with moderate COVID-19. Methods A single-center, retrospective, observational study was conducted on 81 non-ICU admitted patients with moderate COVID-19 according to the criteria issued by the Chinese Health Bureau in the Third People’s Hospital of Yangzhou (Northern Jiangsu People’s Hospital New District Branch) from 4th to 25th August 2021. The demographic, clinical, and laboratory data were reviewed and collected, then the correlation between hypokalemia and prognosis was determined. Results The level of serum potassium of patients ranged from 2.80 mmol/L to 4.70 mmol/L. Hypokalemia was detected in 39 out of the 81 included patients (48.15%) during hospitalization. Patients with hypokalemia had prolonged days of negative nucleic acid conversion and hospital stay. Correlation analysis showed that the level of serum potassium was negatively correlated with days of negative nucleic acid conversion and length of hospital stay. Bivariate logistic regression analysis proved that hypokalemia was a risk factor for prolonged hospital stay in patients with moderate COVID-19. Conclusion Hypokalemia was prevalent in patients with moderate COVID-19 in Yangzhou, China. Hypokalemia was associated with the prolonged hospital stay in patients with moderate COVID-19.
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Affiliation(s)
- Jiangtao Yin
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
- Institute of Digestive Diseases, Jiangsu University, Zhenjiang, People’s Republic of China
| | - Nana Yuan
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Ziqiang Huang
- Department of Infectious Diseases, The Third People’s Hospital of Yangzhou, Yangzhou, People’s Republic of China
| | - Zhenkui Hu
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Quanlei Bao
- Department of Infectious Diseases, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Zhenli Shao
- Nursing Department, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Qiong Mei
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Yong Xu
- Department of Infectious Diseases, The Third People’s Hospital of Yangzhou, Yangzhou, People’s Republic of China
| | - Wenli Wang
- Department of Critical Care Medicine, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
| | - Dadong Liu
- Department of Critical Care Medicine, Jinling Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Li Zhao
- Department of Endocrinology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
- * E-mail: (SW); (LZ)
| | - Shengxia Wan
- Department of Neurology, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China
- * E-mail: (SW); (LZ)
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15
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Abstract
Background: Malnutrition in COVID-19 hospitalized patients is associated with a high-risk
condition to increase disease severity and prolonging the recovery period.
Therefore, nutritional therapy, including supplements plays a critical role
to reduce disease-related complications and the length of hospital stay. Aim: To review the latest evidence on nutritional management options in COVID-19
hospitalized patients, as well as possibly prescribed supplements.
Methods: This review was conducted by considering the
latest recommendations, using the guidelines of the American Society of
Enteral and Parenteral (ASPEN) and the European Society of Enteral and
Parenteral (ESPEN), and searching Web of Science, PubMed/Medline, ISI, and
Medline databases. The relevant articles were found using a mix of related
mesh terms and keywords. We attempted to cover all elements of COVID-19
hospitalized patients’ dietary management. Results: Energy
demand in COVID-19 patients is a vital issue. Indirect Calorimetry (IC) is
the recommended method to measure resting energy expenditure. However, in
the absence of IC, predictive equations may be used. The ratio of
administered diet for the macronutrients could be based on the phase and
severity of Covid-19 disease. Moreover, there are recommendations for taking
micronutrient supplements with known effects on improving the immune system
or reducing inflammation. Conclusions: Nutritional treatment of
COVID-19 patients in hospitals seems to be an important element of their
medical care. Enteral nutrition would be the recommended feeding method for
early nutrition support. However, data in the COVID-19 nutritional domain
relating to micronutrient supplementation are still fragmentary and
disputed, and further study is required.
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Affiliation(s)
- Fatemeh Roudi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Effat Saghi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samaneh Sadat Ayoubi
- Department of Nutrition, Faculty of Medicine, 37552Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Pouryazdanpanah
- Department of Nutrition, Public Health School, Kerman University of Medical Sciences, Kerman, Iran
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16
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Almarashda AMJ, Rabbani SA, Kurian MT, Cherian A. Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates. J Clin Med 2022; 11:jcm11092439. [PMID: 35566563 PMCID: PMC9100822 DOI: 10.3390/jcm11092439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/17/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39−59); 66% male). Age > 45 years (OR = 2.07, 95% CI: 1.04−4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52−6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34−10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69−10.67, p < 0.001), Hb < 13 g/dL (OR = 3.17, 95% CI: 1.51−6.65, p = 0.002), neutrophils > 7 × 103/mcL (OR = 4.89, 95% CI: 1.66−14.37, p=0.004), lymphocytes < 1 × 103/mcL (OR = 7.78, 95% CI: 1.01−60.19, p = 0.049), sodium < 135 mmol/L (OR = 5.42, 95% CI: 1.05−27.95, p = 0.044), potassium < 3.6 mmol/L (OR = 3.36, 95% CI: 1.03−11.01, p = 0.045), urea > 6.5 mmol/L (OR = 3.37, 95% CI: 1.69−6.73, p = 0.001) and LDH > 227 IU/L (OR = 6.26, 95% CI: 1.61−24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients.
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Affiliation(s)
| | - Syed Arman Rabbani
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah P.O. Box 11172, United Arab Emirates
- Correspondence:
| | - Martin Thomas Kurian
- Department of Nephrology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah P.O. Box 4727, United Arab Emirates;
| | - Ajith Cherian
- Department of Internal Medicine, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah P.O. Box 4727, United Arab Emirates;
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17
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Kodama K, Imai T, Asai Y, Kozu Y, Hayashi K, Shimizu T, Gon Y, Ootsuka S. Incidence and risk factors for hyperkalaemia in patients treated for COVID-19 with nafamostat mesylate. J Clin Pharm Ther 2022; 47:1070-1078. [PMID: 35313385 PMCID: PMC9114925 DOI: 10.1111/jcpt.13646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/10/2022] [Accepted: 02/24/2022] [Indexed: 12/15/2022]
Abstract
What is known and objective Nafamostat mesylate (NM) is used clinically in combination with antiviral drugs to treat coronavirus disease (COVID‐19). One of the adverse events of NM is hyperkalaemia due to inhibition of the amiloride‐sensitive sodium channels (ENaC). The incidence and risk factors for hyperkalaemia due to NM have been studied in patients with pancreatitis but not in COVID‐19. COVID‐19 can be associated with hypokalaemia or hyperkalaemia, and SARS‐CoV‐2 is thought to inhibit ENaC. Therefore, frequency and risk factors for hyperkalaemia due to NM may differ between COVID‐19 and pancreatitis. Hyperkalaemia may worsen the respiratory condition of patients. The objective of this study was to determine the incidence and risk factors for hyperkalaemia in COVID‐19 patients treated with favipiravir, dexamethasone and NM. Methods This retrospective study reviewed the records of hospitalized COVID‐19 patients treated with favipiravir and dexamethasone, with or without NM, between March 2020 and January 2021. Multivariable logistic regression analysis was performed to identify the risk factors for hyperkalaemia. Results and Discussion Of 45 patients who received favipiravir and dexamethasone with NM for the treatment of COVID‐19, 21 (47%) experienced hyperkalaemia. The duration of NM administration was a significant predictor of hyperkalaemia (odds ratio: 1.55, 95% confidence interval: 1.04–2.31, p = 0.031). The receiver‐operating characteristic curve analysis determined that the cut‐off value for predicting the number of days until the onset of hyperkalaemia was 6 days and the area under the curve was 0.707. What is new and conclusion This study revealed that the incidence of hyperkalaemia is high in patients treated for COVID‐19 with NM, and that the duration of NM administration is a key risk factor. When NM is administered for the treatment of COVID‐19, it should be discontinued within 6 days to minimize the risk of hyperkalaemia.
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Affiliation(s)
- Kentaro Kodama
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan
| | - Toru Imai
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan
| | - Yasuo Asai
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Yutaka Kozu
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Kentaro Hayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Tetsuo Shimizu
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Yasuhiro Gon
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Itabashi-ku, Japan
| | - Susumu Ootsuka
- Department of Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Japan
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Moreno‐Perez O, Merino E, Alfayate R, Torregrosa ME, Andres M, Leon‐Ramirez J, Boix V, Gil J, Pico A. Male pituitary-gonadal axis dysfunction in post-acute COVID-19 syndrome-Prevalence and associated factors: A Mediterranean case series. Clin Endocrinol (Oxf) 2022; 96:353-362. [PMID: 34160836 PMCID: PMC8444731 DOI: 10.1111/cen.14537] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 through angiotensin-converting enzyme 2 receptor can harm testes function. The objectives were to analyse the prevalence of low serum testosterone (LT) and impaired fertility potential (Leydig and Sertoli cells dysfunction, respectively) in coronavirus disease 2019 (COVID-19) male survivors and to evaluate acute infection-related associated factors. Also, we explore its association with post-acute COVID-19 syndrome (PCS) and quality of life (QOL). MATERIALS AND METHODS Male adults recovered from polymerase chain reaction-confirmed COVID-19 were offered a structured evaluation 8-12 weeks after recovery. The main outcome measure(s) were as follows: LT, defined as total testosterone (TT) < 2 ng/ml or if TT levels 2-4 ng/ml as calculated free testosterone < 6.36 ng/dl; Sertoli cell dysfunction was defined as inhibin-B < 89 pg/ml. Secondary outcome-associated factors were analysed by multiple logistic regression (odds ratio; 95% confidence interval [CI]). QOL was evaluated by SF-36 v.2. RESULTS One hundred and forty-three patients were evaluated at a median (interquartile range) of 77 days (72-83) after disease onset; 72% of them recovered from severe pneumonia. LT was detected in 41 patients (28.7%; 95% CI: 21.8-36.5). Low levels of inhibin-B were detected in 25 patients (18.1%; 95% CI: 12.5-25.3). After multivariate adjustment, obesity and hypokalaemia were associated with LT, whereas age more than 65 was an independent predictor of Sertoli cell dysfunction. LT or Sertoli cell dysfunction was not associated with PCS. Patients with LT had a lower score in four domains of QOL. CONCLUSIONS Prevalence of male LT and impaired fertility potential in COVID-19 survivors is high in the medium term. Traditional risk factors and severity markers for COVID-19 could be predictive.
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Affiliation(s)
- Oscar Moreno‐Perez
- Endocrinology and Nutrition DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
| | - Esperanza Merino
- Unit of Infectious DiseasesAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Rocio Alfayate
- Clinical Analysis DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Maria Eugenia Torregrosa
- Clinical Analysis DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Mariano Andres
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Rheumatology DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Jose‐Manuel Leon‐Ramirez
- Pneumology DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Vicente Boix
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Unit of Infectious DiseasesAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Joan Gil
- Pneumology DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Antonio Pico
- Endocrinology and Nutrition DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
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Matsuo T, Sasai T, Nakashima R, Kuwabara Y, Kato ET, Murakami I, Onizawa H, Akizuki S, Murakami K, Hashimoto M, Yoshifuji H, Tanaka M, Morinobu A, Mimori T. ECG Changes Through Immunosuppressive Therapy Indicate Cardiac Abnormality in Anti-MDA5 Antibody-Positive Clinically Amyopathic Dermatomyositis. Front Immunol 2022; 12:765140. [PMID: 35069538 PMCID: PMC8776991 DOI: 10.3389/fimmu.2021.765140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/16/2021] [Indexed: 01/14/2023] Open
Abstract
Anti-melanoma differentiation-associated gene 5 (MDA5) antibody, a dermatomyositis (DM)-specific antibody, is strongly associated with interstitial lung disease (ILD). Patients with idiopathic inflammatory myopathy (IIM) who are anti-MDA5 antibody positive [anti-MDA5 (+)] often experience chest symptoms during the active disease phase. These symptoms are primarily explained by respiratory failure; nevertheless, cardiac involvement can also be symptomatic. Thus, the aim of this study was to investigate cardiac involvement in anti-MDA5 (+) DM. A total of 63 patients with IIM who underwent electrocardiography (ECG) and ultrasound cardiography (UCG) during the active disease phase from 2016 to 2021 [anti-MDA5 (+) group, n = 21; anti-MDA5-negative (-) group, n = 42] were enrolled in the study, and their clinical charts were retrospectively reviewed. The ECG and UCG findings were compared between the anti-MDA5 (+) and anti-MDA5 (-) groups. All anti-MDA5 (+) patients had DM with ILD. The anti-MDA5 (+) group showed more frequent skin ulcerations and lower levels of leukocytes, muscle enzymes, and electrolytes (Na, K, Cl, and Ca) than the anti-MDA5 (-) group. According to the ECG findings obtained during the active disease phase, the T wave amplitudes were significantly lower for the anti-MDA5 (+) group than for the anti-MDA5 (-) group (I, II, and V4-6 lead; p < 0.01; aVF and V3, p < 0.05). However, the lower amplitudes were restored during the remission phase. Except for the E wave, A wave and Sep e', the UCG results showed no significant differences between the groups. Four patients with anti-MDA5 (+) DM had many leads with lower T wave and cardiac abnormalities (heart failure, diastolic dysfunction, myocarditis) on and after admission. Though anti-MDA5 (+) patients clinically improved after immunosuppressive therapy, some of their ECG findings did not fully recover in remission phase. In conclusion, anti-MDA5 (+) DM appears to show cardiac involvement (electrical activity and function) during the active phase. Further studies are necessary to clarify the actual cardiac condition and mechanism of these findings in patients with anti-MDA5 (+) DM.
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Affiliation(s)
- Takashi Matsuo
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Tsuneo Sasai
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Yoshihiro Kuwabara
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Eri Toda Kato
- Department of Cardiovascular Medicine, Kyoto University, Kyoto, Japan
| | - Isao Murakami
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Hideo Onizawa
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Kyoto, Japan
| | - Shuji Akizuki
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Kosaku Murakami
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Kyoto, Japan.,Department of Clinical Immunology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Kyoto, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University, Kyoto, Japan.,Takeda General Hospital, Kyoto, Japan
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Guédon A, Delarue A, Mohamedi N, Roffé A, Khider L, Gendron N, Goudot G, Détriché G, Chocron R, Oudard S, Smadja D, Mirault T, Messas E. Relationship between kalemia and intensive care unit admission or death in hospitalized COVID-19 patients: A cohort study. JMV-Journal de Médecine Vasculaire 2022; 47:3-10. [PMID: 35393089 PMCID: PMC8557982 DOI: 10.1016/j.jdmv.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023]
Abstract
Background Methods Results Conclusion
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21
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Muhammad A, Forcados GE, Sani H, Ndidi US, Adamu A, Katsayal BS, Sadiq IZ, Abubakar YS, Sulaiman I, Abubakar IB, Yusuf AP, Malami I, Ibrahim S, Abubakar MB. Epigenetic modifications associated with genes implicated in cytokine storm: The potential biotherapeutic effects of vitamins and minerals in COVID‐19. J Food Biochem 2022; 46:e14079. [DOI: 10.1111/jfbc.14079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/25/2021] [Accepted: 12/31/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Aliyu Muhammad
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Hadiza Sani
- Department of Medicine Kaduna State University Kaduna Nigeria
| | - Uche Samuel Ndidi
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | - Auwal Adamu
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Idris Zubairu Sadiq
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
| | | | - Ibrahim Sulaiman
- Department of Human Physiology Federal University Dutse Dutse Nigeria
| | | | | | - Ibrahim Malami
- Department of Pharmacognosy and Ethnopharmacy, Faculty of Pharmaceutical Sciences Usmanu Danfodiyo University Sokoto Nigeria
| | - Sani Ibrahim
- Department of Biochemistry, Faculty of Life Sciences Ahmadu Bello University Zaria Nigeria
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KAYA B, PAYDAS S, KUZU T, DEMİROGLU O, YÜCEL KARAKAYA SP, BALAL M, TAŞOVA Y. Effects of hypokalemia on clinical outcomes in hospitalized patients with Covid-19 pneumonia. Cukurova Medical Journal 2021. [DOI: 10.17826/cumj.989230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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23
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Ventero MP, Moreno-Perez O, Molina-Pardines C, Paytuví-Gallart A, Boix V, Escribano I, Galan I, González-delaAleja P, López-Pérez M, Sánchez-Martínez R, Merino E, Rodríguez JC. Nasopharyngeal Microbiota as an early severity biomarker in COVID-19 hospitalised patients: a retrospective cohort study in a Mediterranean area. J Infect 2021:S0163-4453(21)00647-2. [PMID: 34963638 DOI: 10.1016/j.jinf.2021.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 12/11/2022]
Abstract
This study aimed to analyse the diversity and taxonomic composition of the nasopharyngeal microbiota, to determine its association with COVID-19 clinical outcome. To study the microbiota, we utilized 16S rRNA sequencing of 177 samples that came from a retrospective cohort of COVID-19 hospitalized patients. Raw sequences were processed by QIIME2. The associations between microbiota, invasive mechanical ventilation (IMV), and all-cause mortality were analysed by multiple logistic regression, adjusted for age, gender, and comorbidity. The microbiota α diversity indexes were lower in patients with a fatal outcome, whereas the β diversity analysis showed a significant clustering in these patients. After multivariate adjustment, the presence of Selenomonas spp., Filifactor spp., Actinobacillus spp., or Chroococcidiopsis spp., was associated with a reduction of more than 90% of IMV. Higher diversity and the presence of certain genera in the nasopharyngeal microbiota seem to be early biomarkers of a favourable clinical evolution in hospitalized COVID-19 patients.
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Salerno S, Sun Y, Morris EL, He X, Li Y, Pan Z, Han P, Kang J, Sjoding MW, Li Y. Comprehensive evaluation of COVID-19 patient short- and long-term outcomes: Disparities in healthcare utilization and post-hospitalization outcomes. PLoS One 2021; 16:e0258278. [PMID: 34614008 PMCID: PMC8494298 DOI: 10.1371/journal.pone.0258278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Understanding risk factors for short- and long-term COVID-19 outcomes have implications for current guidelines and practice. We study whether early identified risk factors for COVID-19 persist one year later and through varying disease progression trajectories. METHODS This was a retrospective study of 6,731 COVID-19 patients presenting to Michigan Medicine between March 10, 2020 and March 10, 2021. We describe disease progression trajectories from diagnosis to potential hospital admission, discharge, readmission, or death. Outcomes pertained to all patients: rate of medical encounters, hospitalization-free survival, and overall survival, and hospitalized patients: discharge versus in-hospital death and readmission. Risk factors included patient age, sex, race, body mass index, and 29 comorbidity conditions. RESULTS Younger, non-Black patients utilized healthcare resources at higher rates, while older, male, and Black patients had higher rates of hospitalization and mortality. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss anemia were risk factors for these outcomes. Diabetes with complications, coagulopathy, fluid and electrolyte disorders, and blood loss were associated with lower discharge and higher inpatient mortality rates. CONCLUSIONS This study found differences in healthcare utilization and adverse COVID-19 outcomes, as well as differing risk factors for short- and long-term outcomes throughout disease progression. These findings may inform providers in emergency departments or critical care settings of treatment priorities, empower healthcare stakeholders with effective disease management strategies, and aid health policy makers in optimizing allocations of medical resources.
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Affiliation(s)
- Stephen Salerno
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yuming Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Emily L. Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Xinwei He
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Yajing Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Ziyang Pan
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Peisong Han
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Jian Kang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael W. Sjoding
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Yi Li
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States of America
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De Carvalho H, Richard MC, Chouihed T, Goffinet N, Le Bastard Q, Freund Y, Kratz A, Dubroux M, Masson D, Figueres L, Montassier E. Electrolyte imbalance in COVID-19 patients admitted to the Emergency Department: a case-control study. Intern Emerg Med 2021; 16:1945-1950. [PMID: 33484453 PMCID: PMC7823192 DOI: 10.1007/s11739-021-02632-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022]
Abstract
In patients visiting the emergency department (ED), a potential association between electrolytes disturbance and coronavirus disease 2019 (COVID-19) has not been well studied. We aim to describe electrolyte disturbance and explore risk factors for COVID-19 infection in patients visiting the ED. We carried out a case-control study in three hospitals in France, including adult ED inpatients (≥ 18 years old). A total of 594 ED case patients in whom infection with COVID-19 was confirmed, were matched to 594 non-COVID-19 ED patients (controls) from the same period, according to sex and age. Hyponatremia was defined by a sodium of less than 135 mmol/L (reference range 135-145 mmol/L), hypokalemia by a potassium of less than 3.5 mmol/L (reference range 3.5-5.0 mmol/L), and hypochloremia by a chloride of less than 95 mmol/L (reference range 98-108 mmol/L). Among both case patients and controls, the median (IQR) age was 65 years (IQR 51-76), and 44% were women. Hyponatremia was more common among case patients than among controls, as was hypokalemia and hypochloremia. Based on the results of the multivariate logistic regression, hyponatremia, and hypokalemia were associated with COVID-19 among case patients overall, with an adjusted odds ratio of 1.89 [95% CI 1.24-2.89] for hyponatremia and 1.76 [95% CI 1.20-2.60] for hypokalemia. Hyponatremia and hypokalemia are independently associated with COVID-19 infection in adults visiting the ED, and could act as surrogate biomarkers for the emergency physician in suspected COVID-19 patients.
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Affiliation(s)
| | - Marie Caroline Richard
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris (APHP), Paris, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Centre d'Investigations Cliniques, Université de Lorraine, 1433, Inserm UMR 1116, F-CRIN INI-CRCT, Nancy, France
| | | | | | - Yonathan Freund
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris (APHP), Paris, France
- Sorbonne Université, Paris, France
| | - Antoine Kratz
- Emergency Departement, University Regional Hospital, Nancy, France
| | - Marine Dubroux
- Emergency Departement, University Regional Hospital, Nancy, France
| | - Damien Masson
- Department of Biochemistry, Nantes University Hospital, 44000, Nantes, France
| | - Lucile Figueres
- Department of Nephrology, ITUNCHU Nantes, 44000, Nantes, France
| | - Emmanuel Montassier
- Emergency Department, SAMU44, CHU Nantes, 44000, Nantes, France.
- F-CRIN INI-CRCT, Nancy, France.
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26
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Ramos‐Rincon J, Moreno‐Perez O, Pinargote‐Celorio H, Leon‐Ramirez J, Andres M, Reus S, Herrera‐García C, Martí‐Pastor A, Boix V, Gil J, Sanchez‐Martinez R, Merino E. Clinical Frailty Score vs Hospital Frailty Risk Score for predicting mortality and other adverse outcome in hospitalised patients with COVID-19: Spanish case series. Int J Clin Pract 2021; 75:e14599. [PMID: 34227196 PMCID: PMC8420333 DOI: 10.1111/ijcp.14599] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID-19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID-19. MATERIAL AND METHODS This retrospective cohort study included adult (≥18 years) inpatients with COVID-19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in-hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity. RESULTS Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4-23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8-27.7). Prevalence of frailty increased with age according to both measures: 50-64 years, CFS 1.9% vs HFRS 12.3%; 65-79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P < .001). CFS-defined frailty was independently associated with risk of death (OR 3.67, 95% CI 1.49-9.04) and less treatment with tocilizumab (OR 0.28, 95% CI 0.08-0.93). HFRS-defined frailty was independently associated with length of hospital stay over 10 days (OR 2.89, 95% CI 1.53-5.44), ICU admission (OR 4.18, 95% CI 1.84-9.52) and invasive mechanical ventilation (OR 5.93, 95% CI 2.33-15.10). CONCLUSION In the spring 2020 wave of the COVID-19 pandemic in Spain, CFS-defined frailty was an independent predictor for death, while frailty as measured by the HFRS was associated with length of hospital stay over 10 days, ICU admission and use of invasive mechanical ventilation.
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Affiliation(s)
- Jose‐Manuel Ramos‐Rincon
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
| | - Oscar Moreno‐Perez
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Endocrinology and Nutrition DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Hector Pinargote‐Celorio
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Jose‐Manuel Leon‐Ramirez
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Mariano Andres
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Rheumatology DepartmentAlicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Sergio Reus
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Cristian Herrera‐García
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Ana Martí‐Pastor
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Vicente Boix
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Joan Gil
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Rosario Sanchez‐Martinez
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Esperanza Merino
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
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Salvadori A, Fanari P, Marzullo P, Codecasa F, Tovaglieri I, Cornacchia M, Terruzzi I, Ferrulli A, Palmulli P, Brunani A, Lanzi S, Luzi L. Playing around the anaerobic threshold during COVID-19 pandemic: advantages and disadvantages of adding bouts of anaerobic work to aerobic activity in physical treatment of individuals with obesity. Acta Diabetol 2021; 58:1329-1341. [PMID: 34047810 PMCID: PMC8159723 DOI: 10.1007/s00592-021-01747-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/15/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Obesity is a condition that generally limits work capacity and predisposes to a number of comorbidities and related diseases, the last being COVID-19 and its complications and sequelae. Physical exercise, together with diet, is a milestone in its management and rehabilitation, although there is still a debate on intensity and duration of training. Anaerobic threshold (AT) is a broad term often used either as ventilatory threshold or as lactate threshold, respectively, detected by respiratory ventilation and/or respiratory gases (VCO2 and VO2), and by blood lactic acid. AIMS AND METHODOLOGY This review outlines the role of AT and of the different variations of growth hormone and catecholamine, in subjects with obesity vs normal weight individuals below and beyond AT, during a progressive increase in exercise training. We present a re-evaluation of the effects of physical activity on body mass and metabolism of individuals with obesity in light of potential benefits and pitfalls during COVID-19 pandemic. Comparison of a training program at moderate-intensity exercise (< AT) with training performed at moderate intensity (< AT) plus a final bout of high-intensity (> AT) exercise at the end of the aerobic session will be discussed. RESULTS Based on our data and considerations, a tailored strategy for individuals with obesity concerning the most appropriate intensity of training in the context of rehabilitation is proposed, with special regard to potential benefits of work program above AT. CONCLUSION Adding bouts of exercise above AT may improve lactic acid and H+ disposal and improve growth hormone. Long-term aerobic exercise may improve leptin reduction. In this way, the propensity of subjects with obesity to encounter a serious prognosis of COVID-19 may be counteracted and the systemic and cardiorespiratory sequelae that may ensue after COVID-19, can be overcome. Individuals with serious comorbidities associated with obesity should avoid excessive exercise intensity.
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Affiliation(s)
- Alberto Salvadori
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Paolo Fanari
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Paolo Marzullo
- Division of General Medicine, Ospedale S. Giuseppe, Istituto Auxologico Italiano, via Cadorna 90, 28824, Piancavallo Di Oggebbio (VB), Italy
- Department of Translational Medicine, University of Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Franco Codecasa
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Ilaria Tovaglieri
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Mauro Cornacchia
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Ileana Terruzzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Patrizia Palmulli
- Department of Pulmonary Rehabilitation, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Amelia Brunani
- Department of Rehabilitation Medicine, Istituto Auxologico Italiano IRCCS, Verbania (VB), Italy
| | - Stefano Lanzi
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Livio Luzi
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Via Milanese 300, Sesto San Giovanni, Italy.
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
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Czapla M, Juárez-Vela R, Gea-Caballero V, Zieliński S, Zielińska M. The Association between Nutritional Status and In-Hospital Mortality of COVID-19 in Critically-Ill Patients in the ICU. Nutrients 2021; 13:3302. [PMID: 34684305 PMCID: PMC8538443 DOI: 10.3390/nu13103302] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/19/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has become one of the leading causes of death worldwide. The impact of poor nutritional status on increased mortality and prolonged ICU (intensive care unit) stay in critically ill patients is well-documented. This study aims to assess how nutritional status and BMI (body mass index) affected in-hospital mortality in critically ill COVID-19 patients Methods: We conducted a retrospective study and analysed medical records of 286 COVID-19 patients admitted to the intensive care unit of the University Clinical Hospital in Wroclaw (Poland). RESULTS A total of 286 patients were analysed. In the sample group, 8% of patients who died had a BMI within the normal range, 46% were overweight, and 46% were obese. There was a statistically significantly higher death rate in men (73%) and those with BMIs between 25.0-29.9 (p = 0.011). Nonsurvivors had a statistically significantly higher HF (Heart Failure) rate (p = 0.037) and HT (hypertension) rate (p < 0.001). Furthermore, nonsurvivors were statistically significantly older (p < 0.001). The risk of death was higher in overweight patients (HR = 2.13; p = 0.038). Mortality was influenced by higher scores in parameters such as age (HR = 1.03; p = 0.001), NRS2002 (nutritional risk score, HR = 1.18; p = 0.019), PCT (procalcitonin, HR = 1.10; p < 0.001) and potassium level (HR = 1.40; p = 0.023). CONCLUSIONS Being overweight in critically ill COVID-19 patients requiring invasive mechanical ventilation increases their risk of death significantly. Additional factors indicating a higher risk of death include the patient's age, high PCT, potassium levels, and NRS ≥ 3 measured at the time of admission to the ICU.
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Affiliation(s)
- Michał Czapla
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland;
- Institute of Heart Diseases, University Hospital, 50-566 Wroclaw, Poland
| | - Raúl Juárez-Vela
- Biomedical Research Centre of La Rioja (CIBIR), Research Group GRUPAC, Research Unit on Health System Sustainability (GISSOS), University of La Rioja, 26004 Logroño, Spain
| | - Vicente Gea-Caballero
- Faculty of Health Sciences, International University of Valencia, 46002 Valencia, Spain;
| | - Stanisław Zieliński
- Department and Clinic of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland; (S.Z.); (M.Z.)
- Department of Anaesthesiology and Intensive Care, University Hospital, 50-556 Wrocław, Poland
| | - Marzena Zielińska
- Department and Clinic of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, 50-556 Wrocław, Poland; (S.Z.); (M.Z.)
- Department of Paediatric Anaesthesiology and Intensive Care, University Hospital, 50-556 Wrocław, Poland
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Wang R, He M, Kang Y. Hypophosphatemia at Admission is Associated with Increased Mortality in COVID-19 Patients. Int J Gen Med 2021; 14:5313-5322. [PMID: 34526806 PMCID: PMC8435477 DOI: 10.2147/ijgm.s319717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023] Open
Abstract
Background Electrolyte disturbances are commonly observed in patients with coronavirus disease 2019 (COVID-19) and associated with outcome in these patients. Our study was designed to examine whether hypophosphatemia is associated with mortality in COVID-19 patients. Methods Patients diagnosed with COVID-19 and hospitalized in Renmin Hospital of Wuhan University between January 30 and February 24, 2020 were included in this study. Patients were divided into two groups, a hypophosphatemia group and a non-hypophosphatemia group, based on a serum phosphate level of 0.8 mmol/L. Logistic regression was performed to analyze the relationship between hypophosphatemia and mortality. A locally weighted scatterplot smoothing (LOWESS) curve was plotted to show the detailed association between mortality rate and serum phosphate level. A Kaplan–Meier survival curve was drawn to compare the difference in cumulative survival between the two groups. Results Hypophosphatemia at admission occurred in 33 patients, with an incidence of 7.6%. The hypophosphatemia group had a significantly higher incidence of respiratory failure (54.5% vs 32.6%, p=0.013) and mortality (57.6% vs 15.2%, p<0.001). Multivariate logistic regression indicated that age (OR=1.059, p<0.001), oxygen saturation (OR=0.733, p<0.001), white blood cells (OR=1.428, p<0.001), lymphocytes (OR=0.075, p<0.001) and hypophosphatemia (OR=3.636, p=0.015) were independently associated with mortality in the included patients. The hypophosphatemia group had significantly shorter survival than the non-hypophosphatemia group (p<0.001). Conclusion Hypophosphatemia at admission is associated with increased mortality in COVID-19 patients. More attention and medical care should be given to COVID-19 patients with hypophosphatemia at admission.
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Affiliation(s)
- Ruoran Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China.,COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, People's Republic of China.,COVID19 Medical Team (Hubei) of West China Hospital, Sichuan University, Chengdu, People's Republic of China
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30
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Obremska M, Pazgan-Simon M, Budrewicz K, Bilaszewski L, Wizowska J, Jagielski D, Jankowska-Polanska B, Nadolny K, Madowicz J, Zuwala-Jagiello J, Zysko D, Banasiak W, Simon K. Simple demographic characteristics and laboratory findings on admission may predict in-hospital mortality in patients with SARS-CoV-2 infection: development and validation of the covid-19 score. BMC Infect Dis 2021; 21:945. [PMID: 34521357 PMCID: PMC8438286 DOI: 10.1186/s12879-021-06645-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitutes a major health burden worldwide due to high mortality rates and hospital bed shortages. SARS-CoV-2 infection is associated with several laboratory abnormalities. We aimed to develop and validate a risk score based on simple demographic and laboratory data that could be used on admission in patients with SARS-CoV-2 infection to predict in-hospital mortality. Methods Three cohorts of patients from different hospitals were studied consecutively (developing, validation, and prospective cohorts). The following demographic and laboratory data were obtained from medical records: sex, age, hemoglobin, mean corpuscular volume (MCV), platelets, leukocytes, sodium, potassium, creatinine, and C-reactive protein (CRP). For each variable, classification and regression tree analysis were used to establish the cut-off point(s) associated with in-hospital mortality outcome based on data from developing cohort and before they were used for analysis in the validation and prospective cohort. The covid-19 score was calculated as a sum of cut-off points associated with mortality outcome. Results The developing, validation, and prospective cohorts included 129, 239, and 497 patients, respectively (median age, 71, 67, and 70 years, respectively). The following cut of points associated with in-hospital mortality: age > 56 years, male sex, hemoglobin < 10.55 g/dL, MCV > 92.9 fL, leukocyte count > 9.635 or < 2.64 103/µL, platelet count, < 81.49 or > 315.5 103/µL, CRP > 51.14 mg/dL, creatinine > 1.115 mg/dL, sodium < 134.7 or > 145.4 mEq/L, and potassium < 3.65 or > 6.255 mEq/L. The AUC of the covid-19 score for predicting in-hospital mortality was 0.89 (0.84–0.95), 0.850 (0.75–0.88), and 0.773 (0.731–0.816) in the developing, validation, and prospective cohorts, respectively (P < 0.001The mortality of the prospective cohort stratified on the basis of the covid-19 score was as follows: 0–2 points,4.2%; 3 points, 15%; 4 points, 29%; 5 points, 38.2%; 6 and more points, 60%. Conclusion The covid-19 score based on simple demographic and laboratory parameters may become an easy-to-use, widely accessible, and objective tool for predicting mortality in hospitalized patients with SARS-CoV-2 infection.
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Affiliation(s)
- Marta Obremska
- Department of Preclinical Research, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pazgan-Simon
- Ist Department of Infectious Diseases Regional Specialistic Hospital, Wroclaw, Poland
| | - Katarzyna Budrewicz
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland.
| | - Lukasz Bilaszewski
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | - Joanna Wizowska
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | | | | | - Klaudiusz Nadolny
- Department of Emergency Medical Service, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland.,Faculty of Medicine, Katowice School of Technology, Katowice, Poland
| | - Jarosław Madowicz
- Provincial Specialist Hospital, Tychy, Poland.,Department of Health Sciences, Higher School of Strategic Planning in Dabrowa Gornicza, Dabrowa Gornicza, Poland
| | | | - Dorota Zysko
- Department of Emergency Medicine, Wroclaw Medical University, ul. Borowska 213, 50-556, Wroclaw, Poland
| | | | - Krzysztof Simon
- Ist Department of Infectious Diseases Regional Specialistic Hospital, Wroclaw, Poland.,Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Wroclaw, Poland
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31
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McGlacken‐Byrne SM, Drew SEV, Turner K, Peters C, Amin R. The SARS-CoV-2 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes mellitus: A multi-centre study of the first COVID-19 wave. Diabet Med 2021; 38:e14640. [PMID: 34245598 PMCID: PMC8420510 DOI: 10.1111/dme.14640] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/09/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Children are usually mildly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19). However, the pandemic has caused collateral damage to those with non-COVID-19 diseases. We aimed to determine the impact of the COVID-19 pandemic on the presentation of newly diagnosed childhood onset type 1 diabetes. METHODS This was a cross-sectional study conducted over a 1-year period. We compared the severity of presentation of new-onset type 1 diabetes in children under the age of 18 presenting to the multi-centre North Central London diabetes network before (1 July 2019 to 22 March 2020) and during (23 March 2020 to 30 June 2020) the first wave of the COVID-19 pandemic in the United Kingdom. RESULTS Over the 1-year study period, a total of 30 children presented with new-onset type 1 diabetes during the pre-pandemic period and 17 presented during the first COVID-19 wave. Children presented more frequently in diabetic ketoacidosis (DKA) during the first COVID-19 wave compared with pre-pandemic (pre-pandemic: mild 13%, moderate 6.7%, severe 10%; first COVID-19 wave: mild 5.9%, moderate 24%, severe 47%; p = 0.002). During the first COVID-19 wave, DKA presentations in children with a family history of type 1 diabetes were fewer compared to those without a family history (33.3% vs. 100.0%; p = 0.006). Children presenting in severe DKA pre-pandemic were younger than those not in severe DKA (3.9 years vs. 12.2 years, p < 0.001) but this difference was not significant during the first COVID-19 wave (10.1 years vs. 11.2 years, p = 0.568). Presenting HbA1c measurement was higher in those presenting during the first COVID-19 wave (13.0 ± 1.7 vs. 10.4 ± 3.2%; 119 ± 19 vs. 90 ± 35 mmol/mol; p = 0.008). CONCLUSION The COVID-19 pandemic is associated with increased severity of presentation of childhood onset type 1 diabetes. Whatever the context, young people with suspected new-onset type 1 diabetes should be referred for urgent clinical review.
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Affiliation(s)
| | - Samantha E. V. Drew
- Department of Paediatric Endocrinology and DiabetesGreat Ormond Street HospitalLondonUK
| | - Kelly Turner
- Department of Paediatric Endocrinology and DiabetesGreat Ormond Street HospitalLondonUK
| | - Catherine Peters
- Department of Paediatric Endocrinology and DiabetesGreat Ormond Street HospitalLondonUK
| | - Rakesh Amin
- Department of Paediatric Endocrinology and DiabetesGreat Ormond Street HospitalLondonUK
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32
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Noori M, Nejadghaderi SA, Sullman MJM, Carson-Chahhoud K, Ardalan M, Kolahi AA, Safiri S. How SARS-CoV-2 might affect potassium balance via impairing epithelial sodium channels? Mol Biol Rep 2021; 48:6655-6661. [PMID: 34392451 PMCID: PMC8364628 DOI: 10.1007/s11033-021-06642-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/10/2021] [Indexed: 01/15/2023]
Abstract
Severe acute respiratory syndrome coronaviruses 2 (SARS-CoV-2) is the causative agent of current coronavirus disease 2019 (COVID-19) pandemic. Electrolyte disorders particularly potassium abnormalities have been repeatedly reported as common clinical manifestations of COVID-19. Here, we discuss how SARS-CoV-2 may affect potassium balance by impairing the activity of epithelial sodium channels (ENaC). The first hypothesis could justify the incidence of hypokalemia. SARS-CoV-2 cell entry through angiotensin-converting enzyme 2 (ACE2) may enhance the activity of renin–angiotensin–aldosterone system (RAAS) classical axis and further leading to over production of aldosterone. Aldosterone is capable of enhancing the activity of ENaC and resulting in potassium loss from epithelial cells. However, type II transmembrane serine protease (TMPRSS2) is able to inhibit the ENaC, but it is utilized in the case of SARS-CoV-2 cell entry, therefore the ENaC remains activated. The second hypothesis describe the incidence of hyperkalemia based on the key role of furin. Furin is necessary for cleaving both SARS-CoV-2 spike protein and ENaC subunits. While the furin is hijacked by the virus, the decreased activity of ENaC would be expected, which causes retention of potassium ions and hyperkalemia. Given that the occurrence of hypokalemia is higher than hyperkalemia in COVID-19 patients, the first hypothesis may have greater impact on potassium levels. Further investigations are warranted to determine the exact role of ENaC in SARS-CoV-2 pathogenesis.
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Affiliation(s)
- Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, University of South Australia, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | | | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Saeid Safiri
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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33
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Xu B, Lei Y, Ren X, Yin F, Wu W, Sun Y, Wang X, Sun Q, Yang X, Wang X, Zhang R, Li Z, Fang S, Liu J. SOD1 is a Possible Predictor of COVID-19 Progression as Revealed by Plasma Proteomics. ACS Omega 2021; 6:16826-16836. [PMID: 34250342 PMCID: PMC8247781 DOI: 10.1021/acsomega.1c01375] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/10/2021] [Indexed: 05/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a worldwide health emergency. Patients infected with SARS-CoV-2 present with diverse symptoms related to the severity of the disease. Determining the proteomic changes associated with these diverse symptoms and in different stages of infection is beneficial for clinical diagnosis and management. Here, we performed a tandem mass tag-labeling proteomic study on the plasma of healthy controls and COVID-19 patients, including those with asymptomatic infection (NS), mild syndrome, and severe syndrome in the early phase and the later phase. Although the number of patients included in each group is low, our comparative proteomic analysis revealed that complement and coagulation cascades, cholesterol metabolism, and glycolysis-related proteins were affected after infection with SARS-CoV-2. Compared to healthy controls, ELISA analysis confirmed that SOD1, PRDX2, and LDHA levels were increased in the patients with severe symptoms. Both gene set enrichment analysis and receiver operator characteristic analysis indicated that SOD1 could be a pivotal indicator for the severity of COVID-19. Our results indicated that plasma proteome changes differed based on the symptoms and disease stages and SOD1 could be a predictor protein for indicating COVID-19 progression. These results may also provide a new understanding for COVID-19 diagnosis and treatment.
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Affiliation(s)
- Benhong Xu
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Yuxuan Lei
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
- School
of Public Health (Shenzhen), Sun Yat-sen
University, Guangzhou 510275, China
| | - Xiaohu Ren
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Feng Yin
- State
Key Laboratory of Chemical Oncogenomics, School of Chemical Biology
and Biotechnology, Peking University Shenzhen
Graduate School, Shenzhen 518055, China
- Pingshan
Translational Medicine Center, Shenzhen
Bay Laboratory, Shenzhen 518101, China
| | - Weihua Wu
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Ying Sun
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xiaohui Wang
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Qian Sun
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xifei Yang
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Xin Wang
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Renli Zhang
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Zigang Li
- State
Key Laboratory of Chemical Oncogenomics, School of Chemical Biology
and Biotechnology, Peking University Shenzhen
Graduate School, Shenzhen 518055, China
- Pingshan
Translational Medicine Center, Shenzhen
Bay Laboratory, Shenzhen 518101, China
| | - Shisong Fang
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
| | - Jianjun Liu
- Shenzhen
Center for Disease Control and Prevention, Shenzhen 518055, China
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34
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Noori M, Nejadghaderi SA, Sullman MJM, Carson-Chahhoud K, Kolahi AA, Safiri S. Epidemiology, prognosis and management of potassium disorders in Covid-19. Rev Med Virol 2021; 32:e2262. [PMID: 34077995 PMCID: PMC8209915 DOI: 10.1002/rmv.2262] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 01/19/2023]
Abstract
Coronavirus disease (Covid-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently the largest health crisis facing most countries. Several factors have been linked with a poor prognosis for this disease, including demographic factors, pre-existing comorbidities and laboratory parameters such as white blood cell count, D-dimer, C-reactive protein, albumin, lactate dehydrogenase, creatinine and electrolytes. Electrolyte abnormalities particularly potassium disorders are common among Covid-19 patients. Based on our pooled analysis, hypokalemia and hyperkalemia occur in 24.3% and 4.15% of Covid-19 patients, respectively. Potassium level deviation from the normal range may increase the chances of unfavorable outcomes and even death. Therefore, this article reviewed the epidemiology of potassium disorders and explained how hypokalemia and hyperkalemia are capable of deteriorating cardiac outcomes and the prognosis of Covid-19 for infected patients. The article finishes by highlighting some important considerations in the management of hypokalemia and hyperkalemia in these patients.
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Affiliation(s)
- Maryam Noori
- School of Medicine, Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed A Nejadghaderi
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kristin Carson-Chahhoud
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeid Safiri
- Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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35
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de Melo IS, Sabino-Silva R, Cunha TM, Goulart LR, Reis WL, Jardim ACG, Shetty AK, de Castro OW. Hydroelectrolytic Disorder in COVID-19 patients: Evidence Supporting the Involvement of Subfornical Organ and Paraventricular Nucleus of the Hypothalamus. Neurosci Biobehav Rev 2021; 124:216-223. [PMID: 33577841 PMCID: PMC7872848 DOI: 10.1016/j.neubiorev.2021.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 02/07/2023]
Abstract
Multiple neurological problems have been reported in coronavirus disease-2019 (COVID-19) patients because severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) likely spreads to the central nervous system (CNS) via olfactory nerves or through the subarachnoid space along olfactory nerves into the brain's cerebrospinal fluid and then into the brain's interstitial space. We hypothesize that SARS-CoV-2 enters the subfornical organ (SFO) through the above routes and the circulating blood since circumventricular organs (CVOs) such as the SFO lack the blood-brain barrier, and infection of the SFO causes dysfunction of the hypothalamic paraventricular nucleus (PVN) and supraoptic nucleus (SON), leading to hydroelectrolytic disorder. SARS-CoV-2 can readily enter SFO-PVN-SON neurons because these neurons express angiotensin-converting enzyme-2 receptors and proteolytic viral activators, which likely leads to neurodegeneration or neuroinflammation in these regions. Considering the pivotal role of SFO-PVN-SON circuitry in modulating hydroelectrolyte balance, SARS-CoV-2 infection in these regions could disrupt the neuroendocrine control of hydromineral homeostasis. This review proposes mechanisms by which SARS-CoV-2 infection of the SFO-PVN-SON pathway leads to hydroelectrolytic disorder in COVID-19 patients.
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Affiliation(s)
- Igor Santana de Melo
- Department of Physiology, Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceio, Brazil
| | - Robinson Sabino-Silva
- Department of Physiology, Institute of Biomedical Sciences, Federal University of Uberlandia (UFU), Uberlândia, MG, Brazil.
| | - Thúlio Marquez Cunha
- Department of Pulmonology, School of Medicine, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Luiz Ricardo Goulart
- Institute of Biotechnology, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Wagner Luis Reis
- Department of Physiological, Sciences Biological Sciences Centre Federal University of Santa Catarina (UFSC) Florianopolis, Santa Catarina, Brazil
| | - Ana Carolina Gomes Jardim
- Laboratory of Virology, Institute of Biomedical Sciences, Federal University of Uberlandia, Minas Gerais, Brazil
| | - Ashok K Shetty
- Institute for Regenerative Medicine, Department of Molecular and Cellular Medicine, Texas A&M University College of Medicine, College Station, TX, 77843, USA.
| | - Olagide Wagner de Castro
- Department of Physiology, Institute of Biological Sciences and Health, Federal University of Alagoas (UFAL), Maceio, Brazil.
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36
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Wong Wai Cheong N, Meyyur Aravamudan V, Venkatachalam J, Kuthiah N. Gastrointestinal Symptoms in Association With Hypokalemia Can Be a Predictor of Inferior Outcomes in COVID-19. Cureus 2021; 13:e14466. [PMID: 33996325 PMCID: PMC8118572 DOI: 10.7759/cureus.14466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus disease-2 (SARS-C0V-2), has affected many lives globally. In Singapore, majority of the infected individuals are foreign workers residing in dormitories. A retrospective review conducted over two weeks (April 13 to April 26, 2020) of migrant workers admitted to a public hospital in Singapore revealed that a significant number of them developed hypokalemia. The purpose of this study was to examine any association that might exist between COVID-19 and hypokalemia. Fifty patients in this study had hypokalemia, translating to a prevalence of 28.4% (95% CI: 21.9-35.7). Gastrointestinal (GI) loss was a significant cause of hypokalemia with a prevalence of GI symptoms in the study group (diarrhea, vomiting, poor oral intake) of 5.7% (95% CI: 2.8-10.2). Clinicians should consider screening for hypokalemia in COVID-19 patients and initiate potassium replacement to mitigate any potential arrhythmias.
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Affiliation(s)
| | | | | | - Navin Kuthiah
- Department of Medicine, Woodlands Health Campus, Singapore, SGP
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37
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Abstract
Diuretic-induced hypokalaemia is a common and potentially life-threatening adverse drug reaction in clinical practice. Previous studies revealed a prevalence of 7%-56% of hypokalaemia in patients taking thiazide diuretics. The clinical manifestations of hypokalaemia due to diuretics are non-specific, varying from asymptomatic to fatal arrhythmia. Diagnosis of hypokalaemia is based on the level of serum potassium. ECG is useful in identifying the more severe consequences. A high dosage of diuretics and concomitant use of other drugs that increase the risk of potassium depletion or cardiac arrhythmias can increase the risk of cardiovascular events and mortality. Thiazide-induced potassium depletion may cause dysglycaemia. The risk of thiazide-induced hypokalaemia is higher in women and in black people. Reducing diuretic dose and potassium supplementation are the most direct and effective therapies for hypokalaemia. Combining with a potassium-sparing diuretic or blocker of the renin-angiotensin system also reduces the risk of hypokalaemia. Lowering salt intake and increasing intake of vegetables and fruits help to reduce blood pressure as well as prevent hypokalaemia.
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Affiliation(s)
- Ziying Lin
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Louisa Y F Wong
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Bernard M Y Cheung
- Department of Medicine, University of Hong Kong, Hong Kong, Hong Kong .,State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, Hong Kong
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38
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Abstract
PURPOSE OF REVIEW To summarize recent evidence on prevalence, risk factors, significance, treatment, and prevention of electrolyte disorders in critically ill with a specific focus on disorders during the initiation of nutrition. RECENT FINDINGS Electrolyte disturbances appear to occur often during critical illness, and most of them seem to be associated with impaired outcome. However, a recent systematic review indicated insufficient evidence to answer clinically relevant questions regarding hypophosphatemia. Similar questions (which thresholds of serum levels are clinically relevant; how serum levels should be corrected and how do different correction regimens/approaches influence outcome) are not clearly answered also for other electrolytes. The most crucial feature of electrolyte disturbances related to feeding is refeeding syndrome. Recent evidence supports that additionally to the correction of electrolyte levels, a temporary restriction of calories (reducing the magnitude of this metabolic feature, including electrolyte shifts) may help to improve outcome. SUMMARY Diverse electrolyte disorders often occur in critically ill patients. Hypophosphatemia, hypokalemia, and hypomagnesemia that are encountered after initiation of feeding identify refeeding syndrome. Along with correction of electrolytes, reduction of caloric intake may improve the outcome of the refeeding syndrome.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Luzern, Switzerland
| | - Arthur Raymond Hubert van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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39
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Zhang L, Zetter MA, Guerra EC, Hernández VS, Mahata SK, Eiden LE. ACE2 in the second act of COVID-19 syndrome: Peptide dysregulation and possible correction with oestrogen. J Neuroendocrinol 2021; 33:e12935. [PMID: 33462852 PMCID: PMC7995212 DOI: 10.1111/jne.12935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has become the most critical pandemic of the 21st Century and the most severe since the 1918 influenza pandemic. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infects the host by binding to angiotensin-converting enzyme 2 (ACE2). The role of ACE2 in the pathophysiology of coronavirus disease 2019 (COVID-19) is a topic of debate, with clinical and experimental evidence indicating a multifaceted relationship between ACE2 activity and disease severity. Here, we review the mechanisms by which the peptidergic substrates and products of ACE and ACE2 contribute to physiological and pathophysiological processes and hypothesise how down-regulation of ACE2 by SARS-CoV-2 cellular entry disrupts homeostasis. A better understanding of the endocrinology of the disease, in particular the neuroendocrinology of ACE2 during COVID-19, may contribute to the timely design of new therapeutic strategies, including the regulation of ACE2 itself by steroid hormones, to ameliorate the severity of COVID-19.
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Affiliation(s)
- Limei Zhang
- Dept. PhysiologyLaboratory of Systems NeuroscienceSchool of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Mario A. Zetter
- Dept. PhysiologyLaboratory of Systems NeuroscienceSchool of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Enrique C. Guerra
- Dept. PhysiologyLaboratory of Systems NeuroscienceSchool of MedicineNational Autonomous University of MexicoMexico CityMexico
- MD–PhD Program (PECEM)Faculty of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Vito S. Hernández
- Dept. PhysiologyLaboratory of Systems NeuroscienceSchool of MedicineNational Autonomous University of MexicoMexico CityMexico
| | - Sushil K. Mahata
- Metabolic Physiology and Ultrastructural Biology LaboratoryVA San Diego Healthcare SystemUniversity California San DiegoSan DiegoCAUSA
| | - Lee E. Eiden
- Section on Molecular NeuroscienceNational Institute of Mental Health, Intramural Research ProgramNational Institutes of HealthBethesdaMDUSA
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Alnafiey MO, Alangari AM, Alarifi AM, Abushara A. Persistent Hypokalemia post SARS-coV-2 infection, is it a life-long complication? Case report. Ann Med Surg (Lond) 2021; 62:358-361. [PMID: 33527042 PMCID: PMC7839393 DOI: 10.1016/j.amsu.2021.01.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction and importance SARS-CoV-2 is a novel infection that has affected millions of people around the world. Complications of the infection may affect multiple systems including cardiovascular, neurological, gastrointestinal, urinary, and pulmonary systems. Hypokalemia, which is a life-threatening condition that may lead to arrhythmia and possibly death, has been noticed in more than half of the COVID-19 patients. Further understanding of the disease process and its complications is necessary to guide in preventing the complications from happening in the first place and finding treatment for patients with an already established complications. Case presentation A 34-year old male from Philippines who lives in Saudi Arabia - Riyadh and works as health care provider with no previous history of any medical illness. Presented by himself to the emergency department (ED) with dry cough, shortness of breath, fever, malaise, and fatigability for five days. On examination (RR 25), (T 38.6 °C) and (O2 89% Room air), on auscultation there was a decrease on air entry bilaterally with scattered crepitations, no wheezing or stridor. Covid-19 swab was positive, (Day 1) potassium 2.91 (mmol/L) magnesium (mmol/L) with normal baseline before getting infected. Clinical discussion Patient while in the hospital was on daily potassium oral and IV replacement with IV magnesium replacement. Investigation showed 24Hr urine potassium 47.3 (mmol/L), 24Hr urine magnesium 5.52 (mmol/L), 24Hr urine Creatinine 9.25 (mmol/L), (TTKG) Transtubular Potassium Gradient 18 and (VBG) PH:7.38, Pco2:44 (mmHg) Po2:55 (mmHg) HCO3:25 (mEq/L). Patient has an increased renal potassium loss with normal VBG on separate days and normal Blood pressure that excludes diseases with associated acidemia or alkalemia. Our patient didn't want to go for any invasive diagnostic procedures and favored to wait for spontaneous recovery. Conclusion We followed up the potassium level of our patient for more than 5 months since he was diagnosed with COVID-19 to find out that he is still having hypokalemia, as well as, hypomagnesemia. Long term complications of COVID-19 infection such as hypokalemia and hypomagnesemia need to be observed and followed up closely to avoid life-threatening arrythmias and seizures. The attention of the scientific community to possible long term or permanent complications is needed to help find preventive measures and treatment for patients with complications.
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Affiliation(s)
- Mohammed Obaid Alnafiey
- Department of Internal Medicine, KSMC, Alimam Turki Ibn Abdullah Ibn Muhammed, Ulaishah, Riyadh, 12746, Saudi Arabia
| | - Abdullah Meshari Alangari
- Department of Internal Medicine, KSMC, Alimam Turki Ibn Abdullah Ibn Muhammed, Ulaishah, Riyadh, 12746, Saudi Arabia
| | | | - Ahmed Abushara
- Department of Hematology and Oncology, KSMC, Alimam Turki Ibn Abdullah Ibn Muhammed, Ulaishah, Riyadh, 12746, Saudi Arabia
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Pershina LV, Grabeklis AR, Isankina LN, Skorb EV, Nikolaev KG. Determination of sodium and potassium ions in patients with SARS-Cov-2 disease by ion-selective electrodes based on polyelectrolyte complexes as a pseudo-liquid contact phase. RSC Adv 2021; 11:36215-36221. [PMID: 35492756 PMCID: PMC9043442 DOI: 10.1039/d1ra04582b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/09/2021] [Indexed: 11/21/2022] Open
Abstract
Supramolecular assemblies based on polyelectrolyte complexes made it possible to create complex interfaces with predictable properties. Polyelectrolyte complexes serve as a pseudo-liquid contact in ion-selective electrodes.
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Affiliation(s)
- Liubov V. Pershina
- Infochemistry Scientific Center of ITMO University, 191002 Saint Petersburg, Russian Federation
| | - Andrei R. Grabeklis
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Trubetskaya st., 8, 119991 Moscow, Russian Federation
- Peoples' Friendship University of Russia (RUDN University), Miklukho-Maklay st., 6, Moscow, 117198, Russian Federation
| | - Ludmila N. Isankina
- Children's City Clinical Hospital, No. 5 named after N.F. Filatov, 192889 Saint Petersburg, Russian Federation
| | - Ekaterina V. Skorb
- Infochemistry Scientific Center of ITMO University, 191002 Saint Petersburg, Russian Federation
| | - Konstantin G. Nikolaev
- Infochemistry Scientific Center of ITMO University, 191002 Saint Petersburg, Russian Federation
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Varmani S, Chowhan R, Sharma I, Narang R. COVID-19 and cardiovascular disease: Clinical implications of biochemical pathways. J Pract Cardiovasc Sci 2021. [DOI: 10.4103/jpcs.jpcs_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis 2021; 40:905-919. [PMID: 33389262 PMCID: PMC7778857 DOI: 10.1007/s10096-020-04138-6] [Citation(s) in RCA: 355] [Impact Index Per Article: 118.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 pandemic is caused by the novel coronavirus SARS-CoV-2. Angiotensin-converting enzyme 2 (ACE2) is not only an enzyme but also a functional receptor on cell surfaces through which SARS-CoV-2 enters the host cells and is highly expressed in the heart, kidneys, and lungs and shed into the plasma. ACE2 is a key regulator of the renin-angiotensin-aldosterone system (RAAS). SARS-CoV-2 causes ACE/ACE2 balance disruption and RAAS activation, which leads ultimately to COVID-19 progression, especially in patients with comorbidities, such as hypertension, diabetes mellitus, and cardiovascular disease. Therefore, ACE2 expression may have paradoxical effects, aiding SARS-CoV-2 pathogenicity, yet conversely limiting viral infection. This article reviews the existing literature and knowledge of ACE2 in COVID-19 setting and focuses on its pathophysiologic involvement in disease progression, clinical outcomes, and therapeutic potential.
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Affiliation(s)
- Stephany Beyerstedt
- grid.413562.70000 0001 0385 1941Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, 627 Albert Einstein Avenue, Building A, Morumbi, São Paulo, SP Brazil
| | - Expedito Barbosa Casaro
- grid.413562.70000 0001 0385 1941Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, 627 Albert Einstein Avenue, Building A, Morumbi, São Paulo, SP Brazil
| | - Érika Bevilaqua Rangel
- grid.413562.70000 0001 0385 1941Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, 627 Albert Einstein Avenue, Building A, Morumbi, São Paulo, SP Brazil ,grid.411249.b0000 0001 0514 7202Nephrology Division, Federal University of São Paulo, São Paulo, SP Brazil
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Szoke D, Caruso S, Aloisio E, Pasqualetti S, Dolci A, Panteghini M. Serum potassium concentrations in COVID-19. Clin Chim Acta 2020; 512:26-27. [PMID: 33238182 PMCID: PMC7680631 DOI: 10.1016/j.cca.2020.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Dominika Szoke
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy.
| | - Simone Caruso
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy
| | - Elena Aloisio
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy
| | - Sara Pasqualetti
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy
| | - Alberto Dolci
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy
| | - Mauro Panteghini
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, and Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milano, Italy
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